Molenberg R, Aalbers MW, Appelman APA, et al. - Although aneurysm wall enhancement (AWE) is positively linked to aneurysm instability, current evidence suggests that its absence can be used as a surrogate marker of aneurysm stability.

• Twelve studies with a total of 1,761 aneurysms were included.

• AWE was found to be associated with rupture and growth, as well as symptomatic presentation, in cross-sectional studies.

• Longitudinal studies have found a positive link between AWE and growth or rupture.

• AWE performance evaluation revealed high sensitivities, mixed specificities, low positive predictive values, and high negative predictive values.