Association between white matter hyperintensity burden and intracranial aneurysm rupture
Objective: White matter hyperintensities (WMH) are among the most common imaging markers of cerebral small vessel disease and may reflect diffuse cerebrovascular vulnerability. This study aimed to investigate the relationship between WMH burden and intracranial aneurysm (IA) rupture. Materials and Methods: This retrospective observational study included 120 patients with digital subtraction angiography (DSA)-confirmed intracranial aneurysms. Patients were categorized into ruptured (n = 72) and unruptured (n = 48) aneurysm groups. Demographic characteristics, vascular risk factors, aneurysm morphology, and WMH burden were evaluated. WMH severity was assessed using the Fazekas scale on T2-weighted and fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) sequences. Multivariate logistic regression analysis was performed to identify factors independently associated with aneurysm rupture. Results: Hypertension, smoking, anterior communicating artery aneurysms location, higher aspect ratio, and bleb or secondary outpouching were more frequent in ruptured aneurysms. Total WMH score was significantly higher in the ruptured group (median 3 [0–6] vs. 2 [0–5], P = .005). Multivariable analysis demonstrated that AComA location (OR: 2.61, 95% CI: 1.17–5.82, P = .018), presence of bleb or secondary outpouching (OR: 3.38, 95% CI: 1.54–7.40, P = .002), and total WMH score (OR: 1.28, 95% CI: 1.05–1.56, P = .014) were independently associated with aneurysm rupture. No significant association was found between WMH burden and modified Fisher score among patients with ruptured aneurysms. Conclusions: Increased WMH burden was independently associated with IA rupture. These findings suggest that aneurysm rupture may be influenced not only by local aneurysm morphology but also by diffuse cerebrovascular vulnerability. WMH burden may represent a potential imaging marker associated with aneurysm instability and rupture risk.