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A Proposed Ordinal Scale for Grading Histology in Elastase-Induced, Saccular Aneurysms

D. Daia, Y.H. Dinga, D.A. Lewisa and D.F. Kallmesa

a From the Neuroradiology Research Laboratory, Department of Radiology, Mayo Clinic and Foundation, Rochester, Minn



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  		Fig 1. Photomicrographs illustrating neck healing. All sections were stained with H&E.

A, Representative section (magnification x25) with the neck healing score = 0, showing unorganized laminated thrombus along the entire aneurysm neck in this section.

B, Representative section (magnification x40) with the neck healing score = 1, illustrating unorganized fibrin across the aneurysm neck.

C, Representative section with the neck healing score = 2, showing both organized tissue and unorganized fibrin at the aneurysm neck (magnification x50).

D, Representative section with the neck healing score = 3, showing a thin layer of completely organized tissue across the entire aneurysm neck (magnification x100).

E, Representative section with the neck healing score = 4, showing a thick layer of completely organized tissue traversing the entire aneurysm neck (magnification x60).



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  		Fig 2. Photomicrographs illustrating dome healing. All sections were stained with H&E.

A, Representative section (magnification x20) of a dome score = 0, showing that the aneurysm cavity is completely filled with unorganized thrombus.

B, Representative section (magnification x15) when the dome score = 1, where less than one third of aneurysm cavity is filled with organized tissue.

C, Representative section (magnification x20) with dome score = 2, in that approximately one half of the aneurysm cavity is filled with organized tissue.

D, Representative section (magnification x15) with a dome score = 3, most the aneurysm cavity filled with organized tissue; a residual small area of unorganized thrombus is also evident.

E, Representative section (magnification x15) with the dome score = 4, showing the aneurysm cavity to be entirely filled with loose organized tissue.

F, Representative section (magnification x40) with the dome score = 5. Staining in this section reveals the aneurysm cavity is completely filled with attenuated cellular tissue.



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  		Fig 3. Photomicrographs illustrating histologic coil compaction scoring. All sections were stained with H&E.

A, Representative section for neck compaction score = 3, showing the tissue across the aneurysm neck is convex to the aneurysm cavity (magnification x20).

B, Representative section for a neck compaction score = 2, showing the tissue at the neck is flat (magnification x60).

C, Representative section for a neck compaction score = 1, showing the tissue at the neck slightly concave to the aneurysm cavity (magnification x15).

D, Representative section for a neck compaction score = 0, showing the tissue at the interface between the aneurysm cavity and parent artery is markedly concave to the aneurysm cavity (magnification x15).



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  		Fig 4. Mean and SD for scoring categories, in addition to Total Score, over survival time in weeks. Different colored bars represent the mean ± SD for each variable in the ordinal scale at 2 weeks (n = 5), 4 weeks (n = 8), 10 weeks (n = 5), 16 weeks (n = 6), and 24 weeks (n = 6). Values for 2 weeks are significantly less (P < .05) than for 4 weeks, 16 weeks, and 24 weeks. Ten-week values are significantly less (P < .05) than 24-week values.



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  		Fig 5. A comparison of healing (total score) over time between broad-necked (closed blue circle; >3) and small-necked (closed red triangle; ≤3) aneurysms. Data are represented by mean ± SD. There was a significant difference between the 2 groups (indicated by an asterisk) at the 4-week time period.





Copyright © 2008 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X