Comparison of Rates of Growth between Unruptured and Ruptured Aneurysms Using Magnetic Resonance Angiography.

BACKGROUND AND PURPOSE Growth is a key risk factor for rupture of unruptured cerebral aneurysms. There are few reports of investigations into the actual growth of ruptured intracranial aneurysms. The aim of the present study was to ascertain the risk of rupture of aneurysms based on the growth of unruptured and ruptured aneurysms. METHODS Changes in size on magnetic resonance angiography (MRA) were examined in 50 patients with ruptured cerebral aneurysms. Images obtained before and after subarachnoid hemorrhage were used. Moreover, changes in aneurysm size were retrospectively examined in 73 patients with 100 unruptured cerebral aneurysms that were followed serially with MRA that was performed using a 1.5-T or 3-T system. The size of the aneurysm was determined by measuring the maximum diameter on maximum intensity projection MRA images. Based on these data, the annual growth rates (mm growth/year) of unruptured and ruptured aneurysms were calculated and compared. RESULTS The median annual growth rate of ruptured aneurysms was significantly greater than that of unruptured aneurysms (.69 versus .077 mm/year, P < .01). The annual growth rates of ruptured aneurysms showed a negative correlation between the duration from initial MRA to the time of rupture. CONCLUSION A high annual growth rate is a key risk factor for aneurysm rupture. This finding provides strong evidence for the treatment of unruptured cerebral aneurysms.

[1]  A follow-up study of autosomal dominant polycystic kidney disease with intracranial aneurysms using 3.0 T three-dimensional time-of-flight magnetic resonance angiography. , 2013, European journal of radiology.

[2]  Ming-hua Li,et al.  Large-Cohort Comparison Between Three-Dimensional Time-of-Flight Magnetic Resonance and Rotational Digital Subtraction Angiographies in Intracranial Aneurysm Detection , 2009, Stroke.

[3]  S. Fukuhara,et al.  The natural course of unruptured cerebral aneurysms in a Japanese cohort. , 2012, The New England journal of medicine.

[4]  N. Yasui,et al.  Incidence and risk factors for the growth of unruptured cerebral aneurysms: observation using serial computerized tomography angiography. , 2004, Journal of neurosurgery.

[5]  Yuichi Murayama,et al.  Prediction model for 3‐year rupture risk of unruptured cerebral aneurysms in Japanese patients , 2015, Annals of neurology.

[6]  H. Kataoka,et al.  Judgment and Action in Surgery for Unruptured Intracranial Aneurysms , 2016 .

[7]  H Hunt Batjer,et al.  Relationship of Growth to Aneurysm Rupture in Asymptomatic Aneurysms ≤ 7 mm: A Systematic Analysis of the Literature , 2011, Neurosurgery.

[8]  C. Majoie,et al.  MR Angiography Follow-Up 5 Years after Coiling: Frequency of New Aneurysms and Enlargement of Untreated Aneurysms , 2008, American Journal of Neuroradiology.

[9]  John Huston,et al.  Intracranial Aneurysm Enlargement on Serial Magnetic Resonance Angiography: Frequency and Risk Factors , 2009, Stroke.

[10]  C. Majoie,et al.  De Novo Aneurysm Formation and Growth of Untreated Aneurysms: A 5-Year MRA Follow-Up in a Large Cohort of Patients With Coiled Aneurysms and Review of the Literature , 2011, Stroke.

[11]  Z. Yamagata,et al.  Risk Factors for Growth of Unruptured Intracranial Aneurysms: Follow-up Study by Serial 0.5–T Magnetic Resonance Angiography , 2006, Neurosurgery.

[12]  C. Drake,et al.  Report of World Federation of Neurological Surgeons Committee on a Universal Subarachnoid Hemorrhage Grading Scale. , 1988, Journal of neurosurgery.

[13]  H. Kamitani,et al.  Bleeding Risk in Unruptured and Residual Cerebral Aneurysms – Angiographic Annual Growth Rate in Nineteen Patients , 1999, Acta Neurochirurgica.

[14]  Fisher Cm,et al.  Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. , 1980, Neurosurgery.

[15]  T. Okudera,et al.  Subarachnoid hemorrhage caused by previously diagnosed, previously unruptured intracranial aneurysms: a retrospective analysis of 25 cases. , 1996, Neurosurgery.

[16]  S. Juvela,et al.  Natural history of unruptured intracranial aneurysms: a long-term follow-up study. , 1993, Journal of neurosurgery.

[17]  D. Wiebers,et al.  Intracranial saccular aneurysm enlargement determined using serial magnetic resonance angiography. , 2002, Journal of neurosurgery.

[18]  A. Algra,et al.  Growth rates of intracranial aneurysms: exploring constancy. , 2008, Journal of neurosurgery.

[19]  Toshihiro Ishibashi,et al.  Development of the PHASES score for prediction of risk of rupture of intracranial aneurysms: a pooled analysis of six prospective cohort studies , 2014, The Lancet Neurology.

[20]  Takashi Inoue,et al.  Annual rupture risk of growing unruptured cerebral aneurysms detected by magnetic resonance angiography. , 2012, Journal of neurosurgery.