Correlation of inflow velocity ratio detected by phase contrast magnetic resonance angiography with the bleb color of unruptured intracranial aneurysms

Abstract Background Intraoperative rupture is the most fatal and catastrophic complication of surgery for unruptured intracranial aneurysms (UIAs); thus, it is extremely useful to predict reddish and thin-walled regions of the UIA before surgery. Although several studies have reported a relationship between the hemodynamic characteristics and intracranial aneurysm wall thickness, a consistent opinion is lacking. We aimed to investigate the relationship between objectively and quantitatively evaluated bleb wall color and hemodynamic characteristics using phase-contrast magnetic resonance angiography (PC-MRA). Methods Ten patients diagnosed with UIA, who underwent surgical clipping and preoperative magnetic resonance imaging along with PC-MRA, were included in this study. Bleb wall color was evaluated from an intraoperative video. Based on the Red (R), Green, and Blue values, bleb wall redness (modified R value; mR) was calculated and compared with the hemodynamic characteristics obtained from PC-MRA. Results The wall redness distribution of 18 blebs in 11 UIAs in 10 patients was analyzed. Bleb/neck inflow velocity ratio (Vb/Va: r=.66, P=.003) strongly correlated with mR, while bleb/neck inflow rate ratio (Qb/Qa: r=.58, P=.012) correlated moderately. Multivariate regression analysis revealed that only Vb/Va (P=.017) significantly correlated with mR. There was no correlation between wall shear stress and mR. Conclusions The bleb redness of UIAs and Vb/Va, calculated using PC-MRA, showed a significantly higher correlation. Thus, it is possible to predict bleb thickness non-invasively before surgery. This will facilitate more detailed pre- and intraoperative strategies for clipping and coiling for safe surgery.