Prediction of Impending Rupture in Aneurysms Using 4D-CTA: Histopathological Verification of a Real-Time Minimally Invasive Tool in Unruptured Aneurysms

Abstract

The authors describe the use of a 4D-CT angiogram to predict impending rupture in intact aneurysms, as a real-time, less invasive imaging technique. Histopathological verification and immunostaining of the bleb site performed on the study population reveals the significant predictive value of this tool. The point of maximum amplitude of pulsation of the aneurysm wall in unison with the RR interval of the electrocardiogram determines the potential rupture point. This helps in prioritizing the intervention for unruptured aneurysm cases, provides an effective screening of the high-risk population, and aids preoperative planning of clip application.

Key words

Rupture point - 4D-CT angiogram - unruptured aneurysms - histopathology - immunostaining

References

• 1 Hademenos G J, Masssoud T F, Turjman F, Sayre J W. Anatomical and morphological factors correlating with rupture of intracranial aneurysms in patients referred for endovascular treatment.  Neuroradiology. 1988;  40 755-760
• 2 Hope J KA, Wilson J L, Thomson F J. Three-dimensional CT angiography in the detection and characterization of intracranial berry aneurysms.  AJNR Am J Neuroradiol. 1996;  17 439-445
• 3 Korogu Y, Takahashi M, Mabuchi N. et al . Intracranial aneurysms: diagnostic accuracy of MR angiography with evaluation of maximum intensity projection and source images.  Radiology. 1996;  199 199-207
• 4 Setton A, Davis A J, Bose A. et al . Angiography of cerebral aneurysms.  Neuroimaging Clin N Am. 1996;  6 705-738
• 5 Berenstein A, Flamm E S, Kupersmith M J. Unruptured intracranial aneurysms.  N Eng J Med. 1999;  340 1439-1440
• 6 Connolly Jr E S, Mohr H P, Solomon R A. Unruptured intracranial aneurysms (Letter).  N Eng J Med. 1999;  340 1440-1441
• 7 Caplan L R. Should intracranial aneurysms be treated before they rupture?.  N Eng J Med. 1998;  339 1774-1775
• 8 Mitchell P, Jakubowski J. Failure testing cerebral arteries: are branch points weaker than unbranched vessels?.  Br J Neurosurg. 2002;  16 578-582
• 9 Skirgaudas M, Awad I A, Kim J. et al . Expression of angiogenesis factors and selected vascular wall matrix proteins in intracranial saccular aneurysms.  Neurosurgery. 1996;  39 545-547
• 10 Rinkel G J, Djibuti M, Gijn J van. Prevalence and risks of rupture of intracranial aneurysms. A systematic review.  Stroke. 1998;  29 251-256
• 11 Yoshimoto T, Mizoi K. Importance of management of ruptured cerebral aneurysms.  Surg Neurology. 1997;  47 522-526
• 12 Juvela S, Porras M, Poussa K. Natural history of unruptured intracranial aneurysms: probability and risk factors for aneurysm rupture.  J Neurosurg. 2000;  93 379-387
• 13 Yasui N, Suzuki A, Nihimura H. et al . Long-term follow-up study of unruptured intracranial aneurysms.  Neurosurgery. 1997;  40 1155-1159
• 14 Austin G M, Schievink W, Williams R. Controlled pressure-volume factors in the enlargement of intracranial aneurysms.  Neurosurgery. 1989;  24 722-730
• 15 Canham P B, Finlay H M, Tong S Y. Stereological analysis of the layered collagen of human intracranial aneurysms.  J Micro Sc. 1996;  183 (Pt 2) 170-180
• 16 Hayakawa M, Katada K, Anno H. et al .Imaging of cerebral aneurysm pulsation with ECG gated CT: Possible usefulness in the identification of aneurysmal rupture region. Proceedings of American Society of Neuroradiology 40th Annual Meeting 2002: 272
• 17 Burleson A C, Strother C M, Turitto V T. Computer modeling of intracranial saccular and lateral aneurysms for the study of their hemodynamics. Neurosurgery 1995 37 774-782 discussion 1995 37 782-784
• 18 Ostergaard J R, Reske-Nielsen E, Oxlund H. Histological and morphometric observations on the reticular fibres in the arterial bed of patients with ruptured intracranial saccular aneurysms.  Neurosurgery. 1987;  20 554-558