Value Of High-Resolution Vessel Wall Imaging To Determine Responsible Aneurysms In Subarachnoid Hemorrhage With Intracranial Multiple Aneurysms

Objective: The purpose of this study was to investigate the value of high-resolution vassal wall imaging(HR-VWI)in determining the responsible aneurysm in subarachnoid hemorrhage with intracranial multiple aneurysms,to provide reference for clinical treatment work,and to improve the accuracy of aneurysm localization.Methods: In this study,33 patients with intracranial multiple aneurysms(a total of 69 aneurysms)admitted to our hospital were prospectively studied by using high-resolution magnetic resonance vassal wall imaging,collecting patients’ clinical data,recording the morphological parameters of aneurysms,and calculating the signal index(SI),Wall enhancement index(WEI)and Contrast ratio against stalk(CRstalk)of aneurysms.The differences in size,location,aspect ratio(AR),Wall enhancement index and Contrast ratio against stalk between ruptured and unruptured aneurysms were compared.Single factor logistic regression analysis was used to calculate the odds ratio and 95% confidence interval.Statistically significant indicators were included in the multifactor logistic regression analysis to derive independent risk factors.Results: Aneurysm diameter,type of enhancement,degree of aneurysm wall enhancement,and irregular shape were significantly associated with aneurysm rupture.Statistically significant indicators(P<0.02)were included in the multifactor logistic analysis,WEI(OR:3.63;95% confidence interval:1.02-13.06),CRstalk(OR:4.12;95% confidence interval:1.16-14.6),and Circumferential aneurysmal wall enhancement(CAWE)(OR:3.09;95% confidence interval:2.01-24.49)were strongly correlated with aneurysm rupture.the ROC curve analysis showed that the optimal cut-off values for distinguishing ruptured and unruptured aneurysms were 0.70 and 0.98 for WEI and CRstalk,respectively(area under the curve was 0.82 and 0.71,respectively).there was no significant difference between the area under the WEI and CRstalk curves(P = 0.46).Using the optimal cut-off values of 0.58 for WEl,the sensitivities and specificities were 0.83 and 0.75,respectively.Using the optimal cut-off values of 0.43 for CRstalk,the sensitivities and specificities were 0.72 and 0.7,respectively.Conclusion: The degree of aneurysm wall enhancement and Circumferential aneurysmal wall enhancement are associated with intracranial aneurysm rupture and are independent risk factors for predicting aneurysm rupture,which is independent of aneurysm size and patient characteristics.HR-VWI is useful in determining the site of rupture in patients with multiple aneurysms.