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.
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