Background: Intracranial aneurysms (IAs) remain challenging due to limited tools for rupture risk prediction and long-term management. This thesis aimed to reappraise current IA risk assessment, investigate imaging markers of aneurysm instability, and explore inflammatory biomarkers associated with aneurysm wall pathologies. Methods: A retrospective analysis assessed associations between first-time CTA and MRA examinations and newly diagnosed IAs over a 10-year period. The discriminatory performance of the PHASES score was evaluated in 184 patients with ruptured and unruptured IAs. Anxiety and depression were assessed using HADS questionnaires. In untreated IAs, vessel wall MRI and serum analyses were performed in 80 IA patients and 37 controls to evaluate aneurysm wall enhancement (AWE) and inflammatory cytokines. In 60 coiled IAs, aneurysm wall enhancement (AWE), aneurysm cavity enhancement (ACE), and recanalisation were analysed using follow-up MRI. Results: The annual increasing number of CTA and MRA examinations were significantly associated with higher detection rates of unruptured IAs (p = 0.002; adjusted R² = 0.63). The PHASES score showed poor discrimination between ruptured and unruptured IAs (AUC 0.567). Anxiety and depression levels were marginally elevated, without statistically significant differences. In untreated IAs, AWE was associated with increased IL-6 levels and altered IL-1β signalling. A combined model including PHASES score, IL-6, and IL-1β improved AWE prediction (AUC 0.874). In coiled IAs, AWE was associated with aneurysm recanalisation (p = 0.036), particularly in recanalisation > 3 mm. Conclusions: Current IA risk models remain insufficient. Integrative approaches combining imaging, biological markers, and clinical characteristics may improve personalised management in IA patients.
Evaluation of New Predictors for Intracranial Aneurysm Rupture Risk and Disease Progression
Leber, S. (Autor/-in). 2026
Studienabschlussarbeit: Dissertation