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Xie H, Yu H, Wu H, Wang J, Wu S, Zhang J, Zhao H, Yuan M, Benitez Mendieta J, Anbananthan H, Winter C, Zhu C, Li Z. Quantifying irregular pulsation of intracranial aneurysms using 4D-CTA. J Biomech 2024; 174:112269. [PMID: 39128410 DOI: 10.1016/j.jbiomech.2024.112269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 07/18/2024] [Accepted: 08/06/2024] [Indexed: 08/13/2024]
Abstract
Recent studies have suggested that irregular pulsation of intracranial aneurysm during the cardiac cycle may be potentially associated with aneurysm rupture risk. However, there is a lack of quantification method for irregular pulsations. This study aims to quantify irregular pulsations by the displacement and strain distribution of the intracranial aneurysm surface during the cardiac cycle using four-dimensional CT angiographic image data. Four-dimensional CT angiography was performed in 8 patients. The image data of a cardiac cycle was divided into approximately 20 phases, and irregular pulsations were detected in four intracranial aneurysms by visual observation, and then the displacement and strain of the intracranial aneurysm was quantified using coherent point drift and finite element method. The displacement and strain were compared between aneurysms with irregular and normal pulsations in two different ways (total and stepwise). The stepwise first principal strain was significantly higher in aneurysms with irregular than normal pulsations (0.20±0.01 vs 0.16±0.02, p=0.033). It was found that the irregular pulsations in intracranial aneurysms usually occur during the consecutive ascending or descending phase of volume changes during the cardiac cycle. In addition, no statistically significant difference was found in the aneurysm volume changes over the cardiac cycle between the two groups. Our method can successfully quantify the displacement and strain changes in the intracranial aneurysm during the cardiac cycle, which may be proven to be a useful tool to quantify intracranial aneurysm deformability and aid in aneurysm rupture risk assessment.
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Affiliation(s)
- Hujin Xie
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD 4000, Australia.
| | - Han Yu
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD 4000, Australia.
| | - Hao Wu
- School of Biological Science & Medical Engineering, Southeast University, Nanjing 210096, Jiangsu, China.
| | - Jiaqiu Wang
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD 4000, Australia; School of Engineering, London South Bank University, London, United Kingdom.
| | - Shanglin Wu
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD 4000, Australia.
| | - Jianjian Zhang
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, China.
| | - Huilin Zhao
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, China.
| | - Mingyang Yuan
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD 4000, Australia.
| | - Jessica Benitez Mendieta
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD 4000, Australia.
| | - Haveena Anbananthan
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD 4000, Australia.
| | - Craig Winter
- The Kenneth G Jamieson Department of Neurosurgery, Royal Brisbane and Women's Hospital, Brisbane, QLD 4006, Australia.
| | - Chengcheng Zhu
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, United States.
| | - Zhiyong Li
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD 4000, Australia; Faculty of Sports Science, Ningbo University, Ningbo 315211, Zhejiang, China.
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Goetz A, Jeken-Rico P, Pelissier U, Chau Y, Sédat J, Hachem E. AnXplore: a comprehensive fluid-structure interaction study of 101 intracranial aneurysms. Front Bioeng Biotechnol 2024; 12:1433811. [PMID: 39007055 PMCID: PMC11243300 DOI: 10.3389/fbioe.2024.1433811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 06/03/2024] [Indexed: 07/16/2024] Open
Abstract
Advances in computational fluid dynamics continuously extend the comprehension of aneurysm growth and rupture, intending to assist physicians in devising effective treatment strategies. While most studies have first modelled intracranial aneurysm walls as fully rigid with a focus on understanding blood flow characteristics, some researchers further introduced Fluid-Structure Interaction (FSI) and reported notable haemodynamic alterations for a few aneurysm cases when considering wall compliance. In this work, we explore further this research direction by studying 101 intracranial sidewall aneurysms, emphasizing the differences between rigid and deformable-wall simulations. The proposed dataset along with simulation parameters are shared for the sake of reproducibility. A wide range of haemodynamic patterns has been statistically analyzed with a particular focus on the impact of the wall modelling choice. Notable deviations in flow characteristics and commonly employed risk indicators are reported, particularly with near-dome blood recirculations being significantly impacted by the pulsating dynamics of the walls. This leads to substantial fluctuations in the sac-averaged oscillatory shear index, ranging from -36% to +674% of the standard rigid-wall value. Going a step further, haemodynamics obtained when simulating a flow-diverter stent modelled in conjunction with FSI are showcased for the first time, revealing a 73% increase in systolic sac-average velocity for the compliant-wall setting compared to its rigid counterpart. This last finding demonstrates the decisive impact that FSI modelling can have in predicting treatment outcomes.
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Affiliation(s)
- Aurèle Goetz
- Computing and Fluids Research Group, CEMEF, Mines Paris PSL, Sophia Antipolis, France
| | - Pablo Jeken-Rico
- Computing and Fluids Research Group, CEMEF, Mines Paris PSL, Sophia Antipolis, France
| | - Ugo Pelissier
- Computing and Fluids Research Group, CEMEF, Mines Paris PSL, Sophia Antipolis, France
| | - Yves Chau
- Department of Neuro-Interventional and Vascular Interventional, University Hospital of Nice, Nice, France
| | - Jacques Sédat
- Department of Neuro-Interventional and Vascular Interventional, University Hospital of Nice, Nice, France
| | - Elie Hachem
- Computing and Fluids Research Group, CEMEF, Mines Paris PSL, Sophia Antipolis, France
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Raviol J, Plet G, Hasegawa R, Yu K, Kosukegawa H, Ohta M, Magoariec H, Pailler-Mattei C. Towards the mechanical characterisation of unruptured intracranial aneurysms: Numerical modelling of interactions between a deformation device and the aneurysm wall. J Mech Behav Biomed Mater 2024; 153:106469. [PMID: 38402693 DOI: 10.1016/j.jmbbm.2024.106469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 02/27/2024]
Abstract
Intracranial aneurysm is a critical pathology related to the arterial wall deterioration. This work is an essential aspect of a large scale project aimed at providing clinicians with a non-invasive patient-specific decision support tool regarding the rupture risk assessment. A machine learning algorithm links the aneurysm shape observed and a database of UIA clinical images associated with in vivo wall mechanical properties and rupture characterisation. The database constitution is derived from a device prototype coupled with medical imaging. It provides the mechanical characterisation of the aneurysm from the wall deformation obtained by inverse analysis based on the variation of luminal volume. Before performing in vivo tests of the device on small animals, a numerical model was built to quantify the device's impact on the aneurysm wall under natural blood flow conditions. As the clinician will never be able to precisely situate the device, several locations were considered. In preparation for the inverse analysis procedure, artery material laws of increasing complexity were studied (linear elastic, hyper elastic Fung-like). Considering all the device locations and material laws, the device induced relative displacements to the Systole peak (worst case scenario with the highest mechanical stimulus linked to the blood flow) ranging from 375 μm to 1.28 mm. The variation of luminal volume associated with the displacements was between 0.95 % and 4.3 % compared to the initial Systole volume of the aneurysm. Significant increase of the relative displacements and volume variations were found with the study of different cardiac cycle moments between the blood flow alone and the device application. For forthcoming animal model studies, Spectral Photon CT Counting, with a minimum spatial resolution of 250 μm, was selected as the clinical imaging technique. Based on this preliminary study, the displacements and associated volume variations (baseline for inverse analyse), should be observable and exploitable.
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Affiliation(s)
- J Raviol
- Laboratoire de Tribologie et Dynamique des Systèmes, CNRS UMR 5513, Université de Lyon, École Centrale de Lyon, France
| | - G Plet
- Laboratoire de Tribologie et Dynamique des Systèmes, CNRS UMR 5513, Université de Lyon, École Centrale de Lyon, France
| | - R Hasegawa
- Graduate School of Engineering, Tohuku University, 980-8579, Sendai Miyagi, Japan; Institute of Fluid Science, Tohuku University, 980-8577, Sendai Miyagi, Japan
| | - K Yu
- Institute of Fluid Science, Tohuku University, 980-8577, Sendai Miyagi, Japan
| | - H Kosukegawa
- Institute of Fluid Science, Tohuku University, 980-8577, Sendai Miyagi, Japan
| | - M Ohta
- Institute of Fluid Science, Tohuku University, 980-8577, Sendai Miyagi, Japan; ElyT MaX, CNRS UMI 3537, Université de Lyon, Tohoku University, France, Japan
| | - H Magoariec
- Laboratoire de Tribologie et Dynamique des Systèmes, CNRS UMR 5513, Université de Lyon, École Centrale de Lyon, France
| | - C Pailler-Mattei
- Laboratoire de Tribologie et Dynamique des Systèmes, CNRS UMR 5513, Université de Lyon, École Centrale de Lyon, France; ISPB-Faculté de Pharmacie, Université Claude Bernard Lyon 1, Université de Lyon, France.
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Raviol J, Plet G, Langlois JB, Si-Mohamed S, Magoariec H, Pailler-Mattei C. In vivo mechanical characterization of arterial wall using an inverse analysis procedure: application on an animal model of intracranial aneurysm. ROYAL SOCIETY OPEN SCIENCE 2024; 11:231936. [PMID: 38633347 PMCID: PMC11022001 DOI: 10.1098/rsos.231936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/19/2024] [Accepted: 02/24/2024] [Indexed: 04/19/2024]
Abstract
Intracranial aneurysm is a pathology related to the deterioration of the arterial wall. This work is an essential part of a large-scale project aimed at providing clinicians with a non-invasive patient-specific decision support tool to facilitate the rupture risk assessment. It will lean on the link between the aneurysm shape clinically observed and a database derived from the in vivo mechanical characterization of aneurysms. To supply this database, a deformation device prototype of the arterial wall was developed. Its use coupled with medical imaging (spectral photon-counting computed tomography providing a spatial resolution down to 250 μm) is used to determine the in vivo mechanical properties of the wall based on the inverse analysis of the quantification of the wall deformation observed experimentally. This study presents the in vivo application of this original procedure to an animal model of aneurysm. The mechanical properties of the aneurysm wall identified were consistent with the literature, and the errors between the numerical and experimental results were less than 10%. Based on these parameters, this study allows the assessment of the aneurysm stress state for a known solicitation and points towards the definition of a rupture criterion.
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Affiliation(s)
- J. Raviol
- Ecole Centrale de Lyon, CNRS, ENTPE, LTDS, UMR 5513, Écully69130, France
| | - G. Plet
- Ecole Centrale de Lyon, CNRS, ENTPE, LTDS, UMR 5513, Écully69130, France
| | | | - S. Si-Mohamed
- Université de Lyon, INSA Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F69621, Villeurbanne69100, France
- Département de Radiologie, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron69677, France
| | - H. Magoariec
- Ecole Centrale de Lyon, CNRS, ENTPE, LTDS, UMR 5513, Écully69130, France
| | - C. Pailler-Mattei
- Ecole Centrale de Lyon, CNRS, ENTPE, LTDS, UMR 5513, Écully69130, France
- Université de Lyon, Université Claude Bernard Lyon 1, ISPB-Faculté de Pharmacie, Lyon69008, France
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5
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Chen S, Lv N, Qian Y, Zhang M, Zhang T, Cheng Y. Relationships between irregular pulsation and variations in morphological characteristics during the cardiac cycle in unruptured intracranial aneurysms by 4D-CTA. Front Neurol 2024; 15:1302874. [PMID: 38601339 PMCID: PMC11005792 DOI: 10.3389/fneur.2024.1302874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/13/2024] [Indexed: 04/12/2024] Open
Abstract
Background and purpose Irregular pulsation of the aneurysmal wall has been suggested as a novel predictor for aneurysm rupture. Aneurysm volume variations during the cardiac cycle and the association between irregular pulsation and morphological features have been discussed, but the clinical significance remains unclear. The purpose of this study was to quantify changes in morphological characteristics over the cardiac cycle and examine their correlation with irregular pulsation to facilitate comprehension of aneurysm dynamics. Materials and methods Fourteen unruptured intracranial aneurysms (UIAs) from 11 patients were included in this study, and each of them underwent 4D-CTA after diagnosis by DSA. The R-R intervals were divided into 20-time phases at 5% intervals to determine whether an aneurysm had irregular pulsation throughout the cardiac cycle. CT images from the 20-time phases were used to reconstruct 3D aneurysm models, measure 14 morphological parameters, and quantify each parameter's absolute change and relative rates of change during the cardiac cycle. Results Seven of 14 UIAs exhibited irregular pulsation over the cardiac cycle by 4D-CTA, 5 of which were small aneurysms (< 7 mm). The UIAs with irregular pulsation exhibited greater changes in morphological characteristics. As aneurysm size increased, the absolute change in aneurysm volume increased (p = 0.035), but the relative rates of change in aneurysm size (p = 0.013), height (p = 0.014), width (p = 0.008), height-to-width ratio (p = 0.009), dome-to-neck ratio (p = 0.019) and bottleneck factor (p = 0.012) decreased. Conclusion Although the larger the aneurysm, the greater the amplitude of its volumetric variation, small aneurysms are prone to irregular pulsation during the cardiac cycle and have more pronounced and dramatic morphological changes during the cardiac cycle that may increase the risk of rupture. This proof-of-concept study could help to explain the importance of dynamic changes using 4D-CTA in assessing the rupture risk of UIAs.
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Affiliation(s)
- Shiyao Chen
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Nan Lv
- Cerebrovascular Disease Center, First Affiliated Hospital of Naval Military Medical University, Changhai Hospital of Shanghai, Shanghai, China
| | - Yu Qian
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Mingwei Zhang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Tianyi Zhang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Yunzhang Cheng
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
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6
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Goetz A, Jeken-Rico P, Chau Y, Sédat J, Larcher A, Hachem E. Analysis of Intracranial Aneurysm Haemodynamics Altered by Wall Movement. Bioengineering (Basel) 2024; 11:269. [PMID: 38534544 DOI: 10.3390/bioengineering11030269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 02/27/2024] [Accepted: 03/06/2024] [Indexed: 03/28/2024] Open
Abstract
Computational fluid dynamics is intensively used to deepen our understanding of aneurysm growth and rupture in an attempt to support physicians during therapy planning. Numerous studies assumed fully rigid vessel walls in their simulations, whose sole haemodynamics may fail to provide a satisfactory criterion for rupture risk assessment. Moreover, direct in vivo observations of intracranial aneurysm pulsation were recently reported, encouraging the development of fluid-structure interaction for their modelling and for new assessments. In this work, we describe a new fluid-structure interaction functional setting for the careful evaluation of different aneurysm shapes. The configurations consist of three real aneurysm domes positioned on a toroidal channel. All geometric features, employed meshes, flow quantities, comparisons with the rigid wall model and corresponding plots are provided for the sake of reproducibility. The results emphasise the alteration of flow patterns and haemodynamic descriptors when wall deformations were taken into account compared with a standard rigid wall approach, thereby underlining the impact of fluid-structure interaction modelling.
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Affiliation(s)
- Aurèle Goetz
- Computing and Fluids Research Group, CEMEF, Mines Paris PSL, 06904 Sophia Antipolis, France
| | - Pablo Jeken-Rico
- Computing and Fluids Research Group, CEMEF, Mines Paris PSL, 06904 Sophia Antipolis, France
| | - Yves Chau
- Department of Neuro-Interventional and Vascular Interventional, University Hospital of Nice, 06000 Nice, France
| | - Jacques Sédat
- Department of Neuro-Interventional and Vascular Interventional, University Hospital of Nice, 06000 Nice, France
| | - Aurélien Larcher
- Computing and Fluids Research Group, CEMEF, Mines Paris PSL, 06904 Sophia Antipolis, France
| | - Elie Hachem
- Computing and Fluids Research Group, CEMEF, Mines Paris PSL, 06904 Sophia Antipolis, France
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7
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Pionteck A, Abderezaei J, Fillingham P, Chuang YC, Sakai Y, Belani P, Rigney B, De Leacy R, Fifi JT, Chien A, Colby GP, Jahan R, Duckwiler G, Sayre J, Holdsworth SJ, Mossa-Basha M, Levitt MR, Mocco J, Kurt M, Nael K. Intracranial aneurysm wall displacement depicted by amplified Flow predicts growth. J Neurointerv Surg 2024:jnis-2023-021227. [PMID: 38320850 PMCID: PMC11300705 DOI: 10.1136/jnis-2023-021227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/21/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND Abnormal intracranial aneurysm (IA) wall motion has been associated with IA growth and rupture. Recently, a new image processing algorithm called amplified Flow (aFlow) has been used to successfully track IA wall motion by combining the amplification of cine and four-dimensional (4D) Flow MRI. We sought to apply aFlow to assess wall motion as a potential marker of IA growth in a paired-wise analysis of patients with growing versus stable aneurysms. METHODS In this retrospective case-control study, 10 patients with growing IAs and a matched cohort of 10 patients with stable IAs who had baseline 4D Flow MRI were included. The aFlow was used to amplify and extract IA wall displacements from 4D Flow MRI. The associations of aFlow parameters with commonly used risk factors and morphometric features were assessed using paired-wise univariate and multivariate analyses. RESULTS aFlow quantitative results showed significantly (P=0.035) higher wall motion displacement depicted by mean±SD 90th% values of 2.34±0.72 in growing IAs versus 1.39±0.58 in stable IAs with an area under the curve of 0.85. There was also significantly (P<0.05) higher variability of wall deformation across IA geometry in growing versus stable IAs depicted by the dispersion variables including 121-150% larger standard deviation ([Formula: see text]) and 128-161% wider interquartile range [Formula: see text]. CONCLUSIONS aFlow-derived quantitative assessment of IA wall motion showed greater wall motion and higher variability of wall deformation in growing versus stable IAs.
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Affiliation(s)
- Aymeric Pionteck
- Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Javid Abderezaei
- Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Patrick Fillingham
- Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Ya-Chen Chuang
- Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Yu Sakai
- Diagnostic, Molecular and Interventional Radiology, Mount Sinai Health System, New York, New York, USA
| | - Puneet Belani
- Diagnostic, Molecular and Interventional Radiology, Mount Sinai Health System, New York, New York, USA
| | - Brian Rigney
- Diagnostic, Molecular and Interventional Radiology, Mount Sinai Health System, New York, New York, USA
| | - Reade De Leacy
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Johanna T Fifi
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Aichi Chien
- Radiological Sciences, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Geoffrey P Colby
- Neurosurgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Reza Jahan
- Radiological Sciences, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Gary Duckwiler
- Radiological Sciences, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - James Sayre
- Radiological Sciences, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | | | - Mahmud Mossa-Basha
- Radiology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Michael R Levitt
- Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - J Mocco
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mehmet Kurt
- Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Kambiz Nael
- Diagnostic, Molecular and Interventional Radiology, Mount Sinai Health System, New York, New York, USA
- Radiological Sciences, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
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8
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Xie H, Wu H, Wang J, Mendieta JB, Yu H, Xiang Y, Anbananthan H, Zhang J, Zhao H, Zhu Z, Huang Q, Fang R, Zhu C, Li Z. Constrained estimation of intracranial aneurysm surface deformation using 4D-CTA. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 244:107975. [PMID: 38128464 DOI: 10.1016/j.cmpb.2023.107975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/08/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND AND OBJECTIVE Intracranial aneurysms are relatively common life-threatening diseases, and assessing aneurysm rupture risk and identifying the associated risk factors is essential. Parameters such as the Oscillatory Shear Index, Pressure Loss Coefficient, and Wall Shear Stress are reliable indicators of intracranial aneurysm development and rupture risk, but aneurysm surface irregular pulsation has also received attention in aneurysm rupture risk assessment. METHODS The present paper proposed a new approach to estimate aneurysm surface deformation. This method transforms the estimation of aneurysm surface deformation into a constrained optimization problem, which minimizes the error between the displacement estimated by the model and the sparse data point displacements from the four-dimensional CT angiography (4D-CTA) imaging data. RESULTS The effect of the number of sparse data points on the results has been discussed in both simulation and experimental results, and it shows that the proposed method can accurately estimate the surface deformation of intracranial aneurysms when using sufficient sparse data points. CONCLUSIONS Due to a potential association between aneurysm rupture and surface irregular pulsation, the estimation of aneurysm surface deformation is needed. This paper proposed a method based on 4D-CTA imaging data, offering a novel solution for the estimation of intracranial aneurysm surface deformation.
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Affiliation(s)
- Hujin Xie
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD 4000, Australia.
| | - Hao Wu
- School of Biological Science & Medical Engineering, Southeast University, Nanjing, Jiangsu 210096, China
| | - Jiaqiu Wang
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD 4000, Australia; School of Engineering, London South Bank University, London, UK
| | - Jessica Benitez Mendieta
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Han Yu
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Yuqiao Xiang
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Haveena Anbananthan
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Jianjian Zhang
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, China
| | - Huilin Zhao
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, China
| | - Zhengduo Zhu
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Qiuxiang Huang
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Runxing Fang
- School of Biological Science & Medical Engineering, Southeast University, Nanjing, Jiangsu 210096, China
| | - Chengcheng Zhu
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, United States
| | - Zhiyong Li
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD 4000, Australia; Faculty of Sports Science, Ningbo University, Ningbo, Zhejiang 315211, China.
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9
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Wang B, Shen C, Su Z, Nie X, Zhao J, Qiu S, Li Y. Correlation between the rate of morphological changes and rupture of intracranial aneurysms during one cardiac cycle analyzed by 4D-CTA. Front Neurol 2023; 14:1235312. [PMID: 37849835 PMCID: PMC10577209 DOI: 10.3389/fneur.2023.1235312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/11/2023] [Indexed: 10/19/2023] Open
Abstract
Objective This study aimed to analyze the relationship between the rate of morphological changes and intracranial aneurysm rupture during the cardiac cycle. Methods Eighty-four patients with intracranial aneurysms were retrospectively analyzed and divided into the rupture (42 cases) and unruptured (42 cases) groups. Four-dimensional computed tomography angiography (4D-CTA) was performed to collect quantitative parameters of aneurysm morphology and calculate the morphological change rate. The potential factors associated with aneurysm rupture were determined by comparing the general clinical data and rate of change in the location and morphology of the aneurysm between the two groups. Results Each morphological change rate in the rupture group was generally higher than that of the unruptured group. The rate of dome height change and aneurysm volume change were independent factors associated with aneurysm rupture. ROC curve analysis revealed that the diagnostic accuracy of the aneurysm volume change rate was higher. When the volume change rate was 12.33%, the sensitivity and specificity of rupture were 90.5 and 55.8%, respectively. Conclusion The rate of change in dome height and volume of intracranial aneurysms during one cardiac cycle were independent factors associated with aneurysm rupture.
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Affiliation(s)
- Binghao Wang
- Department of Neurosurgery, Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation, Huzhou, China
- Department of Neurosurgery, Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Chengen Shen
- Department of Neurosurgery, Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation, Huzhou, China
| | - Zhongzhou Su
- Department of Neurosurgery, Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation, Huzhou, China
| | - Xiaohu Nie
- Department of Neurosurgery, Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation, Huzhou, China
| | - Jingjing Zhao
- Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation, Huzhou, China
- Department of Hospital Infection Control, Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
| | - Sheng Qiu
- Department of Neurosurgery, Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation, Huzhou, China
| | - Yuntao Li
- Department of Neurosurgery, Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation, Huzhou, China
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10
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Diab R, Chang D, Zhu C, Levitt MR, Aksakal M, Zhao HL, Huynh TJ, Romero-Sanchez G, Mossa-Basha M. Advanced cross-sectional imaging of cerebral aneurysms. Br J Radiol 2023; 96:20220686. [PMID: 36400095 PMCID: PMC10997029 DOI: 10.1259/bjr.20220686] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/05/2022] [Accepted: 11/07/2022] [Indexed: 11/21/2022] Open
Abstract
While the rupture rate of cerebral aneurysms is only 1% per year, ruptured aneurysms are associated with significant morbidity and mortality, while aneurysm treatments have their own associated risk of morbidity and mortality. Conventional markers for aneurysm rupture include patient-specific and aneurysm-specific characteristics, with the development of scoring systems to better assess rupture risk. These scores, however, rely heavily on aneurysm size, and their accuracy in assessing risk in smaller aneurysms is limited. While the individual risk of rupture of small aneurysms is low, due to their sheer number, the largest proportion of ruptured aneurysms are small aneurysms. Conventional imaging techniques are valuable in characterizing aneurysm morphology; however, advanced imaging techniques assessing the presence of inflammatory changes within the aneurysm wall, hemodynamic characteristics of blood flow within aneurysm sacs, and imaging visualization of irregular aneurysm wall motion have been used to further determine aneurysm instability that otherwise cannot be characterized by conventional imaging techniques. The current manuscript reviews conventional imaging techniques and their value and limitations in cerebral aneurysm characterization, and evaluates the applications, value and limitations of advanced aneurysm imaging and post-processing techniques including intracranial vessel wall MRA, 4D-flow, 4D-CTA, and computational fluid dynamic simulations.
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Affiliation(s)
- Rawan Diab
- American University of Beirut School of
Medicine, Beirut, Lebanon
| | - Dandan Chang
- Department of Radiology, University of
Washington, Seattle, United States
| | - Chengcheng Zhu
- Department of Radiology, University of
Washington, Seattle, United States
| | | | - Mehmet Aksakal
- Department of Radiology, University of
Washington, Seattle, United States
| | - Hui-Lin Zhao
- Deparment of Radiology, Renji Hospital,
Shanghai, China
| | - Thien J. Huynh
- Department of Radiology, Mayo
Clinic-Jacksonville, Jacksonville, United States
| | - Griselda Romero-Sanchez
- Department of Radiology, Instituto Nacional de Ciencias
Medicas y Nutricion Salvador Zubiran, Mexico City,
Mexico
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11
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Zhang J, Li X, Zhao B, Zhang J, Sun B, Wang L, Tian J, Mossa-Basha M, Kim LJ, Yan J, Wan J, Xu J, Zhou Y, Zhao H, Zhu C. Irregular pulsation of aneurysmal wall is associated with symptomatic and ruptured intracranial aneurysms. J Neurointerv Surg 2023; 15:91-96. [PMID: 35169029 DOI: 10.1136/neurintsurg-2021-018381] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/23/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Irregular pulsation of aneurysmal wall detected by four-dimensional CT angiography (4D-CTA) has been described as a novel imaging feature of aneurysm vulnerability. Our study aimed to investigate whether irregular pulsation is associated with symptomatic and ruptured intracranial aneurysms (IAs). METHODS This retrospective study included consecutive patients with IAs who underwent 4D-CTA from January 2018 to July 2021. IAs were categorized as asymptomatic, symptomatic or ruptured. The presence of irregular pulsation (defined as a temporary focal protuberance ≥1 mm on more than three successive frames) was identified on 4D-CTA movies. Univariate and multivariate analyses were used to identify the parameters associated with aneurysm symptomatic or ruptured status. RESULTS Overall, 305 patients with 328 aneurysms (37 ruptured, 60 symptomatic, 231 asymptomatic) were included. Ruptured and symptomatic IAs were significantly larger in size compared with asymptomatic IAs (median (IQR) 6.5 (5.1-8.3) mm, 7.0 (5.5-9.7) mm vs 4.7 (3.8-6.3) mm, p=0.001 and p<0.001, respectively) and had more irregular pulsations (70.3%, 78.3% vs 28.1%, p<0.05). Irregular pulsation (OR 5.03, 95% CI 2.83 to 8.92; p<0.001) was independently associated with aneurysm symptomatic/ruptured status in the whole population. With unruptured IAs, both irregular pulsation (OR 6.31, 95% CI 3.02 to 13.20; p<0.001) and size (OR 1.17, 95% CI 1.03 to 1.32; p=0.015) were independently associated with the symptoms. The combination of irregular pulsation and size increased the accuracy over size alone in identifying symptomatic aneurysms (AUC 0.81 vs 0.77, p=0.007) in unruptured IAs. CONCLUSION In a large cohort of patients with IAs detected by 4D-CTA, the presence of irregular pulsation was independently associated with aneurysm symptomatic and ruptured status.
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Affiliation(s)
- Jianjian Zhang
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao Li
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bing Zhao
- Department of Neurosurgery, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jin Zhang
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Beibei Sun
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lingling Wang
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiaqi Tian
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Louis J Kim
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Jing Yan
- Research Collaboration, Canon Medical Systems (China) Co., LTD, Shanghai, China
| | - Jieqing Wan
- Department of Neurosurgery, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianrong Xu
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Zhou
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huilin Zhao
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, Washington, USA
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12
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Zhou J, Guo Q, Chen Y, Lin B, Ding S, Zhao H, Pan Y, Wan J, Zhao B. Irregular Pulsation of Intracranial Aneurysm Detected by Four-Dimensional CT Angiography and Associated With Small Aneurysm Rupture: A Single-Center Prospective Analysis. Front Neurol 2022; 13:809286. [PMID: 35280280 PMCID: PMC8907400 DOI: 10.3389/fneur.2022.809286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Predicting the risk of rupture of small intracranial aneurysms remains challenging. The irregular pulsation of aneurysms detected by four-dimensional CT angiography (4D-CTA) could be an imaging marker of aneurysm vulnerability. We aimed to investigate the association of irregular pulsation with small aneurysm rupture. Materials and Methods This was a prospective study on intracranial aneurysms detected by 4D-CTA from October 2017 to January 2020. A total of 242 consecutive patients with 316 aneurysms were enrolled. Irregular pulsation was defined as a temporary focal protuberance on more than 3 consecutive frames of the 20 phases in the RR interval. Small aneurysms were defined as those <7 mm. Univariate and multivariate analyses were performed to determine the independent predictors of small aneurysm rupture. Results A total of 169 patients with 217 small intracranial aneurysms were included. Fourteen (6.5%) of the aneurysms had ruptured, and 77 (35.5%) had irregular pulsation. There were no significant differences in age, sex, hypertension, smoking, diabetes, drinking, or hyperlipidemia between the ruptured and unruptured aneurysm groups. The univariate analysis showed that smaller vessel size (p = 0.008), larger size ratio (p = 0.003), larger aspect ratio (p = 0.006), larger flow angle (p = 0.001), large vessel angle (p = 0.004), middle cerebral artery aneurysms (p = 0.046), anterior cerebral artery/posterior communicating artery/posterior circulation aneurysm (p = 0.006), irregular aneurysm (p = 0.001), and t presence of irregular pulsation (p = 0.001) were associated with small aneurysm rupture. The multivariate analysis showed that the presence of irregular pulsation (p = 0.003), anterior cerebral artery/posterior communicating artery/posterior circulation aneurysms (p = 0.014), and larger flow angle (p = 0.006) was independently associated with aneurysm rupture. Multivariate analysis of predictors of the irregular pulsation of small aneurysms showed that the aneurysm rupture (p = 0.022), irregular aneurysm (p < 0.001), and large size ratio (p = 0.005) were independently associated with the presence of irregular pulsation. Conclusions The ruptured small aneurysms more often had irregular pulsation. The irregular pulsation was independently associated with aneurysm rupture and may help evaluate the risk of rupture of small intracranial aneurysms.
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Affiliation(s)
- Jiafeng Zhou
- Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qinhua Guo
- Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yongchun Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Boli Lin
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shenghao Ding
- Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Huilin Zhao
- Department of Radiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yaohua Pan
- Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jieqing Wan
- Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- *Correspondence: Jieqing Wan
| | - Bing Zhao
- Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Bing Zhao
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13
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Vanrossomme AE, Chodzyński KJ, Eker OF, Boudjeltia KZ. Development of experimental ground truth and quantification of intracranial aneurysm pulsation in a patient. Sci Rep 2021; 11:9441. [PMID: 33941796 PMCID: PMC8093229 DOI: 10.1038/s41598-021-88420-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/12/2021] [Indexed: 11/16/2022] Open
Abstract
Aneurysm wall motion has been reported to be associated with rupture. However, its quantification with medical imaging is challenging and should be based on experimental ground-truth to avoid misinterpretation of results. In this work a time-resolved CT angiography (4D-CTA) acquisition protocol is proposed to detect the pulsation of intracranial aneurysms with a low radiation dose. To acquire ground-truth data, the accuracy of volume pulsation detection and quantification in a silicone phantom was assessed by applying pressure sinusoidal waves of increasing amplitudes. These experiments were carried out using a test bench that could reproduce pulsatile waveforms similar to those inside the internal carotid arteries of human subjects. 4D-CTA acquisition parameters (mAs, kVp) were then selected to achieve reliable pulsation detection and quantification with the lowest radiation dose achievable. The resulting acquisition protocol was then used to image an anterior communicating artery aneurysm in a human subject. Data reveals that in a simplified in vitro setting 4D-CTA allows for an effective and reproducible method to detect and quantify aneurysm volume pulsation with an inferior limit as low as 3 mm3 and a background noise of 0.5–1 mm3. Aneurysm pulsation can be detected in vivo with a radiation dose approximating 1 mSv.
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Affiliation(s)
- Axel E Vanrossomme
- Laboratory of Experimental Medecine (ULB 222 Unit), Medicine Faculty, Université Libre de Bruxelles, CHU de Charleroi, 6110, Montigny-le-Tilleul, Belgium. .,Medical Imaging Unit, Centre Hospitalier Universitaire de Charleroi, 6042, Charleroi, Belgium.
| | - Kamil J Chodzyński
- Laboratory of Experimental Medecine (ULB 222 Unit), Medicine Faculty, Université Libre de Bruxelles, CHU de Charleroi, 6110, Montigny-le-Tilleul, Belgium
| | - Omer F Eker
- Hospices Civils de Lyon, Neurointerventional Radiology, 69003, Lyon, France
| | - Karim Zouaoui Boudjeltia
- Laboratory of Experimental Medecine (ULB 222 Unit), Medicine Faculty, Université Libre de Bruxelles, CHU de Charleroi, 6110, Montigny-le-Tilleul, Belgium
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14
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Stam LB, Aquarius R, de Jong GA, Slump CH, Meijer FJA, Boogaarts HD. A review on imaging techniques and quantitative measurements for dynamic imaging of cerebral aneurysm pulsations. Sci Rep 2021; 11:2175. [PMID: 33500470 PMCID: PMC7838168 DOI: 10.1038/s41598-021-81753-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/07/2021] [Indexed: 11/09/2022] Open
Abstract
Measurement of intracranial aneurysm wall motion may refine the current rupture risk estimation. A golden standard for measuring aneurysm pulsation is lacking. The aim is to evaluate magnitudes of aneurysm pulsation as published in current literature. Embase and PubMed were searched for publications containing quantitative measures of cardiac-cycle related cerebral aneurysm pulsation (no date or language restrictions). Eleven studies were included, covering 197 unruptured and untreated cerebral aneurysms. Quantitative pulsation measurements were extracted from the studies. Characteristics of the study population and aneurysms were taken into account, as well as the imaging modality, scanning technique and data processing methods used. A meta-analysis was performed of studies with similar methodologies and individual IA measures and locations. The magnitude of the absolute volume pulsations varied between 14 ± 9 mm3 and 106 ± 123 mm3 and the mean relative volume change varied between 5 and 36%. The meta-analysis revealed a positive correlation between size and absolute volume change. The relative volume change in Basilar artery aneurysms seems smaller. No authors were contacted for original study data and articles only describing visual pulsations were excluded. The variation in methodologies impedes an accurate estimation of the magnitude of IA pulsations. Validation of aneurysm pulsation measurement is crucial prior to clinical studies evaluating IA pulsatility in relation to IA rupture risk. Prerequisite is a reliable and robust imaging method with high spatial and temporal resolution and standardization of the image analysis methods.
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Affiliation(s)
- L B Stam
- Technical Medicine, University of Twente, Enschede, The Netherlands. .,Department of Neurosurgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein-zuid 30, Internal Post Number 633, Nijmegen, The Netherlands.
| | - R Aquarius
- Department of Neurosurgery, Radboud UMC, Nijmegen, The Netherlands
| | - G A de Jong
- Department of Neurosurgery, Radboud UMC, Nijmegen, The Netherlands
| | - C H Slump
- Technical Medical Center, University of Twente, Enschede, The Netherlands
| | - F J A Meijer
- Department of Radiology and Nuclear Medicine, Radboud UMC, Nijmegen, The Netherlands
| | - H D Boogaarts
- Department of Neurosurgery, Radboud UMC, Nijmegen, The Netherlands
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15
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Zhang J, Li X, Zhao B, Zhang J, Sun B, Wang L, Ding S, Liu X, Yan J, Mossa-Basha M, Liu X, Wan J, Zhao H, Xu J, Zhu C. Irregular pulsation of intracranial unruptured aneurysm detected by four-dimensional CT angiography is associated with increased estimated rupture risk and conventional risk factors. J Neurointerv Surg 2021; 13:854-859. [PMID: 33472873 DOI: 10.1136/neurintsurg-2020-016811] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Intracranial aneurysms (IAs) are common in the population and current imaging-based rupture risk assessment needs to be refined. We aimed to use four-dimensional CT angiography (4D-CTA) to investigate the associations of irregular pulsation of IAs with conventional risk factors and the estimated rupture risk. METHODS One hundred and five patients with 117 asymptomatic IAs underwent 4D-CTA. Geometric and morphologic parameters were measured and the presence of irregular pulsation (defined as a temporary focal protuberance ≥1 mm on more than three successive frames) was identified on 4D-CTA movies. One- and 5 year aneurysm rupture risk were estimated using UCAS and PHASES calculators. Univariate and multivariate analyses were performed to investigate the conventional risk factors associated with irregular pulsation. RESULTS Irregular pulsation was observed in 41.0% (48/117) of IAs. Aneurysm size (OR=1.380, 95% CI 1.165 to 1.634), irregular shape (OR=3.737, 95% CI 1.108 to 12.608), and internal carotid artery location (OR=0.151, 95% CI 0.056 to 0.403) were independently associated with irregular pulsation (P<0.05). Aneurysms with irregular pulsation had more than a 6-fold higher estimated rupture risk (1- and 5-year risk [95% CI], 1.56% [0.42%-3.91%], and 2.40% [1.30%-4.30%], respectively) than aneurysms without irregular pulsation (0.23% [0.14%-0.78%] and 0.40% [0.40%-1.30%], respectively) (P<0.001). CONCLUSIONS IAs with irregular pulsation are associated with larger size, irregular-shape, and non-ICA origin, and have more than a 6-fold higher estimated 1- and 5-year rupture risk than aneurysms without irregular pulsation. Irregular pulsation should be validated in future longitudinal studies to determine its predictive value for aneurysm growth and rupture.
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Affiliation(s)
- Jianjian Zhang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xiao Li
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Bing Zhao
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jin Zhang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Beibei Sun
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Lingling Wang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Shenghao Ding
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xiangyu Liu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jing Yan
- Research Collaboration, Canon Medical Systems (China) Co., LTD, Shanghai, China
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Xiaosheng Liu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jieqing Wan
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Huilin Zhao
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jianrong Xu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, Washington, USA
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16
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Gu Y, Zhang Y, Luo M, Zhang H, Liu X, Miao C. Risk Factors for Asymptomatic Intracranial Small Aneurysm Rupture Determined by Electrocardiographic-Gated 4D Computed Tomographic (CT) Angiography. Med Sci Monit 2020; 26:e921835. [PMID: 31942867 PMCID: PMC6984014 DOI: 10.12659/msm.921835] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background To study the risk predictors of intracranial asymptomatic small aneurysm rupture by electrocardiographic (ECG)-gated 4D-CT angiography (4D-CTA). Material/Methods A total of 168 patients with intracranial aneurysms <7 mm who underwent 4D-CTA examinations were retrospectively analyzed and divided into a ruptured group and an unruptured group. The original scanning data of all cases were reconstructed to obtain 20 groups of data in 5% time intervals in the cardiac cycle. After processing with 3D workstation software, 20 sets of images and dynamic images were achieved. The morphological characteristics and clinical features of the 2 groups of aneurysms were analyzed through univariate analysis, then logistic regression analysis was performed for the meaningful indicators. Finally, the optimum diagnostic cut-off point was calculated by ROC curve analysis. Results Univariate analysis showed that sex, smoking history, vascular bifurcation point, pulsation point appearance, aneurysm height, aspect ratio (AR), and size ratio (SR) were significantly different (P<0.05) between the ruptured group and unruptured group. Multivariate regression analysis indicated that the pulsation points (OR=8.188, 95% CI: 3.984–17.198) and high SR values (OR=5.325, 95% CI: 1.503–18.867) were independent predictors of asymptomatic small aneurysm rupture. When the SR value was higher than 1.65, the area below the ROC curve was 0.723, the diagnostic sensitivity was 75%, and the specificity was 80%. Conclusions The occurrence of pulsation points and SR values >1.65 were independent predictors for the rupture of asymptomatic small intracranial aneurysms <7 mm in diameter.
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Affiliation(s)
- Yan Gu
- Department of Radiology, The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, China (mainland)
| | - Yonggang Zhang
- Department of Radiology, The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, China (mainland)
| | - Meng Luo
- Department of Radiology, The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, China (mainland)
| | - Hongwei Zhang
- Department of Neurosurgery, The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, China (mainland)
| | - Xiguang Liu
- Department of Neurosurgery, The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, China (mainland)
| | - Chongchang Miao
- Department of Radiology, The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, China (mainland)
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17
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Kobayashi Y, Kanamori D, Fujii N, Kataoka Y, Hirai E, Yoshioka S, Satoh K, Toyama H, Naito K, Matsuo K. Velopharyngeal closure analysis using four-dimensional computed tomography: a pilot study of healthy volunteers and adult patients with cleft palate. BMC Med Imaging 2019; 19:54. [PMID: 31286915 PMCID: PMC6613253 DOI: 10.1186/s12880-019-0350-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 06/12/2019] [Indexed: 01/12/2023] Open
Abstract
Background Nasopharyngoscopy is a common method to evaluate velopharyngeal closure in patients with cleft palate. However, insertion of a fiberoptic nasopharyngoscope causes discomfort in patients. The aim of this study was to estimate the reliability of short-time exposure images obtained using 320-row area detector computed tomography (320-ADCT) as a novel evaluation method for the assessment of velopharyngeal function. Methods We evaluated five healthy adult volunteers and five postoperative adult patients with cleft palate. During a 3.3-s imaging exposure, the participants were asked to perform two tasks: nasal inspiration and subsequent oral expiration through a catheter into a water-filled cup. The movement of the velopharyngeal structures was recorded during each examination, and the presence of velopharyngeal insufficiency (VPI) and velopharyngeal closure (VPC) patterns were estimated. If VPI was detected, the cross-sectional area was also calculated. Cohen’s kappa and weighted kappa coefficients were used to evaluate the concordance of nasopharyngoscopy and 320-ADCT evaluation. Results Speech pathology evaluation did not reveal hypernasality in any study participant. Micro-VPI was detected by nasopharyngoscopy in one healthy volunteer and two patients. 320-ADCT detected micro-VPI in two more patients. The cross-sectional area of the VPI in these subjects ranged from 2.53 to 16.28 mm2. Nasopharyngoscopy and 320-ADCT were concordant in detecting VPI in eight participants (κ = 0.6) and in assessing VPC patterns in nine (κ = 0.82). Moreover, images obtained using 320-ADCT allowed for reduced dead angle and, thus, easy detection of micro-VPI and Passavant’s ridges. Conclusion Although the radiation exposure cannot be ignored, our novel evaluation method using 320-ADCT enables more detailed evaluation of VPC than nasopharyngoscopy. Future studies should investigate the relationship between 320-ADCT findings and speech pathology evaluations. Electronic supplementary material The online version of this article (10.1186/s12880-019-0350-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yoshikazu Kobayashi
- Department of Dentistry and Oral-Maxillofacial Surgery, Fujita Health University, School of Medicine, 1-98, Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
| | - Daisuke Kanamori
- Department of Dentistry, Nanakuri Memorial Hospital, Fujita Health University, 424-1, Oodoricho, Tsu, Mie, 514-1295, Japan
| | - Naoko Fujii
- Department of Radiology, Bantane Hospital, Fujita Health University, 3-6-10, Otobashi, Nakagawa-ku, Nagoya, Aichi, 454-8509, Japan
| | - Yumi Kataoka
- Department of Radiology, Fujita Health University Hospital, 1-98, Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Emiko Hirai
- Department of Otolaryngology, Fujita Health University, School of Medicine, 1-98, Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Satoshi Yoshioka
- Department of Otolaryngology, Fujita Health University, School of Medicine, 1-98, Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Koji Satoh
- Department of Dentistry and Oral-Maxillofacial Surgery, Fujita Health University, School of Medicine, 1-98, Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Hiroshi Toyama
- Department of Radiology, Fujita Health University, School of Medicine, 1-98, Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Kensei Naito
- Department of Otolaryngology, Fujita Health University, School of Medicine, 1-98, Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Koichiro Matsuo
- Department of Dentistry and Oral-Maxillofacial Surgery, Fujita Health University, School of Medicine, 1-98, Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
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18
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Dynamic Volume Change Rate and Aspect Ratio Are Correlated to the Formation of an Irregular Morphology of Unruptured Intracranial Aneurysm. J Comput Assist Tomogr 2019; 43:294-299. [PMID: 30422836 DOI: 10.1097/rct.0000000000000813] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this research was to study the factors influencing the formation of intracranial aneurysms with irregular morphology by observing the dynamic volume change rate of intracranial unruptured aneurysms and other aneurysm characteristics. METHOD Sixty-five unruptured intracranial aneurysms of 51 consecutive patients from 1 center were included in this study. All patients underwent a dual-source computed tomography electrocardiogram-gated 4-dimensional computed tomography angiography examination. The original data at the end of the scan were reconstructed, and 20 sets of data packages through a cardiac cycle with 5% interval were obtained. Data packages were processed by a 3-dimensional software workstation to obtain 20 sets of images and dynamic diagrams. The volume of each aneurysm in the 20 sets of images was measured, and the volume change was calculated by a specific formula. The other data features of the aneurysm such as aneurysm neck, aneurysm height, aspect ratio (AR), location at bifurcation, and clinical features such as age, sex, hypertension history, type 2 diabetes history, smoking history, family history, multiple aneurysm history, and subarachnoid hemorrhage history, were documented in detail. After single factor analysis data, logistic regression analysis of the meaningful indicator was conducted to study the predictive factors of irregular aneurysms. RESULTS Of the 65 aneurysms, 25 possessed an irregular shape and 40 were of regular shape; 51 were anterior circulatory aneurysms and 14 were posterior circulatory aneurysms. Single factor analysis showed that AR (P = 0.001), volume change rate (P = 0.002), and location of aneurysm at the bifurcation (P = 0.038) of the vessel were significantly correlated with irregular aneurysms, but not correlated with age, sex, hypertension history, type 2 diabetes history, smoking history, family history, multiple aneurysm history, and subarachnoid hemorrhage history. Multifactor analysis showed that volume change rate greater than 30% (P = 0.008; odds ratio, 6.934) and AR greater than 1.4 (P = 0.004; odds ratio, 8.258) were independent correlative factors of the formation of intracranial aneurysm with irregular shape. CONCLUSION The volume change rate and AR are independent correlative factors of the formation of intracranial aneurysm with irregular shape.
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Schetelig D, Frölich A, Knopp T, Werner R. A new cerebral vessel benchmark dataset (CAPUT) for validation of image-based aneurysm deformation estimation algorithms. Sci Rep 2018; 8:15999. [PMID: 30375473 PMCID: PMC6207668 DOI: 10.1038/s41598-018-34489-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/16/2018] [Indexed: 11/10/2022] Open
Abstract
Hemodynamic properties and deformation of vessel structures are assumed to be correlated to the initiation, development, and rupture of cerebral aneurysms. Therefore, precise quantification of wall motion is essential. However, using standard-of-care imaging data, approaches for patient-specific estimation of pulsatile deformation are prone to uncertainties due to, e.g., contrast agent inflow-related intensity changes and small deformation compared to the image resolution. A ground truth dataset that allows evaluating and finetuning algorithms for deformation estimation is lacking. We designed a flow phantom with deformable structures that resemble cerebral vessels and exhibit physiologically plausible deformation. The deformation was simultaneously recorded using a flat panel CT and a video camera, yielding video data with higher resolution and SNR, which was used to compute 'ground truth' structure deformation measures. The dataset was further applied to evaluate registration-based deformation estimation. The results illustrate that registration approaches can be used to estimate deformation with adequate precision. Yet, the accuracy depended on the registration parameters, illustrating the need to evaluate and finetune deformation estimation approaches by ground truth data. To fill the existing gap, the acquired benchmark dataset is provided freely available as the CAPUT (Cerebral Aneurysm PUlsation Testing) dataset, accessible at https://www.github.com/IPMI-ICNS-UKE/CAPUT .
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Affiliation(s)
- Daniel Schetelig
- University Medical Center Hamburg-Eppendorf, Department of Computational Neuroscience, Hamburg, 20246, Germany.
| | - Andreas Frölich
- University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Neuroradiology, Hamburg, 20246, Germany
| | - Tobias Knopp
- University Medical Center Hamburg-Eppendorf, Section for Biomedical Imaging, Hamburg, 20246, Germany.,Hamburg University of Technology, Institute for Biomedical Imaging, Hamburg, 20246, Germany
| | - René Werner
- University Medical Center Hamburg-Eppendorf, Department of Computational Neuroscience, Hamburg, 20246, Germany
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20
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Schetelig D, Sedlacik J, Fiehler J, Frölich A, Knopp T, Sothmann T, Waschkewitz J, Werner R. Analysis of the influence of imaging-related uncertainties on cerebral aneurysm deformation quantification using a no-deformation physical flow phantom. Sci Rep 2018; 8:11004. [PMID: 30030483 PMCID: PMC6054631 DOI: 10.1038/s41598-018-29282-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 07/04/2018] [Indexed: 11/18/2022] Open
Abstract
Cardiac-cycle related pulsatile aneurysm motion and deformation is assumed to provide valuable information for assessing cerebral aneurysm rupture risk. Accordingly, numerous studies addressed quantification of cerebral aneurysm wall motion and deformation. Most of them utilized in vivo imaging data, but image-based aneurysm deformation quantification is subject to pronounced uncertainties: unknown ground-truth deformation; image resolution in the order of the expected deformation; direct interplay between contrast agent inflow and image intensity. To analyze the impact of the uncertainties on deformation quantification, a multi-imaging modality ground-truth phantom study is performed. A physical flow phantom was designed that allowed simulating pulsatile flow through a variety of modeled cerebral vascular structures. The phantom was imaged using different modalities [MRI, CT, 3D-RA] and mimicking physiologically realistic flow conditions. Resulting image data was analyzed by an established registration-based approach for automated wall motion quantification. The data reveals severe dependency between contrast media inflow-related image intensity changes and the extent of estimated wall deformation. The study illustrates that imaging-related uncertainties affect the accuracy of cerebral aneurysm deformation quantification, suggesting that in vivo imaging studies have to be accompanied by ground-truth phantom experiments to foster data interpretation and to prove plausibility of the applied image analysis algorithms.
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Affiliation(s)
- Daniel Schetelig
- University Medical Center Hamburg-Eppendorf, Department of Computational Neuroscience, Hamburg, 20246, Germany.
| | - Jan Sedlacik
- University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Neuroradiology, Hamburg, 20246, Germany
| | - Jens Fiehler
- University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Neuroradiology, Hamburg, 20246, Germany
| | - Andreas Frölich
- University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Neuroradiology, Hamburg, 20246, Germany
| | - Tobias Knopp
- University Medical Center Hamburg-Eppendorf, Section for Biomedical Imaging, Hamburg, 20246, Germany.,Hamburg University of Technology, Institute for Biomedical Imaging, Hamburg, 20246, Germany
| | - Thilo Sothmann
- University Medical Center Hamburg-Eppendorf, Department of Computational Neuroscience, Hamburg, 20246, Germany.,University Medical Center Hamburg-Eppendorf, Department of Radiotherapy and Radiation Oncology, Hamburg, 20246, Germany
| | - Jonathan Waschkewitz
- University Medical Center Hamburg-Eppendorf, Department of Radiotherapy and Radiation Oncology, Hamburg, 20246, Germany
| | - René Werner
- University Medical Center Hamburg-Eppendorf, Department of Computational Neuroscience, Hamburg, 20246, Germany
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Monitoring Dynamic Morphological Changes With Electrocardiography-Gated Dynamic 4-Dimensional Computed Tomography Angiography to Predict Intraoperative Rupture of Intracranial Aneurysms. J Comput Assist Tomogr 2018; 42:286-292. [PMID: 28937485 DOI: 10.1097/rct.0000000000000671] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aims to evaluate dynamic morphological changes of intracranial aneurysms to predict intraoperative aneurysm rupture (IAR) during clipping. METHODS Included in this study were 153 patients, who had ruptured and microsurgical-clipped aneurysms. All patients underwent dual-source computed tomography examination of electrocardiography-gated dynamic 4-dimensional computed tomography angiography before clipping. Original scanning data were reconstructed to produce 20 data sets of cardiac cycles with 5% time intervals. The aneurysm neck, transverse and longitudinal diameters, and volume from the 20 groups of images were measured to calculate their respective change rates. In addition, other data and clinical characteristics were recorded. Data were analyzed by logistic regression to identify factors associated with IAR. RESULTS Of the 153 patients, 24 patients experienced IAR. Multivariable analysis revealed that the aneurysm neck change rate (P = 0.0001; odds ratio, 1.276) and aspect ratio (height/neck ratio, P = 0.025; odds ratio, 2.387) are predictors for IAR. When the change rate was greater than or equal to 60%, and the sensitivity and specificity were 91.7% and 76.7%, respectively. CONCLUSIONS Aneurysm neck change rate is independent predictor of IAR.
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Xu L, Liang F, Gu L, Liu H. Flow instability detected in ruptured versus unruptured cerebral aneurysms at the internal carotid artery. J Biomech 2018; 72:187-199. [PMID: 29602477 DOI: 10.1016/j.jbiomech.2018.03.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 03/03/2018] [Accepted: 03/06/2018] [Indexed: 11/30/2022]
Abstract
Flow instability has emerged as a new hemodynamic metric hypothesized to have potential value in assessing the rupture risk of cerebral aneurysms. However, diverse findings have been reported in the literature. In the present study, high-resolution hemodynamic simulations were performed retrospectively on 35 aneurysms (10 ruptured & 25 unruptured) located at the internal carotid artery (ICA). Simulated hemodynamic parameters were statistically compared between the ruptured and unruptured aneurysms, with emphasis on examining the correlation of flow instability with the status of aneurysm rupture. Pronounced flow instability was detected in 20% (2 out of 10) of the ruptured aneurysms, whereas in 44% (11 out of 25) of the unruptured aneurysms. Statistically, the flow instability metric (quantified by the temporally and spatially averaged fluctuating kinetic energy over the aneurysm sac) did not differ significantly between the ruptured and unruptured aneurysms. In contrast, low wall shear stress area (LSA) and pressure loss coefficient (PLC) exhibited significant correlations with the status of aneurysm rupture. In conclusion, the present study suggests that the presence of flow instability may not correlate closely with the status of aneurysm rupture, at least for ICA aneurysms. On the other hand, the retrospective nature of the study and the small sample size may have to some extent compromised the reliability of the conclusion, and therefore large-scale prospective studies would be needed to further address the issue.
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Affiliation(s)
- Lijian Xu
- School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai 200240, China; Shanghai Jiao Tong University and Chiba University International Cooperative Research Centre (SJTU-CU ICRC), Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai 200240, China
| | - Fuyou Liang
- School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai 200240, China; Shanghai Jiao Tong University and Chiba University International Cooperative Research Centre (SJTU-CU ICRC), Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai 200240, China.
| | - Lixu Gu
- Shanghai Jiao Tong University and Chiba University International Cooperative Research Centre (SJTU-CU ICRC), Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai 200240, China
| | - Hao Liu
- School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai 200240, China; Shanghai Jiao Tong University and Chiba University International Cooperative Research Centre (SJTU-CU ICRC), Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai 200240, China; Graduate School of Engineering, Chiba University, 1-33, Yayoi-cho, Inage-ku, Chiba-shi, Chiba 2638522, Japan.
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23
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Current Perspectives in Imaging Modalities for the Assessment of Unruptured Intracranial Aneurysms: A Comparative Analysis and Review. World Neurosurg 2018; 113:280-292. [PMID: 29360591 DOI: 10.1016/j.wneu.2018.01.054] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 01/05/2018] [Accepted: 01/11/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Intracranial aneurysms (IAs) are pathologic dilatations of cerebral arteries. This systematic review summarizes and compares imaging techniques for assessing unruptured IAs (UIAs). This review also addresses their uses in different scopes of practice. Pathophysiologic mechanisms are reviewed to better understand the clinical usefulness of each imaging modality. METHODS A literature review was performed using PubMed with these search terms: "intracranial aneurysm," "cerebral aneurysm," "magnetic resonance angiography (MRA)," computed tomography angiography (CTA)," "catheter angiography," "digital subtraction angiography," "molecular imaging," "ferumoxytol," and "myeloperoxidase". Only studies in English were cited. RESULTS Since the development and improvement of noninvasive diagnostic imaging (computed tomography angiography and magnetic resonance angiography), many prospective studies and meta-analyses have compared these tests with gold standard digital subtraction angiography (DSA). Although computed tomography angiography and magnetic resonance angiography have lower detection rates for UIAs, they are vital in the treatment and follow-up of UIAs. The reduction in ionizing radiation and lack of endovascular instrumentation with these modalities provide benefits compared with DSA. Novel molecular imaging techniques to detect inflammation within the aneurysmal wall with the goal of stratifying risk based on level of inflammation are under investigation. CONCLUSIONS DSA remains the gold standard for preoperative planning and follow-up for patients with IA. Newer imaging modalities such as ferumoxytol-enhanced magnetic resonance imaging are emerging techniques that provide critical in vivo information about the inflammatory milieu within aneurysm walls. With further study, these techniques may provide aneurysm rupture risk and prediction models for individualized patient care.
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de Jong JP, Kluijtmans L, van Amerongen MJ, Prokop M, Boogaarts HD, Meijer FJA. "On the Spot": The Use of Four-Dimensional Computed Tomography Angiography to Differentiate a True Spot Sign From a Distal Intracranial Aneurysm. World Neurosurg 2017. [PMID: 28625908 DOI: 10.1016/j.wneu.2017.06.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Spontaneous intracerebral hemorrhage may arise from underlying abnormalities, including aneurysms. Computed tomography angiography (CTA) is widely used for the detection of possible underlying causes, which is important because it may have immediate therapeutic consequences. In addition, CTA is used to detect the so-called spot sign, indicating active hemorrhage, which carries a worse prognosis. However, CTA is a snapshot in time. Four-dimensional (4D) CTA is a dynamic type of imaging and has emerged as a valuable imaging technique for different neurovascular disorders. CASE DESCRIPTION Two patients with intracerebral hemorrhage both showed an assumed spot sign on CTA, suggesting active hemorrhage. Additional 4D-CTA showed true active hemorrhage in one patient and a distal intracranial aneurysm in the other. This aneurysm was initially falsely interpreted as a spot sign on conventional CTA. CONCLUSIONS Our case findings show how 4D-CTA can discern active bleeding from aneurysmal hemorrhage in cases with hemorrhagic stroke. This finding proves the additional value of this relatively new technique, because the detected underlying disorders have different therapeutic consequences in the acute setting.
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Affiliation(s)
- Johanna P de Jong
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Leo Kluijtmans
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Martinus J van Amerongen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mathias Prokop
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hieronymus D Boogaarts
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frederick J A Meijer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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Chen W, Xing W, He Z, Peng Y, Wang C, Wang Q. Accuracy of 320-detector row nonsubtracted and subtracted volume CT angiography in evaluating small cerebral aneurysms. J Neurosurg 2016; 127:725-731. [PMID: 27813462 DOI: 10.3171/2016.8.jns16238] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The study aimed to assess the diagnostic accuracy of 320-detector row nonsubtracted and subtracted volume CT angiography (VCTA) in detecting small cerebral aneurysms (< 3 mm) compared with 3D digital subtraction angiography (3D DSA). METHODS Six hundred sixty-two patients underwent 320-detector row VCTA and 3D DSA for suspected cerebral aneurysms. Five neuroradiologists independently reviewed VCTA and 3D DSA images. The 3D DSA was considered the reference standard, and the sensitivity, specificity, and accuracy of nonsubtracted and subtracted VCTA in depicting small aneurysms were analyzed. A p value < 0.05 was considered a significant difference. RESULTS According to 3D DSA images, 98 small cerebral aneurysms were identified in 90 of 662 patients. Nonsubtracted VCTA depicted 90 small aneurysms. Ten small aneurysms were missed, and 2 small aneurysms were misdiagnosed. The missed small aneurysms were located almost in the internal carotid artery, near bone tissue. The sensitivity, specificity, and accuracy of nonsubtracted VCTA in depicting small aneurysms were 89.8%, 99.2%, and 96.5%, respectively, on a per-aneurysm basis. Subtracted VCTA depicted 97 small aneurysms. Three small aneurysms were missed, and 2 small aneurysms were misdiagnosed. The sensitivity, specificity, and accuracy of subtracted VCTA in depicting small aneurysms were 96.9%, 99.2%, and 98.6%, respectively, on a per-aneurysm basis. There was no difference in accuracy between subtracted VCTA and 3D DSA (p = 1.000). However, nonsubtracted VCTA had significantly less sensitivity than 3D DSA and subtracted VCTA (p = 0.039 and 0.016, respectively). CONCLUSIONS Subtracted 320-detector row VCTA is sensitive enough to replace 3D DSA in the diagnosis of small cerebral aneurysms (< 3 mm). The accuracy rate of nonsubtracted VCTA was lower than that of subtracted VCTA and 3D DSA, especially in the assessment of small internal carotid artery aneurysms adjacent to the skull base.
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Affiliation(s)
| | | | | | - Ya Peng
- Neurosurgery, The Third Affiliated Hospital of Soochow University, Changzhou, People's Republic of China
| | - Caoye Wang
- Departments of 1 Interventional Radiology
| | - Qi Wang
- Departments of 1 Interventional Radiology
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Kortman HGJ, Boogaarts HD, Prokop M, Meijer FJA. Four-Dimensional Computed Tomography Angiography Demonstrating a Ruptured Basilar Artery Aneurysm Causing Anterior Cerebral Circulation Arrest. J Stroke Cerebrovasc Dis 2016; 25:e146-7. [PMID: 27256171 DOI: 10.1016/j.jstrokecerebrovasdis.2016.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/07/2016] [Accepted: 05/17/2016] [Indexed: 11/28/2022] Open
Abstract
A 61-year-old woman suffered a pronounced subarachnoid hemorrhage. Conventional computed tomography angiography (CTA) showed no enhancement of the intracranial vasculature, whereas there was normal contrast enhancement of bilateral external carotid artery branches. Subsequent four-dimensional computed tomography angiography (4D-CTA) demonstrated active contrast leakage out of a ruptured basilar tip aneurysm, whereas there was no enhancement of the anterior circulation at any time point, consistent with intracranial anterior circulation arrest. This case illustrates that 4D-CTA is superior to conventional CTA for the evaluation of intracranial flow dynamics and delayed intracranial vascular contrast filling.
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Affiliation(s)
- Hans G J Kortman
- Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Hieronymus D Boogaarts
- Department of Neurosurgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Mathias Prokop
- Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Frederick J A Meijer
- Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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27
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Yoon NK, McNally S, Taussky P, Park MS. Imaging of cerebral aneurysms: a clinical perspective. ACTA ACUST UNITED AC 2016. [DOI: 10.1186/s40809-016-0016-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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28
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Vanrossomme AE, Eker OF, Thiran JP, Courbebaisse GP, Zouaoui Boudjeltia K. Intracranial Aneurysms: Wall Motion Analysis for Prediction of Rupture. AJNR Am J Neuroradiol 2015; 36:1796-802. [PMID: 25929878 PMCID: PMC7965030 DOI: 10.3174/ajnr.a4310] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Intracranial aneurysms are a common pathologic condition with a potential severe complication: rupture. Effective treatment options exist, neurosurgical clipping and endovascular techniques, but guidelines for treatment are unclear and focus mainly on patient age, aneurysm size, and localization. New criteria to define the risk of rupture are needed to refine these guidelines. One potential candidate is aneurysm wall motion, known to be associated with rupture but difficult to detect and quantify. We review what is known about the association between aneurysm wall motion and rupture, which structural changes may explain wall motion patterns, and available imaging techniques able to analyze wall motion.
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Affiliation(s)
- A E Vanrossomme
- From the Laboratory of Experimental Medicine (A.E.V., K.Z.B.), Université Libre de Bruxelles, Bruxelles, Belgium
| | - O F Eker
- Department of Interventional Neuroradiology (O.F.E.), Gui de Chauillac Hospital, Centre Hospitalier Régional Universitaire Montpellier, Montpellier, France
| | - J-P Thiran
- Signal Processing Laboratory (J.-P.T.), Swiss Federal Institute of Technology Lausanne, Lausanne, Switzerland Department of Radiology (J.-P.T.), University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - G P Courbebaisse
- Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé - Centre National de Recherche Scientifique - Unité Mixte de Recherche 5220 (G.P.C.), Institut National des Sciences Appliquées Lyon, Université de Lyon, Lyon, France
| | - K Zouaoui Boudjeltia
- From the Laboratory of Experimental Medicine (A.E.V., K.Z.B.), Université Libre de Bruxelles, Bruxelles, Belgium
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"Sit back, observe, and wait." Or is there a pharmacologic preventive treatment for cerebral aneurysms? Neurosurg Rev 2012; 36:1-9; discussion 9-10. [PMID: 23070279 DOI: 10.1007/s10143-012-0429-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 06/29/2012] [Accepted: 07/29/2012] [Indexed: 10/27/2022]
Abstract
Intracranial aneurysms (IA) are a relatively frequent vascular abnormality. The prevailing opinion is that cerebral aneurysmal disease is related to hemodynamic and genetic factors, associated with structural weakness in the arterial wall which was acquired by a specific, often unknown, event. Possibly the trigger moment of aneurysm formation may depend on the dynamic arterial growth, which is closely related to aging/atherosclerosis. In most individuals, an endovascular/microsurgical approach is possible in order to obliterate the IA. However, in a number of patients with an unruptured IA (UIA), the neurosurgeon's decision is to just "sit back, observe, and wait", based on the favorable natural history of some of the UIAs. Furthermore, some individuals need to be kept under close observation since they have a higher chance of developing IA, especially those with at least two affected first-degree relatives with an IA, subjects with polycystic kidney disease, and patients who have undergone an aneurysm intervention. In these examples prophylactic strategies should be adopted, if it is at all possible. The main question is deciding the best option of clinical treatment for these cases, when surgical approach is contraindicated, or for those subjects who are more prone to develop an IA. In the present article, we hypothetically suggest a pharmacologic form of treatment with statins, beta-adrenergic blocker agents, and/or angiotensin-converting-enzyme inhibitor/angiotensin II receptor blockers to inhibit or slow down IA formation, taking into consideration some pathophysiological aspects related to aneurysmal development, such as: hemodynamic stress, arterial wall inflammation, nitric oxide formation, and atheromatous disease.
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