{
  "abstract": "Background Unruptured intracranial aneurysms (IAs) that become symptomatic have been associated with instability.Objective To investigate the relationship between irregular pulsation on four-dimensional CT angiography (4D-CTA) and aneurysm wall enhancement (AWE) on vessel wall MRI (VW-MRI), and to evaluate their ability to identify symptomatic IAs.Methods This retrospective study included consecutive patients with IAs who underwent 4D-CTA and VW-MRI between March 2018 and May 2023. IAs were categorized as asymptomatic and symptomatic. The presence of irregular pulsation was identified on 4D-CTA video. Qualitative and quantitative AWE were evaluated. Univariate and multivariate analyses were used to identify the parameters associated with symptoms.Results 192 patients with 216 aneurysms (167 asymptomatic and 49 symptomatic) were included. IAs with irregular pulsation had significantly higher wall enhancement index (WEI) than IAs without irregular pulsation (median (IQR), 0.5 (0.2–1.1) vs 0.2 (0.0–0.6), P<0.001). Symptomatic IAs had significantly higher WEI than asymptomatic IAs (median (IQR), 0.7 (0.3–1.5) vs 0.2 (0.0–0.5), P<0.001), and more irregular pulsations (79.6% vs 25.1%, P<0.001). Both irregular pulsation (OR=6.86; 95% CI 2.62 to 17.96; P<0.001) and WEI (OR=2.56; 95% CI 1.14 to 5.71; P=0.022) were independently associated with symptoms. Combination of irregular pulsation and WEI achieved the highest area under the curve of 0.86 in identifying symptomatic aneurysms compared with irregular pulsation or WEI alone (P<0.001 and P=0.002, respectively).Conclusion In a large cohort of patients with unruptured IAs who underwent 4D-CTA and VW-MRI, both irregular pulsation and WEI were independently associated with symptoms. Such measures could identify IAs at higher risk of growth or rupture.",
  "authors": [
    {
      "affiliations": [
        "Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China",
        "College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China"
      ],
      "name": "Jianjian Zhang"
    },
    {
      "affiliations": [
        "Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China",
        "College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China"
      ],
      "name": "Xiao Li"
    },
    {
      "affiliations": [
        "Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China",
        "College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China"
      ],
      "name": "Jin Zhang"
    },
    {
      "affiliations": [
        "Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China",
        "College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China"
      ],
      "name": "Beibei Sun"
    },
    {
      "affiliations": [
        "Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China",
        "College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China"
      ],
      "name": "Lingling Wang"
    },
    {
      "affiliations": [
        "Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China",
        "College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China"
      ],
      "name": "Jiaqi Tian"
    },
    {
      "affiliations": [
        "Department of Radiology, University of Washington, Seattle, Washington, USA"
      ],
      "name": "Mahmud Mossa-Basha"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Washington, Seattle, Washington, USA"
      ],
      "name": "Michael R Levitt"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China"
      ],
      "name": "Bing Zhao"
    },
    {
      "affiliations": [
        "Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China",
        "College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China"
      ],
      "name": "Jianrong Xu"
    },
    {
      "affiliations": [
        "Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China",
        "College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China"
      ],
      "name": "Yan Zhou"
    },
    {
      "affiliations": [
        "Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China",
        "College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China"
      ],
      "name": "Huilin Zhao"
    },
    {
      "affiliations": [
        "Department of Radiology, University of Washington, Seattle, Washington, USA"
      ],
      "name": "Chengcheng Zhu"
    }
  ],
  "title": "Irregular pulsation on 4D-CTA and quantitative wall enhancement on VW-MRI are associated with symptoms of unruptured intracranial aneurysms",
  "uid": "1af0e592-c2d2-5998-830b-ee9b43f16d81"
}