Naomi Larsen
Counseling of patients with incidental intracranial aneurysms poses a challenge to interventional neuroradiologists and neurosurgeons. Several clinical scoring systems have been in use for the stratification of rupture risk. Analysis of aneurysm morphology and hemodynamic variables not only serves as an important tool for patient-specific rupture risk assessment, but also reveals valuable insight into possible mechanisms of evolution, progression, and aneurysm rupture. Still, there is ongoing controversy about which parameters are most reliable for distinguishing aneurysms at a higher risk for rupture from stable aneurysms.
From a practical point of view, an imaging marker for preselection of patients at a higher risk of aneurysm progression, which can be obtained and assessed without the need for time-consuming image postprocessing and specialized computing skills, would be desirable. After wall enhancement of unruptured intracranial aneurysms was described as a possible surrogate marker of wall inflammation and an unstable state, we included high-resolution MR vessel wall imaging in our imaging work-up protocol of patients with incidental intracranial aneurysms.
We aimed to confirm the value of this method by identifying histologic changes in the aneurysm wall that are associated with enhancement and possible destabilization of the wall. Our results contribute to the understanding of the pathologic conditions underlying wall enhancement. I have received some valuable input and comments from colleagues employing vessel wall imaging in their clinical routine and from other research groups conducting research in the field of histologic and biomechanical assessment of aneurysms. I have expanded my research interest to aneurysms after embolization.
I have been investigating temporal enhancement patterns and their association with reperfusion in aneurysms after embolization with the intention to visualize stages of aneurysm healing and identify a potential surrogate marker of advanced or completed aneurysm healing. I presented the results of this research at the annual meeting of the German Radiological Society in May 2019 in Leipzig, Germany and have submitted a manuscript for publication.