AUTHOR=Zhou Jiafeng , Guo Qinhua , Chen Yongchun , Lin Boli , Ding Shenghao , Zhao Huilin , Pan Yaohua , Wan Jieqing , Zhao Bing 

TITLE=Irregular Pulsation of Intracranial Aneurysm Detected by Four-Dimensional CT Angiography and Associated With Small Aneurysm Rupture: A Single-Center Prospective Analysis

JOURNAL=Frontiers in Neurology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.809286

DOI=10.3389/fneur.2022.809286

ISSN=1664-2295

ABSTRACT=ABSTRACT
Objectives: Predicting the risk of rupture of small intracranial aneurysms remains challenging. The irregular pulsation of aneurysms detected by four-dimensional CT angiography (4D-CTA) may be an imaging marker of aneurysm vulnerability. We aimed to investigate the association of the irregular pulsation with small aneurysm rupture. 
Materials and Methods: This was a prospective study of intracranial aneurysms detected by 4D-CTA from October 2017 to January 2020.242 consecutive patients with 316 aneurysms were enrolled. The irregular pulsation was defined as a temporary focal protuberance on more than 3 consecutive frames of the 20 phases in the R-R interval. Small aneurysms were defined as those less than 7 mm. Univariate and multivariate analyses were performed to determine the independent predictors of small aneurysm rupture. 
Results: A total of 169 patients with 217 small intracranial aneurysms were included. 14 (6.5%) aneurysms had ruptured, and 77（35.5%）aneurysms had irregular pulsation. 
There were no significant differences in age, sex, hypertension, smoking, diabetes, drinking, or hyperlipidemia between the ruptured and unruptured aneurysm groups. The univariate analysis showed a smaller vessel size (p=0.017), a larger size ratio (p=0.001), a larger aspect ratio(p=0.004), a larger flow angle (p<0.001), a large vessel angle(p=0.002), and the presence of irregular pulsation(p<0.001), and an irregular aneurysm (p=0.001) were associated with small aneurysm rupture. The multivariate analysis showed the presence of irregular pulsation (p=0.005), and non-internal carotid artery aneurysm (p=0.027), a larger flow angle (p=0.012) was independently associated with aneurysm rupture. Multivariate analysis of predictors of the irregular pulsation of small aneurysms showed aneurysm rupture (p=0.022), an irregular aneurysm (p<0.001), and a large size ratio (p=0.005) were independently associated with the presence of irregular pulsation. 
Conclusions: The ruptured small aneurysms more often had irregular pulsation. The irregular pulsation was independently associated with aneurysm rupture and may help evaluate the risk of rupture of small intracranial aneurysms.