PT  - JOURNAL ARTICLE
AU  - C.J.H.C.M. van Laarhoven
AU  - M.L. Rots
AU  - V.E.C. Pourier
AU  - N.K.N. Jorritsma
AU  - T. Leiner
AU  - J. Hendrikse
AU  - M.D.I. Vergouwen
AU  - G.J. de Borst
TI  - Gadolinium Enhancement of the Aneurysm Wall in Extracranial Carotid Artery Aneurysms
AID  - 10.3174/ajnr.A6442
DP  - 2020 Mar 01
TA  - American Journal of Neuroradiology
PG  - 501--507
VI  - 41
IP  - 3
4099  - http://www.ajnr.org/content/41/3/501.short
4100  - http://www.ajnr.org/content/41/3/501.full
SO  - Am. J. Neuroradiol.2020 Mar 01; 41
AB  - BACKGROUND AND PURPOSE: The natural history and optimal treatment of extracranial carotid artery aneurysms are unknown. Gadolinium enhancement of the aneurysm wall may reflect aneurysm wall inflammation and instability. In this study, we investigated the feasibility of extracranial carotid artery aneurysm wall imaging and explored a potential relationship of aneurysm wall enhancement with aneurysm growth and the presence of (silent) brain infarcts and white matter lesions.MATERIALS AND METHODS: Fourteen conservatively treated patients with 15 asymptomatic extracranial carotid artery aneurysms underwent gadolinium-enhanced 3T MR imaging at 2 time points with a 12-month interval. Primary outcome was growth of the aneurysm sac (≥2.0 mm); secondary outcomes were the presence of (silent) brain infarcts and white matter lesions at baseline and follow-up. MR images were reviewed by 2 independent observers, and inter- and intraobserver reproducibility was assessed.RESULTS: Seven (50%) patients were men; the median age was 55 years (range, 40–69 years). Eleven extracranial carotid artery aneurysms (73%) were saccular (median size, 11 mm; range, 5.0–38.5 mm), and 4 were fusiform (median size, 21.5 mm; range, 10.0–40.0 mm). Eleven of 15 aneurysms (73%) exhibited gadolinium enhancement at baseline. Four aneurysms (27%) showed growth at follow-up imaging, 2 gadolinium-positive (+) and 2 gadolinium-negative (–) (P = .245). Three patients (21%) had ipsilateral brain infarcts at baseline; 1 of them showed a new silent brain infarct at follow-up imaging (gadolinium+). Nine patients (64%) showed bilateral white matter lesions at baseline. In 3 patients, increased white matter lesion severity was observed at follow-up (2 gadolinium+). All observations showed excellent inter- and intraobserver reproducibility.CONCLUSIONS: In this explorative study, we demonstrated that extracranial carotid artery aneurysm wall imaging was feasible. Future well-powered studies are needed to investigate whether extracranial carotid artery aneurysm gadolinium enhancement predicts aneurysm growth and thromboembolic complications.ECAAextracranial carotid artery aneurysmGdgadoliniumWMLwhite matter lesionCARCarotid Aneurysm Registry