Aneurysm wall contrast enhancement after coiling: A retrospective cross-sectional study comparing ruptured and unruptured aneurysms.

OBJECTIVE

We aimed to compare aneurysm wall enhancement post-coil embolization between patients with and without subarachnoid hemorrhage (SAH). We hypothesized that ruptured aneurysms in SAH patients exhibit different enhancement patterns compared to incidentally found unruptured aneurysms. To account for potential confounders affecting wall enhancement, coil packing density and aneurysm size were evaluated.

METHODS

This retrospective cross-sectional single-center study included patients who underwent coil embolization for intracranial aneurysms. These patients were monitored with digital subtraction angiography (DSA) and magnetic resonance imaging (MRI), including a contrast-enhanced black-blood sequence. Aneurysm wall enhancement was assessed by ROI-based signal intensity measurements and supplementary visual scoring, and compared between groups using the Student's t-test and Mann-Whitney U test, respectively. In addition, linear and multivariable regression analyses were performed to explore the effects of coil density and aneurysm size on wall enhancement and to assess the independence of the observed group differences.

RESULTS

Among the 31 patients studied, non-SAH patients showed higher wall signal intensity than SAH patients (ROI measurements: SAH: 813 SI vs. no SAH: 1151 SI, p<0.01; visual assessment showed a consistent trend, p=0.055). Neither coil packing density nor aneurysm size independently predicted wall enhancement, and SAH status remained the only significant independent predictor in multivariable analysis.

CONCLUSIONS

Aneurysm wall enhancement following coil embolization differs significantly between patients with and without SAH. The observed signal differences are preliminary and should be regarded as hypothesis-generating, warranting further investigation in future prospective studies.