Developing and validating the Japanese version of professional attitude scale for nurses.

AIM: We developed and psychometrically tested the Japanese version of the Professional Attitude Scale for Nurses (PASN-J). BACKGROUND: Nurses must recognize the importance of their professionalism; therefore, it is critical to quantitatively measure nurses' professional attitudes. INTRODUCTION: This instrument validation study was designed to generate an itemized scale and examine its content validity/psychometric testing using a sample of Japanese nurses. METHODS: Based on a trait approach focusing on the characteristic traits of the nursing profession, a 59-item draft scale was generated. During November 2017, 2657 nurses from 29 facilities in Japan were surveyed. The questionnaire included demographics, the 59-item draft scale, and a self-report scale of nurses' professional behaviour and nursing practice ability. Using exploratory and confirmatory factor analyses, we evaluated the construct, criterion-related, concurrent, and known-groups validity, and reliability of the PASN-J. RESULTS: Data from 1716 participants were analysed. The analyses yielded a 38-item, 3-factor scale that adequately fit the data. PASN-J scores were positively correlated with nurses' professional behaviour and nursing practice ability. CONCLUSION: The 38-item PASN-J has good reliability and validity, making it useful for measuring the current condition of nursing professionalism and evaluating nursing education. Implications for Nursing and Health Policy: This scale can evaluate nursing education and promote nurses' professionalism. The PASN-J will help identifying the elements of undergraduate nursing education that require further emphasis. Additionally, the PASN-J could facilitate the development of nursing policies to promote professional development in nurses. Ultimately, evaluating nursing education with the PASN-J enhances nurses' professional attitudes and subsequently improves their quality of nursing, nursing efficiency and patient outcomes.

The consumption of fish cooked by different methods was related to the risk of hyperuricemia in Japanese adults: A 3-year follow-up study.

BACKGROUND AND AIMS: Fish consumption is a recognized risk factor for elevated serum uric acid (UA) levels, hyperuricemia, and gout. However, the relationship between the consumption of fish cooked by different methods and the risk of hyperuricemia is unclear. Therefore, we aimed to investigate the relationship between the consumption of fish cooked by different methods and the risk of hyperuricemia in Japanese adults. METHODS AND RESULTS: A 3-year follow-up study was conducted with 424 Japanese adults aged 29-74 years. Fish consumption was assessed using a validated self-administered dietary history questionnaire, and hyperuricemia was defined as serum UA ≥7 mg/dL in men and ≥6 mg/dL in women or the use of any anti-gout treatment. During the 3-year follow-up period, we documented 30 newly diagnosed cases of hyperuricemia. After adjusting for potential confounders, multivariate logistic regressions analysis revealed a significant positive relationship between the risk of hyperuricemia and raw (sashimi and sushi) or roasted fish consumption, but not boiled or fried fish consumption. The odds ratios (95% CI) for hyperuricemia with increasing raw fish consumption were 1.00 (reference), 2.51 (0.85, 7.39), and 3.46 (1.07, 11.14) (P for trend: 0.036). Similarly, the odds ratios (95% CI) with increasing roasted fish consumption were 1.00 (reference), 3.00 (0.75, 11.89), and 5.17 (1.30, 20.62) (P for trend: 0.018). CONCLUSION: This 3-year follow-up study showed that the consumption of raw or roasted fish, but not boiled or fried fish, was related with a higher risk of hyperuricemia in Japanese adults.

Clinical characteristics classified by the serum KL-6 level in patients with organizing pneumonia.

BACKGROUND: The serum Krebs von der Lungen-6 (KL-6) level is a useful marker correlated with the severity of various interstitial lung diseases. There have been few reports about the clinical characteristics of organizing pneumonia (OP) associated with the serum KL-6 levels. OBJECTIVE: This study was performed to determine whether the serum KL-6 levels can help determine the optimal treatment for OP. DESIGNS: Patients diagnosed with OP by clinical, radiological and histopathological findings were retrospectively reviewed. The OP patients were classified into two groups based on their serum KL-6 levels: normal KL-6 and high KL-6 groups. The two groups were compared with regard to their clinical and radiological data and therapeutic response one month after the start of treatment. RESULTS: The clinical records of twenty-two patients diagnosed with OP were reviewed. The serum KL-6 level was elevated in 11 of the 22 patients. There were no obvious differences in the clinical data between the two groups, although patients in the normal KL-6 group tended to have a fever. There were no significant differences in the chest X-ray (CXR) score or computed tomography (CT) score between the two groups. The CXR scores were correlated with the serum KL-6 levels. At 1 month after the diagnosis, 11 patients who needed treatment with prednisolone were included in the high KL-6 group. CONCLUSIONS: Patients with normal KL-6 levels showed lower CXR and CT scores. The serum KL-6 level on admission is a useful marker to judge the need for corticosteroid treatment in OP patients.

Nitrogen and phosphorus effluent loads from a paddy-field district adopting collective crop rotation.

Japanese paddy rice systems commonly adopt the rotation of vegetables, wheat and soybeans with paddy rice. Crop rotation may, however, increase the nutrient load in effluent discharged from the district because more fertilizer is applied to the rotation crops than is applied to paddy crops. We investigated a paddy-field district subject to collective crop rotation and quantified the annual nutrient load of effluent from the district in three consecutive years. The total annual exports of nitrogen and phosphorus over the investigation period ranged from 30.3 to 40.6 kg N ha(-1) and 2.62 to 3.13 kg P ha(-1). The results suggest that rotation cropping increases the effluent nutrient load because applied fertilizer is converted to nitrate, and surface runoff is increased due to the absence of shuttering boards at the field outlets.

Host bone-marrow cells are a source of donor intimal smooth- muscle-like cells in murine aortic transplant arteriopathy.

Long-term solid-organ allografts typically develop diffuse arterial intimal lesions (graft arterial disease; GAD), consisting of smooth-muscle cells (SMC), extracellular matrix and admixed mononuclear leukocytes. GAD eventually culminates in vascular stenosis and ischemic graft failure. Although the exact mechanisms are unknown, chronic low-level alloresponses likely induce inflammatory cells and/or dysfunctional vascular wall cells to secrete growth factors that promote SMC intimal recruitment, proliferation and matrix synthesis. Although prior work demonstrated that the endothelium and medial SMCs lining GAD lesions in cardiac allografts are donor-derived, the intimal SMC origin could not be determined. They are generally presumed to originate from the donor media, leading to interventions that target donor medial SMC proliferation, with limited efficacy. However, other reports indicate that allograft vessels may contain host-derived endothelium and SMCs (refs. 8,9). Moreover, subpopulations of bone-marrow and circulating cells can differentiate into endothelium, and implanted synthetic vascular grafts are seeded by host SMCs and endothelium. Here we used murine aortic transplants to formally identify the source of SMCs in GAD lesions. Allografts in beta-galactosidase transgenic recipients showed that intimal SMCs derived almost exclusively from host cells. Bone-marrow transplantation of beta-galactosidase--expressing cells into aortic allograft recipients demonstrated that intimal cells included those of marrow origin. Thus, smooth-muscle--like cells in GAD lesions can originate from circulating bone--marrow-derived precursors.

Reduction of Alzheimer's disease amyloid-ß in plasma by hemodialysis and its relation to cognitive functions.

BACKGROUND/AIMS: Rapid removal of plasma amyloid-ß (Aß) by blood purification may serve as a peripheral Aß sink from the brain for Alzheimer's disease therapy. We investigated the reduction of plasma Aß during hemodialysis and cognitive states. METHODS: Aß concentrations and Mini-Mental State Examinations (MMSE) were investigated in 37 hemodialysis patients (68.9 ± 4.1 years). RESULTS: The dialyzers effectively removed Aß(1-40) and Aß(1-42), 63.9 ± 14.4 and 51.6 ± 17.0% at 4 h dialysis, resulting in the reduction of Aßs in whole-body circulation by 51.1 ± 8.9 and 32.7 ± 12.0%, respectively. Although the plasma Aßs before dialysis (750.8 ± 171.3 pg/ml for Aß(1-40)) were higher than those reported for Alzheimer's disease patients, the cognitive states of hemodialysis patients were relatively normal, especially of longer dialysis vintages. CONCLUSIONS: Dialyzers effectively reduced Aßs in whole-body circulation. Repeated rapid decrease of plasma Aßs might maintain cognitive state.

Application of cDNA Macroarray for Simultaneous Detection of 12 Potato Viruses.

A complementary DNA (cDNA) macroarray was developed for simultaneous detection of 12 different potato viruses. A suitable region in the viral genome for each was selected for Alfalfa mosaic virus, Cucumber mosaic virus, Potato aucuba mosaic virus, Potato leafroll virus, Potato mop-top virus, Potato virus A, Potato virus M, Potato virus S, Potato virus X, Potato virus Y, Tomato ringspot virus, and Tomato spotted wilt virus, and their respective cDNAs were cloned into plasmid vectors. Capture probes for each virus ranging from 290 to 577 bp were generated by polymerase chain reaction (PCR) and immobilized on a nylon membrane. Total RNAs were extracted from each of these virus infected-plants, and cDNAs were synthesized from the RNA extracts using a random 9-mer primer. Subsequently, PCR reactions were performed using one primer pair for each of the 12 viruses. During PCR, amplified cDNAs were labeled with biotin and used as a target for hybridization analyses on a macroarray membrane. Hybridization signals between capture probes for the 12 viruses and their respective target cDNAs were observed using chemiluminescent or colorimetric detection. In all viruses, hybridization signals with capture probes were detected only when homologous virus targets were examined, and no hybridization to healthy plant extract was observed, facilitating identification of each virus. The results by colorimetric detection agreed with those obtained using chemiluminescence. The macroarray method developed was 5 × 102 to 4 × 106 times more sensitive than enzyme-linked immunosorbent assay and 5 to 5 × 104 times more sensitive than reverse-transcription PCR, except for Alfalfa mosaic virus. Colorimetric detection and substantial reduction in cross-hybridization signals much improved the method compared with other array-based detection methods for practical use.

Sialendoscopic removal of gold filament thread-induced sialolith in the duct of the parotid gland.

Foreign body-induced sialolith is very rare. We report minimally invasive sialendoscopic removal of gold filament thread-induced sialolith in the duct of the parotid gland. A 51-year-old woman with recurrent swelling of the left parotid gland was referred to our hospital. She had undergone insertion of 0.1-mm-diameter gold filament threads into the subdermal skin for facial rejuvenation previously. Computed tomography showed many gold filament threads in the subdermal skin and a sialolith (9.5×4.1×7.9mm) including a gold filament thread in the left parotid duct. The patient underwent endoscopic removal of the sialolith using a 1.6-mm-diameter sialendoscope and Holmium laser under general anesthesia. The sialolith was completely removed with basket and forceps after laser fragmentation, and the broken fragments contained gold filament thread. There was no recurrence of parotid gland swelling after the removal.

Early surgery for treatment of spontaneous hemopneumothorax.

PURPOSE: Spontaneous hemopneumothorax (SHP) is a rare life threatening disorder. We retrospectively investigated patients with SHP who were treated with video- assisted thoracic surgery (VATS), and report our results. METHODS: From January 1993 to July 2006, 239 patients with spontaneous pneumothorax were treated, among whom 11 (4.6%) were diagnosed with SHP. RESULTS: All 11 patients had a collapsed lung condition worse than moderate and a chest tube inserted, of whom 10 underwent an emergency operation. The points of hemorrhaging, each of which were in the apical portion of the lung, were easily revealed during VATS, and we were able to distinguish between brisk flow and seepage. Hemostasis was acquired using VATS in all surgery cases, while the other was treated with tube drainage. The single patient who did not undergo surgical treatment had recurrent spontaneous pneumothorax 3 months later. CONCLUSION: It is important to perform surgery for SHP at the appropriate time. VATS was found to be an easily performed and safe procedure for initial treatment in patients with active hemorrhaging and massive blood clotting in the thorax. The long-term outcome of our patients with early surgical indication was excellent and we recommend early surgical treatment for SHP.

Novel Models for Identification of the Ruptured Aneurysm in Patients with Subarachnoid Hemorrhage with Multiple Aneurysms.

BACKGROUND AND PURPOSE: In patients with SAH with multiple intracranial aneurysms, often the hemorrhage pattern does not indicate the rupture source. Angiographic findings (intracranial aneurysm size and shape) could help but may not be reliable. Our purpose was to test whether existing parameters could identify the ruptured intracranial aneurysm in patients with multiple intracranial aneurysms and whether composite predictive models could improve the identification. MATERIALS AND METHODS: We retrospectively collected angiographic and medical records of 93 patients with SAH with at least 2 intracranial aneurysms (total of 206 saccular intracranial aneurysms, 93 ruptured), in which the ruptured intracranial aneurysm was confirmed through surgery or definitive hemorrhage patterns. We calculated 13 morphologic and 10 hemodynamic parameters along with location and type (sidewall/bifurcation) and tested their ability to identify rupture in the 93 patients. To build predictive models, we randomly assigned 70 patients to training and 23 to holdout testing cohorts. Using a linear regression model with a customized cost function and 10-fold cross-validation, we trained 2 rupture identification models: RIMC using all parameters and RIMM excluding hemodynamics. RESULTS: The 25 study parameters had vastly different positive predictive values (31%-87%) for identifying rupture, the highest being size ratio at 87%. RIMC incorporated size ratio, undulation index, relative residence time, and type; RIMM had only size ratio, undulation index, and type. During cross-validation, positive predictive values for size ratio, RIMM, and RIMC were 86% ± 4%, 90% ± 4%, and 93% ± 4%, respectively. In testing, size ratio and RIMM had positive predictive values of 85%, while RIMC had 92%. CONCLUSIONS: Size ratio was the best individual factor for identifying the ruptured aneurysm; however, RIMC, followed by RIMM, outperformed existing parameters.

Neutral endopeptidase 24.11 in neutrophils modulates protective effects of natriuretic peptides against neutrophils-induced endothelial cytotoxity.

This study was performed to determine effects of atrial and brain natriuretic peptides (ANP, BNP) on neutrophils-induced endothelial injury which is known to play a role in the pathophysiology of ischemia/reperfusion myocardial injury and to examine whether the effects of ANP and BNP on neutrophils are modulated by neutral endopeptidase 24.11 (NEP) in neutrophils themselves. The incubation of human neutrophils with ANP and BNP inhibited the neutrophils-induced detachment of cultured human endothelial cells (HEC). The inhibitory effect of ANP and BNP was associated with the suppressions of the neutrophils adhesiveness to HEC, CD18 expression on the neutrophils and elastase release from the neutrophils. Coincubation with UK73967 or phosphoramidon, inhibitors of NEP, potentiated all of the effects of ANP and BNP on the neutrophil functions, and the NEP inhibitors protected degradation of ANP and BNP by the neutrophils. NEP enzymatic activity in the particulate fractions and immunoreactive NEP expression were found to increase in the neutrophils from patients with early phase of acute myocardial infarction (AMI) by 5.2- and by 4.2-fold of the neutrophils from patients with late phase of AMI, respectively. In an in vivo canine model of myocardial ischemia/reperfusion, the intravenous administration of UK73967 suppressed the neutrophil adherence to endothelium and the neutrophil accumulation in the ischemic/reperfused myocardium. The results indicate that ANP and BNP, which are known to increase in AMI, modulate the neutrophil functions and exert protective effects against the neutrophils-induced endothelial cytotoxity. But the effects are suppressed due to their degradation by the neutrophil own NEP. Thus, neutrophil NEP, which also increases in AMI, may play a role in the pathophysiology of neutrophils-mediated ischemia/reperfusion endothelial and myocardial injury.

Immunohistochemical colocalization of glycoxidation products and lipid peroxidation products in diabetic renal glomerular lesions. Implication for glycoxidative stress in the pathogenesis of diabetic nephropathy.

Advanced glycation end products (AGEs) include a variety of protein adducts whose accumulation alters the structure and function of tissue proteins and stimulates cellular responses. They have been implicated in tissue damage associated with diabetic complications. To assess the possible link between AGE accumulation and the development of diabetic nephropathy (DN), we have examined the immunohistochemical localization of various AGE structures postulated to date, i.e., pentosidine, Nepsilon-(carboxymethyl)lysine (CML), and pyrraline, in diabetic and control kidneys. CML and pentosidine accumulate in the expanded mesangial matrix and thickened glomerular capillary walls of early DN and in nodular lesions and arterial walls of advanced DN, but were absent in control kidneys. By contrast, pyrraline was not found within diabetic glomeruli but was detected in the interstitial connective tissue of both normal and diabetic kidneys. Although the distribution of pyrraline was topographically identical to type III collagen, distribution of pentosidine and CML was not specific for collagen type, suggesting that difference in matrix protein composition per se could not explain heterogeneous AGE localization. Since oxidation is linked closely to the formation of pentosidine and CML, we also immunostained malondialdehyde (MDA), a lipid peroxidation product whose formation is accelerated by oxidative stress, assuming that local oxidative stress may serve as a mechanism of pentosidine and CML accumulation. Consistent with our assumption, diabetic nodular lesions were stained positive for MDA. These findings show that AGE localization in DN varies according to AGE structure, and suggest that the colocalization of markers of glycoxidation (pentosidine and CML) with a marker of lipid peroxidation reflects a local oxidative stress in association with the pathogenesis of diabetic glomerular lesions. Thus, glycoxidation markers may serve as useful biomarkers of oxidative damage in DN.

Beneficial effect of low-density lipoprotein apheresis (LDL-A) on refractory nephrotic syndrome (NS) due to focal glomerulosclerosis (FGS).

AIMS: Hypercholesterolemia is one of the factors which deteriorate renal function in NS especially due to FGS. LDL-A is a potential option for treating NS due to FGS accompanied by hypercholesterolemia and resistant to conventional drug therapy with steroids and/or cyclosporine A (CsA). As reported by Muso et al. [2001], LDL-A combined with drug therapy yields more rapid relief from NS and better prognosis than drug therapy alone. However, very limited data are available on outcome at several years after treatment. The aim of this study was to clarify long-term outcome of NS patients treated with LDL-A and to evaluate the effectiveness of this treatment. PATIENTS AND METHODS: To clarify the long-term outcome of LDL-A, we conducted a retrospective survey on outcome up to 5 years. From 36 hospitals in Japan, 41 patients with NS whose short-term outcomes with LDL-A were reported from 1999-2004 were collected and analyzed. RESULTS: In all, 29 and 15 patients with outcomes determined at 2 and 5 years after treatment, respectively, were obtained. At 2 and 5 years after treatment, 62 and 87% of patients, respectively, were classified into complete or Type 1 incomplete remission. The strength of correlations between outcome and several factors including parameters of renal function measured before and after treatment and treatment condition revealed that early administration of LDL-A after the onset of NS provided a good long-term outcome. The data also suggest that more drastic decrease of LDL favored a better prognosis. CONCLUSIONS: In NS due to FGS treated with LDL-A, long-term outcome was as good as short-term outcome. Early administration of LDL-A after the onset of NS provided a good long-term outcome. To obtain more precise findings regarding the effects of this treatment, a large-scale prospective study will be needed.

Imaging of silkworm meiotic chromosome by atomic force microscopy.

Although structural information of mitotic chromosomes has been accumulated, little information is available for meiotic chromosome structures. Here, we applied atomic force microscopy (AFM) to investigate the ultrastructures of the silkworm, Bombyx mori, meiotic pachytene chromosome in its native state with nanometer scale resolution. Two levels of DNA folding were observed on the meiotic chromosome surface, 50-70 nm granules, which were considered to be 30 nm chromatin fibers, and spherical protrusions of 400-600 nm, which were considered to be chromomeres and arranged on the surface of the chromosome parallel to the chromosome longitudinal axis. These observations suggested that AFM study is an excellent approach for obtaining information concerning the silkworm pachytene chromosome higher order structure.

Facial nerve paralysis after super-selective intra-arterial chemotherapy for oral cancer.

Facial nerve paralysis (FNP) after super-selective intra-arterial chemotherapy (SSIAC) is a relatively rare local side effect of SSIAC to the maxillary artery (MA) or the middle meningeal artery (MMA). The incidence and prognosis of FNP after SSIAC in 381 patients with oral cancer (133 with catheterization of the MA, 248 without) was investigated retrospectively. Only three patients (two male and one female) had FNP, for an incidence of 0.8%. All patients with FNP had undergone catheterization of the MA, and the incidence of FNP in this group was 2.3% (3/133). One of the three patients with FNP had paralysis of the third branch of the trigeminal nerve. FNP occurred a mean of 8.7 days (range 5-11 days) after initial SSIAC, and the mean total dose of cisplatin was 55.8mg (range 42.5-67.2mg) and of docetaxel was 25.4mg (range 17.0-33.6mg). FNP resolved completely a mean of 12.7 months (range 6-19 months) after onset. Because the administration of anticancer agents via the MA or MMA carries a risk of FNP, this information will be useful when obtaining informed consent from patients before treatment.

Niobate nanosheet membranes with enhanced stability for nanofiltration.

Niobate nanosheets are assembled into thin membranes by a vacuum filtration. The nanosheet membranes have a dense and stable structure in water via chemical cross-linking and show higher permeance and salt rejection compared with graphene oxide membranes. A water pathway model based on the void structure is presented to explain the membrane performances.

Development of multicellular spheroids of HeLa cells cocultured with fibroblasts and their response to X-irradiation.

HeLa cells cocultured with human diploid fibroblasts developed a more stable and tightly packed spheroid than did HeLa cells alone. Mature spheroids with central necrosis resembled the cord structure of solid tumors in histological appearance and distribution of cells labeled by [3H]thymidine. Electron microscopy showed that HeLa cells in the spheroid are in close contact with each other and have abundant intercellular junctions. The rate of cell loss from spheroid surface, expressed as cells lost per sq mm of spheroid surface per hr, was twice as high for spheroids of HeLa cells alone as for cocultured spheroids. The radiation dose-survival curve for cells in small spheroids without central necrosis was characterized by a wide shoulder than that for cells grown in monolayer or that for single-cell suspension from the same batch of the spheroids, but the terminal slope was similar for all survival curves. Development of central necrosis in larger spheroids coincided with a further increase in radioresistance, and the terminal D0 in the survival curve was 3 times that of single-cell suspension from the spheroids of the same batch. The radioresistant tail in the survival curve, however, disappeared when the spheroids were irradiated in medium containing a hypoxic cell radiosensitizer, misonidazole. These findings suggest that spheroids of HeLa cells cocultured with fibroblasts simulate the cord structure of solid tumors not only in structure but also in response to radiation.

Role of phospholipase in the genesis of doxorubicin-induced cardiomyopathy in rats.

The role of phospholipase on the mechanism of doxorubicin-induced cardiomyopathy was investigated in the heart mitochondria of Wistar rats. In the in vivo study, rats were divided into 3 groups: 1, the control group, untreated; 2, the doxorubicin 1-day group, in which doxorubicin (4 mg/kg) was injected s.c. once; and 3, the doxorubicin 4-day group, in which doxorubicin (4 mg/kg) was injected once a day for 4 consecutive days. In each group, the level of lipid peroxides and the phospholipase activity, the phospholipid content, and the enzymic activities in the respiratory chain were measured. The doxorubicin 4-day group showed significant increases of lipid peroxide level and phospholipase activity and an inhibition of mitochondrial respiratory function compared with the control group, while the doxorubicin 1-day group showed no significant difference. In the in vitro study, Experiment 1, intact rat heart mitochondria were incubated with 0.1 unit of phospholipase A2. After the incubation, the enzymic activities of the respiratory chain were disturbed in the same manner as in the in vivo experiment. In Experiment 2, rat heart mitochondria were incubated with ascorbate and ferrous sulfate. The experiment demonstrated the elevation of phospholipase activity associated with lipid peroxidation. These results suggested that the enhanced phospholipase activity caused by lipid peroxidation is responsible for the mechanism of doxorubicin-induced cardiomyopathy.

Quantitative Assessment of Circumferential Enhancement along the Wall of Cerebral Aneurysms Using MR Imaging.

BACKGROUND AND PURPOSE: The incidence of wall enhancement of cerebral aneurysms on vessel wall MR imaging has been described as higher in ruptured intracranial aneurysms than in unruptured intracranial aneurysms, but the difference in the degree of enhancement between ruptured and unruptured aneurysms is unknown. We compared the degree of enhancement between ruptured and unruptured intracranial aneurysms by using quantitative MR imaging measures. MATERIALS AND METHODS: We performed quantitative analyses of circumferential enhancement along the wall of cerebral aneurysms in 28 ruptured and 76 unruptured consecutive cases by using vessel wall MR imaging. A 3D-T1-weighted fast spin-echo sequence was obtained before and after contrast media injection, and the wall enhancement index was calculated. We then compared characteristics between ruptured and unruptured aneurysms. RESULTS: The wall enhancement index was significantly higher in ruptured than in unruptured aneurysms (1.70 ± 1.06 versus 0.89 ± 0.88, respectively; P = .0001). The receiver operating characteristic curve analysis found that the most reliable cutoff value of the wall enhancement index to differentiate ruptured from unruptured aneurysms was 0.53 (sensitivity, 0.96; specificity, 0.47). The wall enhancement index remained significant in the multivariate logistic regression analysis (P < .0001). CONCLUSIONS: Greater circumferential enhancement along the wall of cerebral aneurysms correlates with the ruptured state. A quantitative evaluation of circumferential enhancement by using vessel wall MR imaging could be useful in differentiating ruptured from unruptured intracranial aneurysms.