1
|
Veeturi SS, Hall S, Fujimura S, Mossa-Basha M, Sagues E, Samaniego EA, Tutino VM. Imaging of Intracranial Aneurysms: A Review of Standard and Advanced Imaging Techniques. Transl Stroke Res 2024:10.1007/s12975-024-01261-w. [PMID: 38856829 DOI: 10.1007/s12975-024-01261-w] [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: 04/16/2024] [Revised: 04/16/2024] [Accepted: 05/13/2024] [Indexed: 06/11/2024]
Abstract
The treatment of intracranial aneurysms is dictated by its risk of rupture in the future. Several clinical and radiological risk factors for aneurysm rupture have been described and incorporated into prediction models. Despite the recent technological advancements in aneurysm imaging, linear length and visible irregularity with a bleb are the only radiological measure used in clinical prediction models. The purpose of this article is to summarize both the standard imaging techniques, including their limitations, and the advanced techniques being used experimentally to image aneurysms. It is expected that as our understanding of advanced techniques improves, and their ability to predict clinical events is demonstrated, they become an increasingly routine part of aneurysm assessment. It is important that neurovascular specialists understand the spectrum of imaging techniques available.
Collapse
Affiliation(s)
- Sricharan S Veeturi
- Canon Stroke and Vascular Research Center, Clinical and Translational Research Center, University at Buffalo, 875 Ellicott Street, Buffalo, NY, 14214, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA
| | - Samuel Hall
- Department of Neurosurgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Soichiro Fujimura
- Department of Mechanical Engineering, Tokyo University of Science, Tokyo, Japan
- Division of Innovation for Medical Information Technology, The Jikei University School of Medicine, Tokyo, Japan
| | | | - Elena Sagues
- Department of Neurology, University of Iowa, Iowa City, IA, USA
| | | | - Vincent M Tutino
- Canon Stroke and Vascular Research Center, Clinical and Translational Research Center, University at Buffalo, 875 Ellicott Street, Buffalo, NY, 14214, USA.
- Department of Pathology and Anatomical Sciences, University at Buffalo, Buffalo, NY, USA.
| |
Collapse
|
2
|
Li Y, Huan L, Lu W, Li J, Wang H, Wang B, Song Y, Peng C, Wang J, Yang X, Hao J. Integrate prediction of machine learning for single ACoA rupture risk: a multicenter retrospective analysis. Front Neurol 2023; 14:1126640. [PMID: 37920830 PMCID: PMC10619904 DOI: 10.3389/fneur.2023.1126640] [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: 12/18/2022] [Accepted: 09/11/2023] [Indexed: 11/04/2023] Open
Abstract
Background Statistically, Anterior communicating aneurysm (ACoA) accounts for 30 to 35% of intracranial aneurysms. ACoA, once ruptured, will have an acute onset and cause severe neurological dysfunction and even death. Therefore, clinical analysis of risk factors related to ACoA and the establishment of prediction model are the benefits to the primary prevention of ACoA. Methods Among 1,436 cases of single ACoA patients, we screened 1,325 valid cases, classified risk factors of 1,124 cases in the ruptured group and 201 cases in the unruptured group, and assessed the risk factors, respectively, and predicted the risk of single ACoA rupture by using the logistic regression and the machine learning. Results In the ruptured group (84.8%) of 1,124 cases and the unruptured group (15.2%) of 201 cases, the multivariable logistic regression (MLR) model shows hemorrhagic stroke history (OR 95%CI, p:0.233 (0.120-0.454),<0.001) and the age stratification of 60-69 years (OR 95%CI, p:0.425 (0.271-0.668),<0.001) has a significant statistic difference. In the RandomForest (RF) model, hemorrhagic stroke history and age are the best predictive factors. Conclusion We combined the analysis of MLR, RF, and PCA models to conclude that hemorrhagic stroke history and gender affect single ACoA rupture. The RF model with web dynamic nomogram, allows for real-time personalized analysis based on different patients' conditions, which is a tremendous advantage for the primary prevention of single ACoA rupture. Clinical trial registration https://www.chictr.org.cn/showproj.html?proj=178501.
Collapse
Affiliation(s)
- Yang Li
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Linchun Huan
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Department of Neurosurgery, Linyi People's Hospital of Shandong Province, Linyi, Shandong, China
| | - Wenpeng Lu
- Department of Neurosurgery, The First People's Hospital of Jining, Jining, Shandong, China
| | - Jian Li
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Hongping Wang
- Department of Neurosurgery, Tangshan Workers Hospital, Tangshan, Hebei, China
| | - Bangyue Wang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yunfei Song
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Chao Peng
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Jiyue Wang
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Xinyu Yang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Jiheng Hao
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, Shandong, China
| |
Collapse
|
3
|
Zhang Y, Bai J, Kang F, Li W, Xiao Z, Ma Y, Chai E. A nomogram to predict the risk of bleeding after discharge from stent-assisted ruptured aneurysm embolization in a Chinese population. Neurosurg Rev 2023; 46:42. [PMID: 36707467 DOI: 10.1007/s10143-023-01952-2] [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: 10/27/2022] [Revised: 12/03/2022] [Accepted: 01/23/2023] [Indexed: 01/29/2023]
Abstract
The occurrence of bleeding events after stent-assisted embolization of a ruptured artery requiring continuous double antiplatelet therapy may seriously affect the prognosis of this group of patients. A nomogram can provide a personalized, more accurate risk estimate based on predictors. We, therefore, developed a nomogram to predict the probability of bleeding events in patients with stent-assisted ruptured aneurysm embolization. We performed a single-center retrospective analysis of data collected from patients undergoing stent-assisted ruptured aneurysm embolization between January 2018 and December 2021. Forward stepwise logistic regression was performed to identify independent predictors of adverse events of bleeding after stent-assisted embolization and to establish nomograms. Discrimination and calibration of this model were performed using the area under the ROC curve (AUC-ROC) and the calibration plot. The model is internally validated by using resampling (1000 replicates). A total of 131 patients were identified, and a total of 118 patients met the study criteria. The predictors included in the nomogram were body mass index (BMI), AAi, and MA-ADP. The model showed good resolving power with a ROC area of 0.893 (95% CI: 0.834 ~ 0.952) for this model with good calibration. The nomogram can be used to individualize, visualize, and accurately predict the risk probability of bleeding events after stent-assisted embolization of ruptured aneurysms.
Collapse
Affiliation(s)
- Yichuan Zhang
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, China
- Key Laboratory of Cerebrovascular Diseases in Gansu Province, Gansu Provincial Hospital, Lanzhou, China
| | - Jinbo Bai
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Fu Kang
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Wei Li
- Key Laboratory of Cerebrovascular Diseases in Gansu Province, Gansu Provincial Hospital, Lanzhou, China
- The First Clinical Medical College of Gansu, University of Traditional Chinese Medicine, Lanzhou, China
| | - Zaixing Xiao
- Key Laboratory of Cerebrovascular Diseases in Gansu Province, Gansu Provincial Hospital, Lanzhou, China
- The First Clinical Medical College of Gansu, University of Traditional Chinese Medicine, Lanzhou, China
| | - Yong Ma
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, China
- Key Laboratory of Cerebrovascular Diseases in Gansu Province, Gansu Provincial Hospital, Lanzhou, China
| | - Erqing Chai
- Key Laboratory of Cerebrovascular Diseases in Gansu Province, Gansu Provincial Hospital, Lanzhou, China.
- Cerebrovascular Disease Center, Gansu Provincial Hospital, No. 24 Donggang East Road, Lanzhou, Gansu, 730000, China.
- Emergency General Hospital, Beijing, China.
| |
Collapse
|
4
|
Risk factors for the rupture of mirror middle cerebral artery aneurysm using computer-assisted semiautomated measurement and hemodynamic analysis. J Stroke Cerebrovasc Dis 2022; 31:106841. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 10/01/2022] [Accepted: 10/03/2022] [Indexed: 11/21/2022] Open
|
5
|
Zhou J, Xia N, Li Q, Zheng K, Jia X, Wang H, Zhao B, Liu J, Yang Y, Chen Y. Predicting the rupture status of small middle cerebral artery aneurysms using random forest modeling. Front Neurol 2022; 13:921404. [PMID: 35968311 PMCID: PMC9366079 DOI: 10.3389/fneur.2022.921404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/05/2022] [Indexed: 01/04/2023] Open
Abstract
Objective Small intracranial aneurysms are increasingly being detected; however, a prediction model for their rupture is rare. Random forest modeling was used to predict the rupture status of small middle cerebral artery (MCA) aneurysms with morphological features. Methods From January 2009 to June 2020, we retrospectively reviewed patients with small MCA aneurysms (<7 mm). The aneurysms were randomly split into training (70%) and internal validation (30%) cohorts. Additional independent datasets were used for the external validation of 78 small MCA aneurysms from another four hospitals. Aneurysm morphology was determined using computed tomography angiography (CTA). Prediction models were developed using the random forest and multivariate logistic regression. Results A total of 426 consecutive patients with 454 small MCA aneurysms (<7 mm) were included. A multivariate logistic regression analysis showed that size ratio (SR), aspect ratio (AR), and daughter dome were associated with aneurysm rupture, whereas aneurysm angle and multiplicity were inversely associated with aneurysm rupture. The areas under the receiver operating characteristic (ROC) curves (AUCs) of random forest models using the five independent risk factors in the training, internal validation, and external validation cohorts were 0.922, 0.889, and 0.92, respectively. The random forest model outperformed the logistic regression model (p = 0.048). A nomogram was developed to assess the rupture of small MCA aneurysms. Conclusion Random forest modeling is a good tool for evaluating the rupture status of small MCA aneurysms and may be considered for the management of small aneurysms.
Collapse
Affiliation(s)
- Jiafeng Zhou
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Nengzhi Xia
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qiong Li
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Radiology, Wenzhou Central Hospital, Wenzhou, China
| | - Kuikui Zheng
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiufen Jia
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hao Wang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Bing Zhao
- Department of Neurosurgery, Renji Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jinjin Liu
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yunjun Yang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Yunjun Yang
| | - Yongchun Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Yongchun Chen
| |
Collapse
|
6
|
Xin S, Chen Y, Zhao B, Liang F. Combination of Morphological and Hemodynamic Parameters for Assessing the Rupture Risk of Intracranial Aneurysms: a Retrospective Study On Mirror Middle Cerebral Artery Aneurysms. J Biomech Eng 2022; 144:1135619. [PMID: 35147191 DOI: 10.1115/1.4053793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Indexed: 11/08/2022]
Abstract
Discordant findings were frequently reported by studies dedicated to exploring the association of morphological/hemodynamic factors with the rupture of intracranial aneurysms (IAs), probably owing to insufficient control of confounding factors. In this study, we aimed to minimize the influences of confounding factors by focusing IAs of interest on mirror aneurysms and, meanwhile, modeling IAs together with the cerebral arterial network to improve the physiological fidelity of hemodynamic simulation. 52 mirror aneurysms located at the middle cerebral artery (MCA) in 26 patients were retrospectively investigated. Numerical tests performed on two randomly selected patients demonstrated that over truncation of cerebral arteries proximal to the MCA during image-based model reconstruction led to uncertain changes in computed values of intra-aneurysmal hemodynamic parameters, which justified the minimal truncation strategy adopted in our study. Five morphological parameters (i.e., volume (V), height (H), dome area (DA), non-sphericity index (NSI), and size ratio (SR)) and two hemodynamic parameters (i.e., peak WSS (peakWSS), and pressure loss coefficient (PLc)) were found to differ significantly between the ruptured and unruptured aneurysms and proved by receiver operating characteristic (ROC) analysis to have potential value for differentiating the rupture status of aneurysm with the areas under curve (AUCs) ranging from 0.681 to 0.763. Integrating V, SR, peakWSS and PLc or some of them into regression models considerably improved the classification of aneurysms, elevating AUC up to 0.864, which indicates that morphological and hemodynamic parameters have complementary roles in assessing the risk of aneurysm rupture.
Collapse
Affiliation(s)
- Shangzhe Xin
- State Key Laboratory of Ocean Engineering, School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Yongchun Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang
| | - Bing Zhao
- Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Fuyou Liang
- State Key Laboratory of Ocean Engineering, School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
| |
Collapse
|
7
|
Scullen T, Mathkour M, Teja N, Dumont AS. Commentary: Aneurysm Wall Enhancement Is Associated With Decreased Intrasaccular IL-10 and Morphological Features of Instability. Neurosurgery 2021; 89:E215-E217. [PMID: 34318890 DOI: 10.1093/neuros/nyab279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 06/12/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tyler Scullen
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, Louisiana, USA
| | - Mansour Mathkour
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, Louisiana, USA
| | - Nikhil Teja
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Aaron S Dumont
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, Louisiana, USA
| |
Collapse
|
8
|
Al-Sharydah A, Al-Abdulwahhab A, Al-Suhibani S, Al-Muhanna A, Abohimed A, AlSharidah A, Alabbas F. The Analysis of Morphoradiological Parameters in Predicting Risk of Basilar Artery Tip Aneurysm Rupture: A Retrospective Cohort Study. Int J Gen Med 2021; 14:3335-3342. [PMID: 34285558 PMCID: PMC8285279 DOI: 10.2147/ijgm.s318880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/02/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Basilar artery tip aneurysms can have fatal consequences and poor prognostic outcomes in case of rupture. We investigated the standard parameters used to evaluate aneurysmal morphology to predict aneurysm rupture. Patients and Methods We measured the differences between ruptured and unruptured basilar bifurcation aneurysms in terms of morphological features, including aneurysm size, size ratio, aneurysm height, perpendicular height, aneurysm width, bottleneck ratio, aspect ratio, and present daughter domes, using 3D angiography. Results Among 34 patients, 21 (61.8%) and 13 (38.2%) had ruptured and unruptured basilar tip aneurysms, respectively. In the ruptured group, the mean aneurysm size, and aspect, size, and bottleneck ratios were 6.8 ± 1.9 mm, 3.2 ± 1.0, 2.3 ± 0.5, and 2.2 ± 0.4, respectively, compared to 4.5 ± 1.5 mm, 4.4 ± 2.0, 1.6 ± 0.4, and 2.7 ± 0.7, respectively, in the non-ruptured group. Univariate analysis showed a larger aneurysmal cross-sectional diameter (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.5-5.392; p < 0.05), a larger size ratio (OR, 21.375; 95% CI, 3.283-139.177; p < 0.05), and presence of a daughter dome (OR, 72.0; 95% CI, 6.7-776.5; p < 0.05) with ruptured basilar artery tip aneurysms. Conclusion A larger aneurysm size and size ratio, and the presence of a daughter dome were significantly associated with increased rupture risk in basilar tip aneurysms.
Collapse
Affiliation(s)
- Abdulaziz Al-Sharydah
- Diagnostic and Interventional Radiology Department, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Al-Khobar City, Eastern Province, Saudi Arabia
| | - Abdulrahman Al-Abdulwahhab
- Diagnostic and Interventional Radiology Department, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Al-Khobar City, Eastern Province, Saudi Arabia
| | - Sari Al-Suhibani
- Diagnostic and Interventional Radiology Department, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Al-Khobar City, Eastern Province, Saudi Arabia
| | - Afnan Al-Muhanna
- Diagnostic and Interventional Radiology Department, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Al-Khobar City, Eastern Province, Saudi Arabia
| | - Abdullah Abohimed
- Department of Medical Imaging, Ministry of National Guard Health Affairs, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdulmonem AlSharidah
- College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Al-Khobar City, Eastern Province, Saudi Arabia
| | - Faisal Alabbas
- College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Al-Khobar City, Eastern Province, Saudi Arabia
| |
Collapse
|