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Yang R, Ren Y, Kok HK, Smith PD, Kebria PM, Khosravi A, Maingard J, Yeo M, Hall J, Foo M, Zhou K, Jhamb A, Russell J, Brooks M, Asadi H. Verification of a simplified aneurysm dimensionless flow parameter to predict intracranial aneurysm rupture status. Br J Radiol 2024; 97:1357-1364. [PMID: 38796680 PMCID: PMC11186560 DOI: 10.1093/bjr/tqae106] [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: 03/20/2022] [Revised: 04/07/2023] [Accepted: 05/16/2024] [Indexed: 05/28/2024] Open
Abstract
OBJECTIVES Aneurysm number (An) is a novel prediction tool utilizing parameters of pulsatility index (PI) and aneurysm geometry. An has been shown to have the potential to differentiate intracranial aneurysm (IA) rupture status. The objective of this study is to investigate the feasibility and accuracy of An for IA rupture status prediction using Australian based clinical data. METHODS A retrospective study was conducted across three tertiary referral hospitals between November 2017 and November 2020 and all saccular IAs with known rupture status were included. Two sets of An values were calculated based on two sets of PI values previously reported in the literature. RESULTS Five hundred and four IA cases were included in this study. The results demonstrated no significant difference between ruptured and unruptured status when using An ≥1 as the discriminator. Further analysis showed no strong correlation between An and IA subtypes. The area under the curve (AUC) indicated poor performance in predicting rupture status (AUC1 = 0.55 and AUC2 = 0.56). CONCLUSIONS This study does not support An ≥1 as a reliable parameter to predict the rupture status of IAs based on a retrospective cohort. Although the concept of An is supported by hemodynamic aneurysm theory, further research is needed before it can be applied in the clinical setting. ADVANCES IN KNOWLEDGE This study demonstrates that the novel prediction tool, An, proposed in 2020 is not reliable and that further research of this hemodynamic model is needed before it can be incorporated into the prediction of IA rupture status.
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Affiliation(s)
- Runlin Yang
- Department of Radiology, Austin Hospital, Melbourne, 3084, Australia
| | - Yifan Ren
- Interventional Radiology Service—Department of Radiology, Austin Hospital, Melbourne, 3084, Australia
| | - Hong Kuan Kok
- Interventional Radiology Service, Northern Health Radiology, Melbourne, 3076, Australia
| | - Paul D Smith
- Melbourne Medical School, The University of Melbourne, Parkville, 3052, Australia
- Department of Neurosurgery, St Vincent’s Hospital, Melbourne, 3065, Australia
| | - Parham Mohsenzadeh Kebria
- Institute for Intelligent Systems Research and Innovation, Deakin University, Waurn Ponds, 3216, Australia
| | - Abbas Khosravi
- Institute for Intelligent Systems Research and Innovation, Deakin University, Waurn Ponds, 3216, Australia
| | - Julian Maingard
- Interventional Radiology Service—Department of Radiology, Austin Hospital, Melbourne, 3084, Australia
- Interventional Neuroradiology Service—Department of Radiology, Austin Hospital, Melbourne, 3084, Australia
- School of Medicine—Faculty of Health, Deakin University, Waurn Ponds, 3216, Australia
| | - Melissa Yeo
- Department of Radiology, Western Health, Melbourne, 3011, Australia
| | - Jonathan Hall
- Department of Radiology, St Vincent’s Hospital Melbourne, Melbourne, 3065, Australia
| | - Michelle Foo
- Interventional Radiology Service—Department of Radiology, Austin Hospital, Melbourne, 3084, Australia
| | - Kevin Zhou
- Department of Radiology, Monash Health, Monash University, Melbourne, 3168, Australia
| | - Ashu Jhamb
- Interventional Radiology Service—Department of Radiology, St Vincent’s Hospital Melbourne, Melbourne, 3065, Australia
| | - Jeremy Russell
- Department of Neurosurgery, Austin Hospital, Melbourne, 3084, Australia
| | - Mark Brooks
- Interventional Radiology Service—Department of Radiology, Austin Hospital, Melbourne, 3084, Australia
- The Florey Institute of Neuroscience and Mental Health, Melbourne, 3052, Australia
| | - Hamed Asadi
- Interventional Neuroradiology Service—Department of Radiology, Austin Hospital, Melbourne, 3084, Australia
- School of Medicine—Faculty of Health, Deakin University, Waurn Ponds, 3216, Australia
- The Florey Institute of Neuroscience and Mental Health, Melbourne, 3052, Australia
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Raghuram A, Patel R, Varon A, Sabotin R, Sanchez S, Derdeyn CP, Jabbour P, Hasan DM, Samaniego EA. Volumetric surveillance of brain aneurysms: Pitfalls of MRA. Interv Neuroradiol 2023; 29:532-539. [PMID: 35549745 PMCID: PMC10549707 DOI: 10.1177/15910199221100619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/26/2022] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Untreated brain aneurysms are usually surveilled with serial MR imaging and evaluated with 2D multiplanar measurements. The assessment of aneurysm growth may be more accurate with volumetric analysis. We evaluated the accuracy of a magnetic resonance angiography (MRA) segmentation pipeline for aneurysm volume measurement and surveillance. METHODS A pipeline to determine aneurysm volume was developed and tested on two aneurysm phantoms imaged with time-of flight (TOF) MRA and 3D rotational angiography (3DRA). The accuracy of the pipeline was then evaluated by reconstructing 10 aneurysms imaged with contrast enhanced-MRA (CE-MRA) and 3DRA. This calibrated and refined post-processing pipeline was subsequently used to analyse aneurysms from our prospectively acquired database. Volume changes above the threshold of error were considered true volume changes. The accuracy of these measurements was analysed. RESULTS TOF-MRA reconstructions were not as accurate as CE-MRA reconstructions. When compared to 3DRA, CE-MRA underestimated aneurysm volume by 7.8% and did not accurately register the presence of blebs. Eighteen aneurysms (13 saccular and 5 fusiform) were analysed with the optimized 3D volume reconstruction pipeline, with a mean follow-up time of 11 months. Artifact accounted for 10.2% error in volume measurements using serial CE-MRA. When this margin of error was used to assess aneurysms volume in serial imaging with CE-MRA, only two fusiform aneurysms changed in volume. The variations in volume of these two fusiform aneurysms were caused by intra-mural and intrasaccular thrombosis. CONCLUSIONS CE-MRA and TOF-MRA 3D volume reconstructions may not register minor morphological changes such as the appearance of blebs. CE-MRA underestimates volume by 7.8% compared to 3DRA. Serial CE-MRA volume measurements had a larger margin of error of approximately 10.2%. MRA-based volumetric measurements may not be appropriate for aneurysm surveillance.
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Affiliation(s)
- Ashrita Raghuram
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Rishi Patel
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Alberto Varon
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Ryan Sabotin
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Sebastian Sanchez
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Colin P Derdeyn
- Department of Radiology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - David M. Hasan
- Department of Neurosurgery, Duke University, Durham, NC, USA
| | - Edgar A. Samaniego
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
- Department of Radiology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Elmokadem AH, Elged BA, Abdel Razek A, El-Serougy LG, Kasem MA, EL-Adalany MA. Interobserver reliability of computed tomography angiography in the assessment of ruptured intracranial aneurysm and impact on patient management. World J Radiol 2023; 15:201-215. [PMID: 37424734 PMCID: PMC10324495 DOI: 10.4329/wjr.v15.i6.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/17/2023] [Accepted: 05/31/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Aneurysmal subarachnoid hemorrhage is an emergency that can lead to a high mortality rate and many severe complications. It is critical to make a rapid radiological evaluation of ruptured intracranial aneurysms (RIAs) to determine the appropriate surgical treatment.
AIM To assess the reliability of computed tomography angiography (CTA) in assessing different features of ruptured intracranial aneurysm and its impact on patient management.
METHODS The final cohort of this study consisted of 146 patients with RIAs (75 male and 71 female) who underwent cerebral CTA. Their age ranged from 25 to 80, and the mean age ± SD was 57 ± 8.95 years. Two readers were asked to assess different features related to the aneurysm and perianeurysmal environment. Inter-observer agreement was measured using kappa statistics. Imaging data extracted from non-contrast computed tomography and CTA were considered to categorize the study population into two groups according to the recommended therapeutic approach.
RESULTS The inter-observer agreement of both reviewers was excellent for the detection of aneurysms (K = 0.95, P = 0.001), aneurysm location (K = 0.98, P = 0.001), and (K = 0.98, P = 0.001), morphology (K = 0.92, P = 0.001) and margins (K = 0.95, P = 0.001). There was an excellent interobserver agreement for the measurement of aneurysm size (K = 0.89, P = 0.001), neck (K = 0.85, P = 0.001), and dome-to-neck ratio (K = 0.98, P = 0.001). There was an excellent inter-observer agreement for the detection of other aneurysm-related features such as thrombosis (K = 0.82, P = 0.001), calcification (K = 1.0, P = 0.001), bony landmark (K = 0.89, P = 0.001) and branch incorporation (K = 0.91, P = 0.001) as well as perianeurysmal findings including vasospasm (K = 0.91, P = 0.001), perianeurysmal cyst (K = 1.0, P = 0.001) and associated vascular lesions (K = 0.83, P = 0.001). Based on imaging features, 87 patients were recommended to have endovascular treatment, while surgery was recommended in 59 patients. 71.2% of the study population underwent the recommended therapy.
CONCLUSION CTA is a reproducible promising diagnostic imaging modality for detecting and characterizing cerebral aneurysms.
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Affiliation(s)
- Ali H Elmokadem
- Department of Radiology, Mansoura University, Mansoura 35516, Egypt
| | | | | | | | - Mohamed Ali Kasem
- Department of Neurosurgery, Mansoura University, Mansoura 35516, Egypt
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Ou C, Qian Y, Chong W, Hou X, Zhang M, Zhang X, Si W, Duan CZ. A deep learning-based automatic system for intracranial aneurysms diagnosis on three-dimensional digital subtraction angiographic images. Med Phys 2022; 49:7038-7053. [PMID: 35792717 DOI: 10.1002/mp.15846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/11/2022] [Accepted: 06/27/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Intracranial aneurysms (IAs) are a life-threatening disease. Their rupture can lead to hemorrhagic stroke. Most studies applying deep learning for the detection of aneurysms are based on angiographic images. However, critical diagnostic information such as morphology and aneurysm location are not captured by deep learning algorithms and still require manual assessments. PURPOSE Digital subtraction angiography (DSA) is the gold standard for aneurysm diagnosis. To facilitate the fully automatic diagnosis of aneurysms, we proposed a comprehensive system for the detection, morphology measurement, and location classification of aneurysms on three-dimensional DSA images, allowing automatic diagnosis without further human input. METHODS The system comprised three neural networks: a network for aneurysm detection, a network for morphology measurement, and a network for aneurysm location identification. A cross-scale dual-path transformer module was proposed to effectively fuse local and global information to capture aneurysms of varying sizes. A multitask learning approach was also proposed to allow an accurate localization of aneurysm neck for morphology measurement. RESULTS The cross-scale dual-path transformer module was shown to outperform other state-of-the-art network architectures, improving segmentation, and classification accuracy. The detection network in our system achieved an F2 score of 0.946 (recall 93%, precision 100%), better than the winning team in the Cerebral Aneurysm Detection and Analysis challenge. The measurement network achieved a relative error of less than 10% for morphology measurement, at the same level as human operators. Perfect accuracy (100%) was achieved on aneurysm location classification. CONCLUSIONS We have demonstrated that a comprehensive system can automatically detect, measure morphology and report the aneurysm location of aneurysms without human intervention. This can be a potential tool for the diagnosis of IAs, improving radiologists' performance and reducing their workload.
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Affiliation(s)
- Chubin Ou
- Neurosurgery Center, Department of Cerebrovascular Surgery, The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, The Neurosurgery Institute of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Yi Qian
- Neurosurgery Center, Department of Cerebrovascular Surgery, The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, The Neurosurgery Institute of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | | | - Xiaoxi Hou
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Mingzi Zhang
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Xin Zhang
- Neurosurgery Center, Department of Cerebrovascular Surgery, The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, The Neurosurgery Institute of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Weixin Si
- Guangdong Provincial Key Laboratory of Computer Vision and Virtual Reality Technology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Chuan-Zhi Duan
- Neurosurgery Center, Department of Cerebrovascular Surgery, The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, The Neurosurgery Institute of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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Timmins K, Kuijf H, Vergouwen M, Ruigrok Y, Velthuis B, van der Schaaf I. Relationship between 3D Morphologic Change and 2D and 3D Growth of Unruptured Intracranial Aneurysms. AJNR Am J Neuroradiol 2022; 43:416-421. [PMID: 35144935 PMCID: PMC8910794 DOI: 10.3174/ajnr.a7418] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/02/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Untreated unruptured intracranial aneurysms are usually followed radiologically to detect aneurysm growth, which is associated with increased rupture risk. The ideal aneurysm size cutoff for defining growth remains unclear and also whether change in morphology should be part of the definition. We investigated the relationship between change in aneurysm size and 3D quantified morphologic changes during follow-up. MATERIALS AND METHODS We performed 3D morphology measurements of unruptured intracranial aneurysms on baseline and follow-up TOF-MRAs. Morphology measurements included surface area, compactness, elongation, flatness, sphericity, shape index, and curvedness. We investigated the relation between morphologic change between baseline and follow-up scans and unruptured intracranial aneurysm growth, with 2D and 3D growth defined as a continuous variable (correlation statistics) and a categoric variable (t test statistics). Categoric growth was defined as ≥1-mm increase in 2D length or width. We assessed unruptured intracranial aneurysms that changed in morphology and the proportion of growing and nongrowing unruptured intracranial aneurysms with statistically significant morphologic change. RESULTS We included 113 patients with 127 unruptured intracranial aneurysms. Continuous growth of unruptured intracranial aneurysms was related to an increase in surface area and flatness and a decrease in the shape index and curvedness. In 15 growing unruptured intracranial aneurysms (12%), curvedness changed significantly compared with nongrowing unruptured intracranial aneurysms. Of the 112 nongrowing unruptured intracranial aneurysms, 10 (9%) changed significantly in morphology (flatness, shape index, and curvedness). CONCLUSIONS Growing unruptured intracranial aneurysms show morphologic change. However, nearly 10% of nongrowing unruptured intracranial aneurysms change in morphology, suggesting that they could be unstable. Future studies should investigate the best growth definition including morphologic change and size to predict aneurysm rupture.
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Affiliation(s)
- K.M. Timmins
- From the Image Sciences Institute (K.M.T., H.J.K.)
| | - H.J. Kuijf
- From the Image Sciences Institute (K.M.T., H.J.K.)
| | - M.D.I. Vergouwen
- Department of Neurology and Neurosurgery (M.D.I.V., Y.M.R.), University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Y.M. Ruigrok
- Department of Neurology and Neurosurgery (M.D.I.V., Y.M.R.), University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - B.K. Velthuis
- Department of Radiology (B.K.V., I.C.v.d.S.), University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - I.C. van der Schaaf
- Department of Radiology (B.K.V., I.C.v.d.S.), University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Algin O, Yuce G, Koc U, Ayberk G. A comparison between the CS-TOF and the CTA/DSA for WEB device management. Interv Neuroradiol 2022; 28:29-42. [PMID: 33957798 PMCID: PMC8905082 DOI: 10.1177/15910199211014708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE There is no study on the role of three-dimensional compressed sensing time of flight MR angiography (3D-CS-TOF) in the management of the WEB device. We evaluated the efficacy of 3-tesla 3D-CS-TOF for the management and follow-up of the WEB device implantations. MATERIALS AND METHODS Seventy-three aneurysms of 69 patients treated with the WEB device were retrospectively examined. Morphological parameters and embolization results of the aneurysms were assessed and compared on 3D-CS-TOF, CTA, and DSA images. RESULTS Occluded, neck remnant, and recurrent aneurysms were observed in 61 (83.6%), 7 (9.6%), and 5 (6.8%) aneurysms, respectively. Inter- and intra-reader agreement values related to aneurysm size measurements were perfect. Aneurysms size, age, and proximal vessel tortuosity were negatively correlated with the visibility of the aneurysms and parent vessels on 3D-CS-TOF images (p = 0.043; p = 0.032; p < 0.001, respectively). Subarachnoid hemorrhage and age are associated with 3D-CS-TOF artifacts (p = 0.031; p = 0.005, respectively). 3D-CS-TOF findings are in perfect agreement with DSA or CT angiography (CTA) results (p < 0.001). CONCLUSION According to our results, 3D-CS-TOF can be an easy, fast, and reliable alternative for the management or follow-up of WEB assisted embolization.
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Affiliation(s)
- Oktay Algin
- National MR Research Center (UMRAM), Bilkent University, Ankara, Turkey,Department of Radiology, Yildirim Beyazit University, Ankara, Turkey,Department of Interventional Radiology, City Hospital, Bilkent, Ankara, Turkey,Oktay Algin, Department of Radiology, City Hospital, Yildirim Beyazit University, Bilkent, Ankara, Turkey.
| | - Gokhan Yuce
- Department of Interventional Radiology, City Hospital, Bilkent, Ankara, Turkey
| | - Ural Koc
- Department of Interventional Radiology, City Hospital, Bilkent, Ankara, Turkey,General Directorate of Health Information Systems, Ministry of Health, Ankara, Turkey
| | - Gıyas Ayberk
- Department of Neurosurgery, Yildirim Beyazit University, Ankara, Turkey
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Timmins KM, Kuijf HJ, Vergouwen MDI, Otten MJ, Ruigrok YM, Velthuis BK, van der Schaaf IC. Reliability and Agreement of 2D and 3D Measurements on MRAs for Growth Assessment of Unruptured Intracranial Aneurysms. AJNR Am J Neuroradiol 2021; 42:1598-1603. [PMID: 34210663 DOI: 10.3174/ajnr.a7186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/29/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Reliable and reproducible measurement of unruptured intracranial aneurysm growth is important for unruptured intracranial aneurysm rupture risk assessment. This study aimed to compare the reliability and reproducibility of 2D and 3D growth measurements of unruptured intracranial aneurysms. MATERIALS AND METHODS 2D height, width, and neck and 3D volume measurements of unruptured intracranial aneurysms on baseline and follow-up TOF-MRAs were performed by two observers. The reliability of individual 2D and 3D measurements and of change (growth) between paired scans was assessed (intraclass correlation coefficient) and stratified for aneurysm location. The smallest detectable change on 2D and 3D was determined. Proportions of growing aneurysms were compared, and Bland-Altman plots were created. RESULTS Seventy-two patients with 84 unruptured intracranial aneurysms were included. The interobserver reliability was good-to-excellent for individual measurements (intraclass correlation coefficient > 0.70), poor for 2D change (intraclass correlation coefficient < 0.5), and good for 3D change (intraclass correlation coefficient = 0.76). For both 2D and 3D, the reliability was location-dependent and worse for irregularly shaped aneurysms. The smallest detectable changes for 2D height, width, and neck and 3D volume measurements were 1.5 , 2.0, and 1.9 mm and 0.06 mL, respectively. The proportion of growing unruptured intracranial aneurysms decreased from 10% to 2%, depending on the definition of growth (1 mm or the smallest detectable changes for 2D and 3D). CONCLUSIONS The interobserver reliability of the size measurements of individual 2D and 3D unruptured intracranial aneurysms was good-to-excellent but lower for 2D and 3D growth measurements. For growth assessment, 3D measurements are more reliable than 2D measurements. The smallest detectable change for 2D measurements was larger than 1 mm, the current clinical definition of unruptured intracranial aneurysm growth.
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Affiliation(s)
- K M Timmins
- From the Image Sciences Institute (K.M.T., H.J.K.)
| | - H J Kuijf
- From the Image Sciences Institute (K.M.T., H.J.K.)
| | | | - M J Otten
- , UMC Utrecht Brain Center, and Department of Radiology (M.J.O., B.K.V., I.C.v.d.S), University Medical Center Utrecht, Utrecht, the Netherlands
| | - Y M Ruigrok
- Department of Neurology and Neurosurgery (M.D.I.V., Y.M.R.)
| | - B K Velthuis
- , UMC Utrecht Brain Center, and Department of Radiology (M.J.O., B.K.V., I.C.v.d.S), University Medical Center Utrecht, Utrecht, the Netherlands
| | - I C van der Schaaf
- , UMC Utrecht Brain Center, and Department of Radiology (M.J.O., B.K.V., I.C.v.d.S), University Medical Center Utrecht, Utrecht, the Netherlands
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Comparing methods of detecting and segmenting unruptured intracranial aneurysms on TOF-MRAS: The ADAM challenge. Neuroimage 2021; 238:118216. [PMID: 34052465 DOI: 10.1016/j.neuroimage.2021.118216] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/11/2021] [Accepted: 05/26/2021] [Indexed: 11/24/2022] Open
Abstract
Accurate detection and quantification of unruptured intracranial aneurysms (UIAs) is important for rupture risk assessment and to allow an informed treatment decision to be made. Currently, 2D manual measures used to assess UIAs on Time-of-Flight magnetic resonance angiographies (TOF-MRAs) lack 3D information and there is substantial inter-observer variability for both aneurysm detection and assessment of aneurysm size and growth. 3D measures could be helpful to improve aneurysm detection and quantification but are time-consuming and would therefore benefit from a reliable automatic UIA detection and segmentation method. The Aneurysm Detection and segMentation (ADAM) challenge was organised in which methods for automatic UIA detection and segmentation were developed and submitted to be evaluated on a diverse clinical TOF-MRA dataset. A training set (113 cases with a total of 129 UIAs) was released, each case including a TOF-MRA, a structural MR image (T1, T2 or FLAIR), annotation of any present UIA(s) and the centre voxel of the UIA(s). A test set of 141 cases (with 153 UIAs) was used for evaluation. Two tasks were proposed: (1) detection and (2) segmentation of UIAs on TOF-MRAs. Teams developed and submitted containerised methods to be evaluated on the test set. Task 1 was evaluated using metrics of sensitivity and false positive count. Task 2 was evaluated using dice similarity coefficient, modified hausdorff distance (95th percentile) and volumetric similarity. For each task, a ranking was made based on the average of the metrics. In total, eleven teams participated in task 1 and nine of those teams participated in task 2. Task 1 was won by a method specifically designed for the detection task (i.e. not participating in task 2). Based on segmentation metrics, the top two methods for task 2 performed statistically significantly better than all other methods. The detection performance of the top-ranking methods was comparable to visual inspection for larger aneurysms. Segmentation performance of the top ranking method, after selection of true UIAs, was similar to interobserver performance. The ADAM challenge remains open for future submissions and improved submissions, with a live leaderboard to provide benchmarking for method developments at https://adam.isi.uu.nl/.
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Acar T, Karakas AB, Ozer MA, Koc AM, Govsa F. Building Three-Dimensional Intracranial Aneurysm Models from 3D-TOF MRA: a Validation Study. J Digit Imaging 2021; 32:963-970. [PMID: 31410678 DOI: 10.1007/s10278-019-00256-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
To create realistic three-dimensional (3D) vascular models from 3D time-of-flight magnetic resonance angiography (3D-TOF MRA) of an intracranial aneurysm (IA). Thirty-two IAs in 31 patients were printed using 3D-TOF MRA source images from polylactic acid (PLA) raw material. Two observers measured the maximum IA diameter at the longest width twice separately. A total mean of four measurements as well as each observer's individual average MRA lengths were calculated. After printing, 3D-printed anatomic models (PAM) underwent computed tomography (CT) acquisition and each observer measured them using the same algorithm as applied to MRA. Inter- and intra-observer consistency for the MRA and CT measurements were analyzed using the intraclass correlation coefficient (ICC) and a Bland-Altman plot. The mean maximum aneurysm diameter obtained from four MRA evaluations was 8.49 mm, whereas it was 8.83 mm according to the CT 3D PAM measurement. The Wilcoxon test revealed slightly larger mean CT 3D PAM diameters than the MRA measurements. The Spearman's correlation test yielded a positive correlation between MRA and CT lengths of 3D PAMs. Inter and intra-observer consistency were high in consecutive MRA and CT measurements. According to Bland-Altman analyses, the aneurysmal dimensions obtained from CT were higher for observer 1 and observer 2 (a mean of 0.32 mm and 0.35 mm, respectively) compared to the MRA measurements. CT dimensions were slightly overestimated compared to MRA measurements of the created models. We believe the discrepancy may be related to the Laplacian algorithm applied for surface smoothing and the high slice thickness selection that was used. However, ICC provided high consistency and reproducibility in our cohort. Therefore, it is technically possible to produce 3D intracranial aneurysm models from 3D-TOF MRA images.
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Affiliation(s)
- Turker Acar
- Department of Radiology, University of Health Sciences Bozyaka Education and Training Hospital, Izmir, Turkey
- Department of Anatomy Digital Imaging and 3D Modelling Laboratory, Faculty of Medicine, Ege University School of Medicine, TR-35100, Izmir, Turkey
- Department of Radiology, University of Ottawa Faculty of Medicine and The Ottawa Hospital Research, Institute, Ottawa, Ontario, Canada
| | - Asli Beril Karakas
- Department of Anatomy Digital Imaging and 3D Modelling Laboratory, Faculty of Medicine, Ege University School of Medicine, TR-35100, Izmir, Turkey
| | - Mehmet Asim Ozer
- Department of Anatomy Digital Imaging and 3D Modelling Laboratory, Faculty of Medicine, Ege University School of Medicine, TR-35100, Izmir, Turkey
| | - Ali Murat Koc
- Department of Radiology, University of Health Sciences Bozyaka Education and Training Hospital, Izmir, Turkey
| | - Figen Govsa
- Department of Anatomy Digital Imaging and 3D Modelling Laboratory, Faculty of Medicine, Ege University School of Medicine, TR-35100, Izmir, Turkey.
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Chernov IV, Kutin MA, Kheyreddin AS, Konovalov AN, Shekhtman OD, Eliava SS, Kalinin PL. [Combination of pituitary adenomas and intracranial aneurysms]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2021; 85:94-103. [PMID: 33560625 DOI: 10.17116/neiro20218501194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The combination of intracranial tumors and asymptomatic brain aneurysms is an urgent problem, since it can significantly affect surgical intervention. Aneurysms are common in patients with meningioma, glioma and pituitary adenoma. According to certain authors, combination of aneurysms with pituitary adenomas is 7 times more common than with other tumors. In these cases, a comprehensive examination of the patient and decision-making on surgical strategy are required. This review is devoted to epidemiology, diagnosis and treatment of patients with a combination of pituitary adenomas and intracranial aneurysms detected intraoperatively or at the preoperative stage. The manuscript is illustrated by cases observed at the Burdenko Neurosurgery Center.
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Affiliation(s)
- I V Chernov
- Burdenko Neurosurgery Center, Moscow, Russia
| | - M A Kutin
- Burdenko Neurosurgery Center, Moscow, Russia
| | | | | | | | | | - P L Kalinin
- Burdenko Neurosurgery Center, Moscow, Russia
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11
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Molenberg R, Aalbers MW, Metzemaekers JDM, Mazuri A, Luijckx GJ, Groen RJM, Uyttenboogaart M, van Dijk JMC. Clinical relevance of short-term follow-up of unruptured intracranial aneurysms. Neurosurg Focus 2020; 47:E7. [PMID: 31261130 DOI: 10.3171/2019.4.focus1995] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 04/09/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Unruptured intracranial aneurysms are common incidental findings on brain imaging. Short-term follow-up for conservatively treated aneurysms is routinely performed in most cerebrovascular centers, although its clinical relevance remains unclear. In this study, the authors assessed the extent of growth as well as the rupture risk during short-term follow-up of conservatively treated unruptured intracranial aneurysms. In addition, the influence of patient-specific and aneurysm-specific factors on growth and rupture risk was investigated. METHODS The authors queried their prospective institutional neurovascular registry to identify patients with unruptured intracranial aneurysms and short-term follow-up imaging, defined as follow-up MRA and/or CTA within 3 months to 2 years after initial diagnosis. Medical records and questionnaires were used to acquire baseline information. The authors measured aneurysm size at baseline and at follow-up to detect growth. Rupture was defined as a CT scan-proven and/or CSF-proven subarachnoid hemorrhage (SAH). RESULTS A total of 206 consecutive patients with 267 conservatively managed unruptured aneurysms underwent short-term follow-up at the authors' center. Seven aneurysms (2.6%) enlarged during a median follow-up duration of 1 year (range 0.3-2.0 years). One aneurysm (0.4%) ruptured 10 months after initial discovery. Statistically significant risk factors for growth or rupture were autosomal-dominant polycystic kidney disease (RR 8.3, 95% CI 2.0-34.7), aspect ratio > 1.6 or size ratio > 3 (RR 10.8, 95% CI 2.2-52.2), and initial size ≥ 7 mm (RR 10.7, 95% CI 2.7-42.8). CONCLUSIONS Significant growth of unruptured intracranial aneurysms may occur in a small proportion of patients during short-term follow-up. As aneurysm growth is associated with an increased risk of rupture, the authors advocate that short-term follow-up is clinically relevant and has an important role in reducing the risk of a potential SAH.
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Affiliation(s)
| | | | | | - Aryan Mazuri
- 3Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Maarten Uyttenboogaart
- 2Neurology, and.,3Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Chong BW, Bendok BR, Krishna C, Sattur M, Brown BL, Tawk RG, Miller DA, Rangel-Castilla L, Babiker H, Frakes DH, Theiler A, Cloft H, Kallmes D, Lanzino G. A Multicenter Pilot Study on the Clinical Utility of Computational Modeling for Flow-Diverter Treatment Planning. AJNR Am J Neuroradiol 2019; 40:1759-1765. [PMID: 31558504 PMCID: PMC7028542 DOI: 10.3174/ajnr.a6222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 08/05/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Selection of the correct flow-diverter size is critical for cerebral aneurysm treatment success, but it remains challenging due to the interplay of device size, anatomy, and deployment. Current convention does not address these challenges well. The goals of this pilot study were to determine whether computational modeling improves flow-diverter sizing over current convention and to validate simulated deployments. MATERIALS AND METHODS Seven experienced neurosurgeons and interventional neuroradiologists used computational modeling to prospectively plan 19 clinical interventions. In each patient case, physicians simulated 2-4 flow-diverter sizes that were under consideration based on preprocedural imaging. In addition, physicians identified a preferred device size using the current convention. A questionnaire on the impact of computational modeling on the procedure was completed immediately after treatment. Rotational angiography image data were acquired after treatment and compared with flow-diverter simulations to validate the output of the software platform. RESULTS According to questionnaire responses, physicians found the simulations useful for treatment planning, and they increased their confidence in device selection in 94.7% of cases. After viewing the simulations results, physicians selected a device size that was different from the original conventionally planned device size in 63.2% of cases. The average absolute difference between clinical and simulated flow-diverter lengths was 2.1 mm. In 57% of cases, average simulated flow-diverter diameters were within the measurement uncertainty of clinical flow-diverter diameters. CONCLUSIONS Physicians found computational modeling to be an impactful and useful tool for flow-diverter treatment planning. Validation results showed good agreement between simulated and clinical flow-diverter diameters and lengths.
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Affiliation(s)
- B W Chong
- From the Department of Neurosurgery (B.W.C., B.R.B., C.K., M.S.), Mayo Clinic, Phoenix, Arizona
- Department of Biological and Health Systems Engineering (B.W.C., D.H.F.), Arizona State University, Tempe, Arizona
| | - B R Bendok
- From the Department of Neurosurgery (B.W.C., B.R.B., C.K., M.S.), Mayo Clinic, Phoenix, Arizona
| | - C Krishna
- From the Department of Neurosurgery (B.W.C., B.R.B., C.K., M.S.), Mayo Clinic, Phoenix, Arizona
| | - M Sattur
- From the Department of Neurosurgery (B.W.C., B.R.B., C.K., M.S.), Mayo Clinic, Phoenix, Arizona
| | - B L Brown
- Department of Neurosurgery (B.L.B., R.G.T., D.A.M.), Mayo Clinic, Jacksonville, Florida
| | - R G Tawk
- Department of Neurosurgery (B.L.B., R.G.T., D.A.M.), Mayo Clinic, Jacksonville, Florida
| | - D A Miller
- Department of Neurosurgery (B.L.B., R.G.T., D.A.M.), Mayo Clinic, Jacksonville, Florida
| | - L Rangel-Castilla
- Department of Neurosurgery (L.R.-C., A.T., H.C., D.K., G.L.), Mayo Clinic, Rochester, Minnesota
| | - H Babiker
- Endovantage, LLC (H.B.), Phoenix, Arizona
| | - D H Frakes
- Department of Biological and Health Systems Engineering (B.W.C., D.H.F.), Arizona State University, Tempe, Arizona
| | - A Theiler
- Department of Neurosurgery (L.R.-C., A.T., H.C., D.K., G.L.), Mayo Clinic, Rochester, Minnesota
| | - H Cloft
- Department of Neurosurgery (L.R.-C., A.T., H.C., D.K., G.L.), Mayo Clinic, Rochester, Minnesota
| | - D Kallmes
- Department of Neurosurgery (L.R.-C., A.T., H.C., D.K., G.L.), Mayo Clinic, Rochester, Minnesota
| | - G Lanzino
- Department of Neurosurgery (L.R.-C., A.T., H.C., D.K., G.L.), Mayo Clinic, Rochester, Minnesota
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13
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Macaya F, Moreu M, Ruiz-Pizarro V, Salazar CH, Pozo E, Aldazábal A, Guerra R, Rosati S, Salinas P, Gonzalo N, Pérez-Vizcayno MJ, Pérez de Isla L, Fernández-Ortiz A, Macaya C, Adlam D, Arrazola J, Escaned J. Screening of extra-coronary arteriopathy with magnetic resonance angiography in patients with spontaneous coronary artery dissection: a single-centre experience. Cardiovasc Diagn Ther 2019; 9:229-238. [PMID: 31275813 DOI: 10.21037/cdt.2019.04.09] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Current consensus recommends extended vascular investigation in patients with spontaneous coronary artery dissection (SCAD). We here report our experience with the use of magnetic resonance angiography (MRA) for screening extra-coronary arteriopathy in patients presenting with SCAD. Methods Patients presenting with SCAD in a Spanish centre underwent prospective contrast-enhanced MRA to assess the cephalic and abdominopelvic arterial territories. Fibromuscular dysplasia (FMD) was diagnosed following European consensus criteria. Other vascular abnormalities were recorded separately. Two vascular radiologists supervised the acquisitions and independently analysed the results for all cases. Results Forty patients with SCAD [mean age 50.9±8.6 years, 90% (n=36) women] were included in the study, 12 patients declined to participate and 5 were excluded (metallic implanted devices). All enrolled patients underwent the screening protocol without complications. MRA demonstrated at least one extra-coronary vascular abnormality in 16 patients (40%): 5 (12.5%) were diagnosed with FMD, 6 (15%) showed arterial tortuosity, 3 (7.5%) had non-FMD focal stenoses, and 2 (5%) were found to have small aneurysms at the celiac trunk and splenic artery. No intracranial aneurysms were detected. At a mean follow-up of 4±3 years from the index episode, two cases experienced SCAD recurrences, one in a patient with FMD and the other one in a patient with arterial tortuosity. No deaths or strokes occurred. Conclusions Systematic extended vascular study with MRA was feasible and demonstrated associated extra-coronary arteriopathy in a substantial proportion of patients presenting with SCAD; however, none required additional intervention or led to vascular events. MRA, being a radiation-free modality, may be the preferred method for screening extracoronary arteriopathy in SCAD, a condition primarily affecting young and middle-age women sensitive to the risks of radiation.
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Affiliation(s)
- Fernando Macaya
- Hospital Clínico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | - Manuel Moreu
- Hospital Clínico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | | | - Carlos H Salazar
- Hospital Clínico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | - Eduardo Pozo
- Hospital Clínico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | - Andrés Aldazábal
- Hospital Clínico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | - Reddy Guerra
- Hospital Clínico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | - Santiago Rosati
- Hospital Clínico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | - Pablo Salinas
- Hospital Clínico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | - Nieves Gonzalo
- Hospital Clínico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | | | | | | | - Carlos Macaya
- Hospital Clínico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | - David Adlam
- Leicester NIHR Biomedical Research Unit, Glenfield Hospital, Leicester University, Leicester, UK
| | - Juan Arrazola
- Hospital Clínico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | - Javier Escaned
- Hospital Clínico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
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Prevalence of Unruptured Intracranial Aneurysms Coexisting with Pituitary Adenomas. World Neurosurg 2019; 126:e526-e533. [DOI: 10.1016/j.wneu.2019.02.084] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 02/18/2019] [Accepted: 02/19/2019] [Indexed: 12/20/2022]
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Asymptomatic unruptured intracranial aneurysms in the older people. Eur Geriatr Med 2019; 10:119-127. [PMID: 32720269 PMCID: PMC7385013 DOI: 10.1007/s41999-018-0122-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 10/11/2018] [Indexed: 11/20/2022]
Abstract
Purpose Unruptured intracranial aneurysm commonly occurs in the older people. Because the rupture risk increases with age, the factors associated with aneurysms might be different according to age. We aimed to evaluate unruptured intracranial aneurysm characteristics in healthy, symptom-free older patients. Methods Patients who visited the health examination center of two regional university hospitals and underwent computed tomography angiography between March 2001 and March 2017 were included. The putative aneurysm risk factors were identified; the aneurysm size and shape were determined by CT angiography, and measuring the ASPECT and dome/neck ratios. All images were interpreted independently by a neurosurgeon and a neurologist for improving size measurement accuracy. Results The unruptured intracranial aneurysm prevalence was 2.23% and 2.75% in the patients aged ≤ 60 and > 60 years, respectively. Among the younger group, female sex [odds ratio (OR), 1.85; P = 0.002], age (OR, 1.05; P < 0.001), hypertension (OR, 1.88; P < 0.001), coronary artery disease (OR, 0.26; P < 0.001), smoking (OR, 2.04; P < 0.001), and stroke family history (OR, 1.36; P = 0.047) were independently associated with aneurysm; anterior communicating artery aneurysms were the largest. Among the older group, female sex (OR, 1.76; P = 0.005), hypertension (OR, 2.54; P < 0.001), coronary artery disease (OR, 0.27; P < 0.001), and stroke family history (OR, 1.94; P = 0.003) were independently associated with aneurysm; internal carotid artery aneurysms were the largest. Conclusions The factors related to unruptured intracranial aneurysm formation varied by age, and coronary artery disease protected against aneurysm formation regardless of age. The factors affecting unruptured intracranial aneurysm formation are different according to age and aneurysm location.
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Castier J, Portella T, Ricolfi F, Thouant P. Metastatic fusiform aneurysms from atrial myxoma: A case report and literature review. J Neuroradiol 2017; 44:400-403. [DOI: 10.1016/j.neurad.2017.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 06/20/2017] [Accepted: 06/30/2017] [Indexed: 11/29/2022]
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