Lack of Baseline Intracranial Aneurysm Wall Enhancement Predicts Future Stability: A Systematic Review and Meta-Analysis of Longitudinal Studies

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 = 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.