Role of Vessel Wall Imaging in the Diagnosis of Intracranial Aneurysms

Abstract

MR vessel wall imaging（VWI）is an emerging modality that offers a fundamentally different perspective by focusing on the pathology within the aneurysm wall, as opposed to the traditional imaging paradigms that prioritize the aneurysm lumen. Current evidence suggests that VWI could potentially provide new insights into the diagnosis of intracranial aneurysms. Aneurysm wall enhancement in unruptured and ruptured aneurysms may reflect an unstable state of the aneurysm and culprit lesions in cases with multiple aneurysms. The absence of enhancement in unruptured aneurysms may be a marker of a stable state. This review focuses on the utility of VWI in the diagnosis of intracranial aneurysms. First, we discuss the mechanism of aneurysm wall enhancement. Second, we review its clinical application in the diagnosis of ruptured and unruptured aneurysms, particularly the emergence of aneurysm wall enhancement as a biomarker of aneurysm evolution. The assertive implementation of VWI in routine clinical practice will be facilitated by large prospective studies to validate wall enhancement as a biomarker of aneurysm evolution.