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Ma Z, Zhuang Y, Long X, Yu B, Li J, Yang Y, Yu Y. Modeling and evaluation of biomechanics and hemodynamic based on patient-specific small intracranial aneurysm using fluid-structure interaction. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 244:107963. [PMID: 38064956 DOI: 10.1016/j.cmpb.2023.107963] [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: 09/06/2023] [Revised: 11/20/2023] [Accepted: 11/29/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND AND OBJECTIVE Rupture of small intracranial aneurysm (IA) often leads to the development of highly fatal clinical syndromes such as subarachnoid hemorrhage. Due to the patient specificity of small IA, there are many difficulties in evaluating the rupture risk of small IA such as multiple influencing factors, high clinical experience requirements and poor reusability. METHODS In this study, clinical methods such as transcranial doppler (TCD) and magnetic resonance imaging (MRI) are used to obtain patient-specific parameters, and the fluid-structure interaction method (FSI) is used to model and evaluate the biomechanics and hemodynamics of patient-specific small IA. RESULTS The results show that a spiral vortex stably exists in the patient-specific small IA. Due to the small size of the patient-specific small IA, the blood flow velocity still maintains a high value with maximum reaching 3 m/s. The inertial impact of blood flow and vortex convection have certain influence on hemodynamic and biomechanics parameters. They cause three high value areas of WSSM on the patient-specific small IA with maximum of 180 Pa, 130 Pa and 110 Pa, respectively. They also cause two types of WSS concentration points, positive normal stress peak value areas and negative normal stress peak value areas to appear. CONCLUSION This paper found that the factors affecting hemodynamic parameters and biomechanical parameters are different. Unlike hemodynamic parameters, biomechanical parameters are also affected by blood pressure in addition to blood flow velocity. This study reveals the relationship between the flow field distribution and changes of patient-specific small IA, biomechanics and hemodynamics.
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Affiliation(s)
- Zijian Ma
- Guangdong Key Laboratory of Environmental Catalysis and Health Risk Control, School of Environmental Science and Engineering, Institute of Environmental Health and Pollution Control, Guangdong University of Technology, Guangzhou, 510006, China
| | - Yijie Zhuang
- Guangdong Key Laboratory of Environmental Catalysis and Health Risk Control, School of Environmental Science and Engineering, Institute of Environmental Health and Pollution Control, Guangdong University of Technology, Guangzhou, 510006, China.
| | - Xiaoao Long
- Neurosurgery Department, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524023, Guangdong, China.
| | - Bo Yu
- Neurosurgery Department, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524023, Guangdong, China
| | - Jiawang Li
- Neurosurgery Department, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524023, Guangdong, China
| | - Yan Yang
- Guangdong Key Laboratory of Environmental Catalysis and Health Risk Control, School of Environmental Science and Engineering, Institute of Environmental Health and Pollution Control, Guangdong University of Technology, Guangzhou, 510006, China; Synergy Innovation Institute of GDUT, Shantou 515041, Guangdong, China
| | - Yingxin Yu
- Guangdong Key Laboratory of Environmental Catalysis and Health Risk Control, School of Environmental Science and Engineering, Institute of Environmental Health and Pollution Control, Guangdong University of Technology, Guangzhou, 510006, China; Synergy Innovation Institute of GDUT, Shantou 515041, Guangdong, China
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Saalfeld S, Stahl J, Korte J, Miller Marsh LM, Preim B, Beuing O, Cherednychenko Y, Behme D, Berg P. Can Endovascular Treatment of Fusiform Intracranial Aneurysms Restore the Healthy Hemodynamic Environment?–A Virtual Pilot Study. Front Neurol 2022; 12:771694. [PMID: 35140672 PMCID: PMC8818669 DOI: 10.3389/fneur.2021.771694] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/08/2021] [Indexed: 11/13/2022] Open
Abstract
Numerous studies assess intracranial aneurysm rupture risk based on morphological and hemodynamic parameter analysis in addition to clinical information such as aneurysm localization, age, and sex. However, intracranial aneurysms mostly occur with a saccular shape located either lateral to the parent artery or at a bifurcation. In contrast, fusiform intracranial aneurysms (FIAs), i.e., aneurysms with a non-saccular, dilated form, occur in approximately 3–13% of all cases and therefore have not yet been as thoroughly studied. To improve the understanding of FIA hemodynamics, this pilot study contains morphological analyses and image-based blood flow simulations in three patient-specific cases. For a precise and realistic comparison to the pre-pathological state, each dilation was manually removed and the time-dependent blood flow simulations were repeated. Additionally, a validated fast virtual stenting approach was applied to evaluate the effect of virtual endovascular flow-diverter deployment focusing on relevant hemodynamic quantities. For two of the three patients, post-interventional information was available and included in the analysis. The results of this numerical pilot study indicate that complex flow structures, i.e., helical flow phenomena and the presence of high oscillating flow features, predominantly occur in FIAs with morphologically differing appearances. Due to the investigation of the individual healthy states, the original flow environment could be restored which serves as a reference for the virtual treatment target. It was shown that the realistic deployment led to a considerable stabilization of the individual hemodynamics in all cases. Furthermore, a quantification of the stent-induced therapy effect became feasible for the treating physician. The results of the morphological and hemodynamic analyses in this pilot study show that virtual stenting can be used in FIAs to quantify the effect of the planned endovascular treatment.
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Affiliation(s)
- Sylvia Saalfeld
- Research Campus STIMULATE, University of Magdeburg, Magdeburg, Germany
- Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
- *Correspondence: Sylvia Saalfeld
| | - Janneck Stahl
- Research Campus STIMULATE, University of Magdeburg, Magdeburg, Germany
- Department of Fluid Dynamics and Technical Flows, University of Magdeburg, Magdeburg, Germany
| | - Jana Korte
- Research Campus STIMULATE, University of Magdeburg, Magdeburg, Germany
- Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
| | - Laurel Morgan Miller Marsh
- Research Campus STIMULATE, University of Magdeburg, Magdeburg, Germany
- Department of Fluid Dynamics and Technical Flows, University of Magdeburg, Magdeburg, Germany
- Department of Mechanical Engineering, University of Washington, Seattle, WA, United States
| | - Bernhard Preim
- Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
| | - Oliver Beuing
- Department of Radiology, AMEOS Hospital Bernburg, Bernburg, Germany
| | - Yurii Cherednychenko
- Endovascular Centre, Dnipropetrovsk Regional Clinical Hospital named after I.I. Mechnikov, Dnipro, Ukraine
| | - Daniel Behme
- Research Campus STIMULATE, University of Magdeburg, Magdeburg, Germany
- Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany
| | - Philipp Berg
- Research Campus STIMULATE, University of Magdeburg, Magdeburg, Germany
- Department of Fluid Dynamics and Technical Flows, University of Magdeburg, Magdeburg, Germany
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3
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Gaidzik F, Pravdivtseva M, Larsen N, Jansen O, Hövener JB, Berg P. Luminal enhancement in intracranial aneurysms: fact or feature?-A quantitative multimodal flow analysis. Int J Comput Assist Radiol Surg 2021; 16:1999-2008. [PMID: 34519953 PMCID: PMC8589743 DOI: 10.1007/s11548-021-02486-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 08/17/2021] [Indexed: 11/04/2022]
Abstract
Purpose Intracranial aneurysm (IA) wall enhancement on post-contrast vessel wall magnetic resonance imaging (VW-MRI) is assumed to be a biomarker for vessel wall inflammation and aneurysm instability. However, the exact factors contributing to enhancement are not yet clarified. This study investigates the relationship between luminal enhancement and intra-aneurysmal flow behaviour to assess the suitability of VW-MRI as a surrogate method for determining quantitative and qualitative flow behaviour in the aneurysm sac. Methods VW-MRI signal is measured in the lumen of three patient-specific IA flow models and compared with the intra-aneurysmal flow fields obtained using phase-contrast magnetic resonance imaging (PC-MRI) and computational fluid dynamics (CFD). The IA flow models were supplied with two different time-varying flow regimes. Results Overall, the velocity fields acquired using PC-MRI or CFD were in good agreement with the VW-MRI enhancement patterns. Generally, the regions with slow-flowing blood show higher VW-MRI signal intensities, whereas high flow leads to a suppression of the signal. For all aneurysm models, a signal value above three was associated with velocity values below three cm/s. Conclusion Regions with lower enhancements have been correlated with the slow and high flow at the same time. Thus, further factors like flow complexity and stability can contribute to flow suppression in addition to the flow magnitude. Nevertheless, VW-MRI can qualitatively assess intra-aneurysmal flow phenomena and estimate the velocity range present in the corresponding region.
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Affiliation(s)
- Franziska Gaidzik
- Laboratory of Fluid Dynamics and Technical Flows, Otto-von-Guericke University, University of Magdeburg, Forschungscampus STIMULATE, Universitätsplatz 3, 39106, Magdeburg, Germany.
| | - Mariya Pravdivtseva
- Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), Kiel University, Kiel, Germany.,Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - Naomi Larsen
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - Jan-Bernd Hövener
- Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), Kiel University, Kiel, Germany.,Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - Philipp Berg
- Laboratory of Fluid Dynamics and Technical Flows, Otto-von-Guericke University, University of Magdeburg, Forschungscampus STIMULATE, Universitätsplatz 3, 39106, Magdeburg, Germany
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4
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Neyazi B, Swiatek VM, Skalej M, Beuing O, Stein KP, Hattingen J, Preim B, Berg P, Saalfeld S, Sandalcioglu IE. Rupture risk assessment for multiple intracranial aneurysms: why there is no need for dozens of clinical, morphological and hemodynamic parameters. Ther Adv Neurol Disord 2020; 13:1756286420966159. [PMID: 33403004 PMCID: PMC7739206 DOI: 10.1177/1756286420966159] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 09/21/2020] [Indexed: 12/23/2022] Open
Abstract
Introduction: A multitude of approaches have been postulated for assessing the risk of intracranial aneurysm rupture. However, the amount of potential predictive factors is not applicable in clinical practice and they are rejected in favor of the more practical PHASES score. For the subgroup of multiple intracranial aneurysms (MIAs), the PHASES score might severely underestimate the rupture risk, as only the aneurysm with the largest diameter is considered for risk evaluation. Methods: In this study, we investigated 38 patients harboring a total number of 87 MIAs with respect to their morphological and hemodynamical characteristics. For the determination of the best suited parameters regarding their predictive power for aneurysm rupture, we conducted three phases of statistical evaluation. The statistical analysis aimed to identify parameters that differ significantly between ruptured and unruptured aneurysms, show smallest possible correlations among each other and have a high impact on rupture risk prediction. Results: Significant differences between ruptured and unruptured aneurysms were found in 16 out of 49 parameters. The lowest correlation were found for gamma, aspect ratio (AR1), aneurysm maximal relative residence time (Aneurysm_RRT_max) and aneurysm mean relative residence time. The data-driven parameter selection yielded a significant correlation of only two parameters (AR1 and the Aneurysm_RRT_max) with rupture state (area under curve = 0.75). Conclusion: A high number of established morphological and hemodynamical parameters seem to have no or only low effect on prediction of aneurysm rupture in patients with MIAs. For best possible rupture risk assessment of patients with MIAs, only the morphological parameter AR1 and the hemodynamical parameter Aneurysm_RRT_max need to be included in the prediction model.
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Affiliation(s)
- Belal Neyazi
- Department of Neurosurgery, Otto-von-Guericke University, Leipziger Straße 44, Magdeburg, Saxony Anhalt 39120, Germany
| | - Vanessa M Swiatek
- Department of Neurosurgery, Otto-von-Guericke University, Magdeburg, Saxony Anhalt, Germany
| | - Martin Skalej
- Department of Neuroradiology, Otto-von-Guericke University, Magdeburg, Saxony Anhalt, Germany
| | - Oliver Beuing
- Department of Neuroradiology, Otto-von-Guericke University, Magdeburg, Saxony Anhalt, Germany
| | - Klaus-Peter Stein
- Department of Neurosurgery, Otto-von-Guericke University, Magdeburg, Saxony Anhalt, Germany
| | - Jörg Hattingen
- Institute of Neuroradiology, KRH Klinikum Nordstadt, Hanover, Niedersachsen, Germany
| | - Bernhard Preim
- Department of Simulation and Graphics, Otto-von-Guericke University, Magdeburg, Saxony Anhalt, Germany
| | - Philipp Berg
- Department of Fluid Dynamics and Technical Flows, Otto-von-Guericke University, Magdeburg, Saxony Anhalt, Germany
| | - Sylvia Saalfeld
- Department of Simulation and Graphics, Otto-von-Guericke University, Magdeburg, Saxony Anhalt, Germany
| | - I Erol Sandalcioglu
- Department of Neurosurgery, Otto-von-Guericke University, Magdeburg, Saxony Anhalt, Germany
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5
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Larsen N, Flüh C, Saalfeld S, Voß S, Hille G, Trick D, Wodarg F, Synowitz M, Jansen O, Berg P. Multimodal validation of focal enhancement in intracranial aneurysms as a surrogate marker for aneurysm instability. Neuroradiology 2020; 62:1627-1635. [PMID: 32681192 PMCID: PMC7666674 DOI: 10.1007/s00234-020-02498-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/13/2020] [Indexed: 11/09/2022]
Abstract
Purpose Circumferential enhancement on MR vessel wall imaging has been proposed as a biomarker of a higher risk of rupture in intracranial aneurysms. Focal enhancement is frequently encountered in unruptured aneurysms, but its implication for risk stratification and patient management remains unclear. This study investigates the association of focal wall enhancement with hemodynamic and morphological risk factors and histologic markers of wall inflammation and degeneration. Methods Patients with an unruptured middle cerebral artery aneurysm who underwent 3D rotational angiography and 3T MR vessel wall imaging showing focal wall enhancement were included. Hemodynamic parameters were calculated based on flow simulations and compared between enhanced regions and the entire aneurysm surface. Morphological parameters were semiautomatically extracted and quantitatively associated with wall enhancement. Histological analysis included detection of vasa vasorum, CD34, and myeloperoxidase staining in a subset of patients. Results Twenty-two aneurysms were analyzed. Enhanced regions were significantly associated with lower AWSS, lower maxOSI, and increased LSA. In multivariate analysis, higher ellipticity index was an independent predictor of wall enhancement. Histologic signs of inflammation and degeneration and higher PHASES score were significantly associated with focal enhancement. Conclusion Focal wall enhancement is colocalized with hemodynamic factors that have been related to a higher rupture risk. It is correlated with morphological factors linked to rupture risk, higher PHASES score, and histologic markers of wall destabilization. The results support the hypothesis that focal enhancement could serve as a surrogate marker for aneurysm instability.
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Affiliation(s)
- Naomi Larsen
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein Campus Kiel, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Germany.
| | - Charlotte Flüh
- Department of Neurosurgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Sylvia Saalfeld
- Forschungscampus STIMULATE, University of Magdeburg, Magdeburg, Germany.,Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
| | - Samuel Voß
- Forschungscampus STIMULATE, University of Magdeburg, Magdeburg, Germany.,Institute of Fluid Dynamics and Thermodynamics, University of Magdeburg, Magdeburg, Germany
| | - Georg Hille
- Forschungscampus STIMULATE, University of Magdeburg, Magdeburg, Germany.,Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
| | - David Trick
- Institute of Pathology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Fritz Wodarg
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein Campus Kiel, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Germany
| | - Michael Synowitz
- Department of Neurosurgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein Campus Kiel, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Germany
| | - Philipp Berg
- Forschungscampus STIMULATE, University of Magdeburg, Magdeburg, Germany.,Institute of Fluid Dynamics and Thermodynamics, University of Magdeburg, Magdeburg, Germany
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Rajagopal N, Yamada Y, Balaji A, Kawase T, Kato Y. Rare cases of multiple unruptured intracranial aneurysms: Illustrative report and review on management options. INTERDISCIPLINARY NEUROSURGERY 2019. [DOI: 10.1016/j.inat.2019.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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7
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Rajagopal N, Balaji A, Yamada Y, Kawase T, Kato Y. Etiopathogenesis, clinical presentation and management options of mirror aneurysms: A comparative analysis with non-mirror multiple aneurysms. INTERDISCIPLINARY NEUROSURGERY 2019. [DOI: 10.1016/j.inat.2019.100535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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8
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Rajabzadeh-Oghaz H, Wang J, Varble N, Sugiyama SI, Shimizu A, Jing L, Liu J, Yang X, Siddiqui AH, Davies JM, Meng H. Novel Models for Identification of the Ruptured Aneurysm in Patients with Subarachnoid Hemorrhage with Multiple Aneurysms. AJNR Am J Neuroradiol 2019; 40:1939-1946. [PMID: 31649161 DOI: 10.3174/ajnr.a6259] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 08/23/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE In patients with SAH with multiple intracranial aneurysms, often the hemorrhage pattern does not indicate the rupture source. Angiographic findings (intracranial aneurysm size and shape) could help but may not be reliable. Our purpose was to test whether existing parameters could identify the ruptured intracranial aneurysm in patients with multiple intracranial aneurysms and whether composite predictive models could improve the identification. MATERIALS AND METHODS We retrospectively collected angiographic and medical records of 93 patients with SAH with at least 2 intracranial aneurysms (total of 206 saccular intracranial aneurysms, 93 ruptured), in which the ruptured intracranial aneurysm was confirmed through surgery or definitive hemorrhage patterns. We calculated 13 morphologic and 10 hemodynamic parameters along with location and type (sidewall/bifurcation) and tested their ability to identify rupture in the 93 patients. To build predictive models, we randomly assigned 70 patients to training and 23 to holdout testing cohorts. Using a linear regression model with a customized cost function and 10-fold cross-validation, we trained 2 rupture identification models: RIMC using all parameters and RIMM excluding hemodynamics. RESULTS The 25 study parameters had vastly different positive predictive values (31%-87%) for identifying rupture, the highest being size ratio at 87%. RIMC incorporated size ratio, undulation index, relative residence time, and type; RIMM had only size ratio, undulation index, and type. During cross-validation, positive predictive values for size ratio, RIMM, and RIMC were 86% ± 4%, 90% ± 4%, and 93% ± 4%, respectively. In testing, size ratio and RIMM had positive predictive values of 85%, while RIMC had 92%. CONCLUSIONS Size ratio was the best individual factor for identifying the ruptured aneurysm; however, RIMC, followed by RIMM, outperformed existing parameters.
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Affiliation(s)
- H Rajabzadeh-Oghaz
- From the Canon Stroke and Vascular Research Center (H.R.-O., N.V., A.H.S., J.M.D., H.M.).,Departments of Mechanical and Aerospace Engineering (H.R.-O., N.V., H.M.)
| | - J Wang
- Biostatistics (J.W.), University at Buffalo, Buffalo, New York
| | - N Varble
- From the Canon Stroke and Vascular Research Center (H.R.-O., N.V., A.H.S., J.M.D., H.M.).,Departments of Mechanical and Aerospace Engineering (H.R.-O., N.V., H.M.)
| | - S-I Sugiyama
- Department of Neuroanesthesia (S.-I.S.), Kohnan Hospital, Sendai, Japan.,Department of Neurosurgery (S.-I.S., A.S.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - A Shimizu
- Department of Neurosurgery (S.-I.S., A.S.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - L Jing
- Department of Interventional Neuroradiology (L.J., J.L., X.Y., H.M.), Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - J Liu
- Department of Interventional Neuroradiology (L.J., J.L., X.Y., H.M.), Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - X Yang
- Department of Interventional Neuroradiology (L.J., J.L., X.Y., H.M.), Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - A H Siddiqui
- From the Canon Stroke and Vascular Research Center (H.R.-O., N.V., A.H.S., J.M.D., H.M.).,Departments of Neurosurgery (A.H.S., J.M.D.).,Radiology (A.H.S.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.,Jacobs Institute (A.H.S., J.M.D), Buffalo, New York
| | - J M Davies
- From the Canon Stroke and Vascular Research Center (H.R.-O., N.V., A.H.S., J.M.D., H.M.).,Departments of Neurosurgery (A.H.S., J.M.D.).,Bioinformatics (J.M.D.).,Jacobs Institute (A.H.S., J.M.D), Buffalo, New York
| | - H Meng
- From the Canon Stroke and Vascular Research Center (H.R.-O., N.V., A.H.S., J.M.D., H.M.) .,Departments of Mechanical and Aerospace Engineering (H.R.-O., N.V., H.M.).,Department of Interventional Neuroradiology (L.J., J.L., X.Y., H.M.), Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Berg P, Voß S, Janiga G, Saalfeld S, Bergersen AW, Valen-Sendstad K, Bruening J, Goubergrits L, Spuler A, Chiu TL, Tsang ACO, Copelli G, Csippa B, Paál G, Závodszky G, Detmer FJ, Chung BJ, Cebral JR, Fujimura S, Takao H, Karmonik C, Elias S, Cancelliere NM, Najafi M, Steinman DA, Pereira VM, Piskin S, Finol EA, Pravdivtseva M, Velvaluri P, Rajabzadeh-Oghaz H, Paliwal N, Meng H, Seshadhri S, Venguru S, Shojima M, Sindeev S, Frolov S, Qian Y, Wu YA, Carlson KD, Kallmes DF, Dragomir-Daescu D, Beuing O. Multiple Aneurysms AnaTomy CHallenge 2018 (MATCH)-phase II: rupture risk assessment. Int J Comput Assist Radiol Surg 2019; 14:1795-1804. [PMID: 31054128 DOI: 10.1007/s11548-019-01986-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 04/23/2019] [Indexed: 01/10/2023]
Abstract
PURPOSE Assessing the rupture probability of intracranial aneurysms (IAs) remains challenging. Therefore, hemodynamic simulations are increasingly applied toward supporting physicians during treatment planning. However, due to several assumptions, the clinical acceptance of these methods remains limited. METHODS To provide an overview of state-of-the-art blood flow simulation capabilities, the Multiple Aneurysms AnaTomy CHallenge 2018 (MATCH) was conducted. Seventeen research groups from all over the world performed segmentations and hemodynamic simulations to identify the ruptured aneurysm in a patient harboring five IAs. Although simulation setups revealed good similarity, clear differences exist with respect to the analysis of aneurysm shape and blood flow results. Most groups (12/71%) included morphological and hemodynamic parameters in their analysis, with aspect ratio and wall shear stress as the most popular candidates, respectively. RESULTS The majority of groups (7/41%) selected the largest aneurysm as being the ruptured one. Four (24%) of the participating groups were able to correctly select the ruptured aneurysm, while three groups (18%) ranked the ruptured aneurysm as the second most probable. Successful selections were based on the integration of clinically relevant information such as the aneurysm site, as well as advanced rupture probability models considering multiple parameters. Additionally, flow characteristics such as the quantification of inflow jets and the identification of multiple vortices led to correct predictions. CONCLUSIONS MATCH compares state-of-the-art image-based blood flow simulation approaches to assess the rupture risk of IAs. Furthermore, this challenge highlights the importance of multivariate analyses by combining clinically relevant metadata with advanced morphological and hemodynamic quantification.
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Affiliation(s)
| | - Samuel Voß
- University of Magdeburg, Magdeburg, Germany
| | | | | | | | | | | | | | | | | | | | | | - Benjamin Csippa
- Budapest University of Technology and Economics, Budapest, Hungary
| | - György Paál
- Budapest University of Technology and Economics, Budapest, Hungary
| | - Gábor Závodszky
- Budapest University of Technology and Economics, Budapest, Hungary
| | | | | | | | | | | | | | - Saba Elias
- Houston Methodist Research Institute, Houston, TX, USA
| | | | | | | | | | - Senol Piskin
- The University of Texas at San Antonio, San Antonio, TX, USA
| | - Ender A Finol
- The University of Texas at San Antonio, San Antonio, TX, USA
| | | | | | | | | | - Hui Meng
- State University of New York, Buffalo, NY, USA
| | | | | | | | | | | | - Yi Qian
- Macquarie University, Sydney, Australia
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10
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Goubergrits L, Hellmeier F, Bruening J, Spuler A, Hege HC, Voss S, Janiga G, Saalfeld S, Beuing O, Berg P. Multiple Aneurysms AnaTomy CHallenge 2018 (MATCH): uncertainty quantification of geometric rupture risk parameters. Biomed Eng Online 2019; 18:35. [PMID: 30909934 PMCID: PMC6434802 DOI: 10.1186/s12938-019-0657-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/19/2019] [Indexed: 03/04/2023] Open
Abstract
Background Geometric parameters have been proposed for prediction of cerebral aneurysm rupture risk. Predicting the rupture risk for incidentally detected unruptured aneurysms could help clinicians in their treatment decision. However, assessment of geometric parameters depends on several factors, including the spatial resolution of the imaging modality used and the chosen reconstruction procedure. The aim of this study was to investigate the uncertainty of a variety of previously proposed geometric parameters for rupture risk assessment, caused by variability of reconstruction procedures. Materials 26 research groups provided segmentations and surface reconstructions of five cerebral aneurysms as part of the Multiple Aneurysms AnaTomy CHallenge (MATCH) 2018. 40 dimensional and non-dimensional geometric parameters, describing aneurysm size, neck size, and irregularity of aneurysm shape, were computed. The medians as well as the absolute and relative uncertainties of the parameters were calculated. Additionally, linear regression analysis was performed on the absolute uncertainties and the median parameter values. Results A large variability of relative uncertainties in the range between 3.9 and 179.8% was found. Linear regression analysis indicates that some parameters capture similar geometric aspects. The lowest uncertainties < 6% were found for the non-dimensional parameters isoperimetric ratio, convexity ratio, and ellipticity index. Uncertainty of 2D and 3D size parameters was significantly higher than uncertainty of 1D parameters. The most extreme uncertainties > 80% were found for some curvature parameters. Conclusions Uncertainty analysis is essential on the road to clinical translation and use of rupture risk prediction models. Uncertainty quantification of geometric rupture risk parameters provided by this study may help support development of future rupture risk prediction models. Electronic supplementary material The online version of this article (10.1186/s12938-019-0657-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Leonid Goubergrits
- Institute for Computational and Imaging Science in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Florian Hellmeier
- Institute for Computational and Imaging Science in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Jan Bruening
- Institute for Computational and Imaging Science in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | | | | | - Samuel Voss
- Department of Fluid Dynamics and Technical Flows, University of Magdeburg, Magdeburg, Germany.,Forschungscampus STIMULATE, Magdeburg, Germany
| | - Gábor Janiga
- Department of Fluid Dynamics and Technical Flows, University of Magdeburg, Magdeburg, Germany.,Forschungscampus STIMULATE, Magdeburg, Germany
| | - Sylvia Saalfeld
- Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany.,Forschungscampus STIMULATE, Magdeburg, Germany
| | - Oliver Beuing
- Institute of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany.,Forschungscampus STIMULATE, Magdeburg, Germany
| | - Philipp Berg
- Department of Fluid Dynamics and Technical Flows, University of Magdeburg, Magdeburg, Germany.,Forschungscampus STIMULATE, Magdeburg, Germany
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Tekin E, Pehlivan M, Kitiş Ö. Cervical blood flow velocity values in patients with unilateral intracranial aneurysm: Preliminary results. ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2019. [DOI: 10.25000/acem.451820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Semiautomatic neck curve reconstruction for intracranial aneurysm rupture risk assessment based on morphological parameters. Int J Comput Assist Radiol Surg 2018; 13:1781-1793. [PMID: 30159832 DOI: 10.1007/s11548-018-1848-x] [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: 01/10/2018] [Accepted: 08/14/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Morphological parameters of intracranial aneurysms (IAs) are well established for rupture risk assessment. However, a manual measurement is error-prone, not reproducible and cumbersome. For an automatic extraction of morphological parameters, a 3D neck curve reconstruction approach to delineate the aneurysm from the parent vessel is required. METHODS We present a 3D semiautomatic aneurysm neck curve reconstruction for the automatic extraction of morphological parameters which was developed and evaluated with an experienced neuroradiologist. We calculate common parameters from the literature and include two novel angle-based parameters: the characteristic dome point angle and the angle difference of base points. RESULTS We applied our method to 100 IAs acquired with rotational angiography in clinical routine. For validation, we compared our approach to manual segmentations yielding highly significant correlations. We analyzed 95 of these datasets regarding rupture state. Statistically significant differences were found in ruptured and unruptured groups for maximum diameter, maximum height, aspect ratio and the characteristic dome point angle. These parameters were also found to statistically significantly correlate with each other. CONCLUSIONS The new 3D neck curve reconstruction provides robust results for all datasets. The reproducibility depends on the vessel tree centerline and the user input for the initial dome point and parameters characterizing the aneurysm neck region. The characteristic dome point angle as a new metric regarding rupture risk assessment can be extracted. It requires less computational effort than the complete neck curve reconstruction.
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