Lack of baseline intracranial aneurysm wall enhancement predicts future stability: A systematic review and meta-analysis of longitudinal studies

A. S. Larson, V. T. Lehman, G. Lanzino, W. Brinjikji

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: The utility of vessel wall MR imaging in identifying unstable intracranial aneurysms has been suggested but remains controversial. PURPOSE: Our aim was to provide further insight into the potential relationship between aneurysm wall enhancement on initial vessel wall imaging and aneurysm instability at follow-up. DATA SOURCES: Our sources were PubMed, Scopus, the Web of Science, and the Cochrane Central Register of Controlled Trials. STUDY SELECTION: We searched for English language studies that reported the presence of vessel wall enhancement of unruptured intracranial aneurysms on baseline vessel wall imaging studies with longitudinal follow-up of aneurysm status. DATA ANALYSIS: Aneurysms were grouped into “stable” and “unstable” groups at follow-up on the basis of growth, symptomatic manifestation, or rupture. The association of each group with aneurysm wall enhancement on initial vessel wall imaging was determined. DATA SYNTHESIS: Three studies constituting 407 aneurysms were included. Aneurysms with wall enhancement were at higher risk of being unstable at follow-up (risk ratio ¼ 3.6; 95% confidence interval, 1.7-7.5). The sensitivity of aneurysm wall enhancement on vessel wall imaging was 74.3% (95% CI, 56.7%-87.5%), specificity was 58.3% (95% CI, 53.1%-63.4%), positive predictive value was 14.4% (95% CI, 11.8%-17.4%), negative predictive value was 96.0% (95% CI, 93.2%-97.7%), and the overall accuracy of the test was 59.7% (95% CI, 54.8%-64.5%). LIMITATIONS: Only 3 studies were identified for inclusion in this analysis. More longitudinal studies of vessel wall imaging and aneurysm progression are needed. CONCLUSIONS: The lack of wall enhancement may be a predictor of aneurysm stability. The utility of vessel wall imaging in detecting unstable aneurysms requires more data.

Original languageEnglish (US)
JournalAmerican Journal of Neuroradiology
Volume41
Issue number9
DOIs
StatePublished - Sep 1 2020

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

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