Aneurysm Wall Enhancement Can Predict Rupture Point in Intracranial Aneurysms With Multiple Blebs

Neurosurgery 96:593–599, 2025

• Aneurysm Wall Enhancement (AWE) can predict rupture points in intracranial aneurysms with multiple blebs.

• Vessel Wall MRI (VW-MRI) is used to visualize ruptured aneurysms, showing characteristic AWE.

• Higher AWE is associated with ruptured blebs, while lower wall shear stress (WSS) is observed in ruptured versus unruptured blebs.

• CRstalk (contrast ratio of the aneurysm wall against the stalk) is a significant predictor of rupture status, with higher values indicating ruptured blebs.

• AWE is independent of WSS in predicting rupture status and can guide treatment strategies.

• Study limitations include its retrospective nature and small sample size; future studies with high-resolution MRI are suggested.

• Clinical value: AWE helps determine which aneurysm to treat first, especially in cases with multiple aneurysms, improving surgical safety.