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Sturiale CL, Auricchio AM, Skrap B, Stifano V, Albanese A. The clinical challenge of subarachnoid hemorrhage associated with multiple aneurysms when the bleeding source is not certainly identifiable. J Neurosurg Sci 2024; 68:301-309. [PMID: 34763396 DOI: 10.23736/s0390-5616.21.05609-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Multiple intracranial aneurysms (IAs) are encountered in 20-30% of the subarachnoid hemorrhages (SAH). Neuroimaging and clinical examination are usually sufficient to detect the bleeding source, but sometimes it can be misdiagnosed with catastrophic consequences. METHODS We reviewed our diagnostic work-up for all patients admitted from January 2016 to December 2020 for SAH with multiple IAs accounting for our rate of diagnostic failure. Then, we grouped the patients into 4 categories according to aneurysms topography and described our operative protocol in case of uncertain bleeding origin. RESULTS Sixty-two patients harboring 161 IAs were included. The bleeding source was identified in 56 patients (90.3%), who harbored other 81 bystander aneurysms. In 6 cases (9.7%) with a total of 24 aneurysms we failed the bleeding source identification. According to IAs topography, we grouped the IAs multiplicity in: 1) anterior plus posterior circulation IAs; 2) multiple posterior circulation IAs; 3) bilateral anterior circulation IAs; and 4) multiple ipsilateral anterior circulation IAs. In case of unidentified bleeding source, key-elements favoring the simultaneous multiple IAs treatment were their number, morphology, topography, clinicians' experience, and management modality as endovascular treatment allows a faster exclusion of multiple IAs distant one each other compared with surgery. MCA involvement represented the more frequent reason to prefer multiple clipping rather than multiple coiling. CONCLUSIONS In a small percentage of patients with SAH with multiple IAs, bleeding source identification can be difficult. Until the routinely availability of new tools such as vessel wall imaging or computational fluid dynamics, an experienced neurovascular team and strategies aiming to simultaneously exclude multiple IAs remain mandatory.
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Affiliation(s)
- Carmelo L Sturiale
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy -
| | - Anna M Auricchio
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Benjamin Skrap
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vito Stifano
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessio Albanese
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Li W, Wang C, Wang Y, Zhao Y, Yang X, Liu X, Liu J. A model with multiple intracranial aneurysms: possible hemodynamic mechanisms of aneurysmal initiation, rupture and recurrence. Chin Neurosurg J 2024; 10:13. [PMID: 38711139 PMCID: PMC11071235 DOI: 10.1186/s41016-024-00364-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/26/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Hemodynamic factors play an important role in aneurysm initiation, growth, rupture, and recurrence, while the mechanism of the hemodynamic characteristics is still controversial. A unique model of multiple aneurysms (initiation, growth, rupture, and recurrence) is helpful to avoids the confounders and further explore the possible hemodynamic mechanisms of aneurysm in different states. METHODS We present a model with multiple aneurysms, and including the states of initiation, growth, rupture, and recurrence, discuss the proposed mechanisms, and describe computational fluid dynamic model that was used to evaluate the likely hemodynamic effect of different states of the aneurysms. RESULTS The hemodynamic analysis suggests that high flow impingement and high WSS distribution at normal parent artery was found before aneurysmal initiation. The WSS distribution and flow velocity were decreased in the new sac after aneurysmal growth. Low WSS was the risk hemodynamic factor for aneurysmal rupture. High flow concentration region on the neck plane after coil embolization still marked in recanalized aneurysm. CONCLUSIONS Associations have been identified between high flow impingement and aneurysm recanalization, while low WSS is linked to the rupture of aneurysms. High flow concentration and high WSS distribution at normal artery associated with aneurysm initiation and growth, while after growth, the high-risk hemodynamics of aneurysm rupture was occurred, which is low WSS at aneurysm dome.
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Affiliation(s)
- Wenqiang Li
- Department of Interventional Neuroradiology and Neurosurgery, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Beijing, China
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chao Wang
- Department of Interventional Neuroradiology and Neurosurgery, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Beijing, China
| | - Yanmin Wang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yapeng Zhao
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinjian Yang
- Department of Interventional Neuroradiology and Neurosurgery, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Beijing, China
| | - Xianzhi Liu
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Jian Liu
- Department of Interventional Neuroradiology and Neurosurgery, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Beijing, China.
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Guo KK, Liu CY, Li GH, Xiang JP, Leng XC, Cai YK, Hu XB. Differences and Correlations of Morphological and Hemodynamic Parameters between Anterior Circulation Bifurcation and Side-wall Aneurysms. Curr Med Sci 2024; 44:391-398. [PMID: 38517676 DOI: 10.1007/s11596-024-2846-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/16/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE The objective of this research was to explore the difference and correlation of the morphological and hemodynamic features between sidewall and bifurcation aneurysms in anterior circulation arteries, utilizing computational fluid dynamics as a tool for analysis. METHODS In line with the designated inclusion criteria, this study covered 160 aneurysms identified in 131 patients who received treatment at Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, China, from January 2021 to September 2022. Utilizing follow-up digital subtraction angiography (DSA) data, these cases were classified into two distinct groups: the sidewall aneurysm group and the bifurcation aneurysm group. Morphological and hemodynamic parameters in the immediate preoperative period were meticulously calculated and examined in both groups using a three-dimensional DSA reconstruction model. RESULTS No significant differences were found in the morphological or hemodynamic parameters of bifurcation aneurysms at varied locations within the anterior circulation. However, pronounced differences were identified between sidewall and bifurcation aneurysms in terms of morphological parameters such as the diameter of the parent vessel (Dvessel), inflow angle (θF), and size ratio (SR), as well as the hemodynamic parameter of inflow concentration index (ICI) (P<0.001). Notably, only the SR exhibited a significant correlation with multiple hemodynamic parameters (P<0.001), while the ICI was closely related to several morphological parameters (R>0.5, P<0.001). CONCLUSIONS The significant differences in certain morphological and hemodynamic parameters between sidewall and bifurcation aneurysms emphasize the importance to contemplate variances in threshold values for these parameters when evaluating the risk of rupture in anterior circulation aneurysms. Whether it is a bifurcation or sidewall aneurysm, these disparities should be considered. The morphological parameter SR has the potential to be a valuable clinical tool for promptly distinguishing the distinct rupture risks associated with sidewall and bifurcation aneurysms.
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Affiliation(s)
- Kai-Kai Guo
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Chang-Ya Liu
- Department of Emergency, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Gao-Hui Li
- Artery Flow Technology Co., Ltd., Hangzhou, 310051, China
| | | | | | - Yi-Ke Cai
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xue-Bin Hu
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Johnson MD, Palmisciano P, Yamani AS, Hoz SS, Prestigiacomo CJ. A Systematic Review and Meta-Analysis of 3-Dimensional Morphometric Parameters for Cerebral Aneurysms. World Neurosurg 2024; 183:214-226.e5. [PMID: 38160907 DOI: 10.1016/j.wneu.2023.12.131] [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: 10/21/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Imaging modalities with increased spatial resolution have allowed for more precise quantification of cerebral aneurysm shape in 3-dimensional (3D) space. We conducted a systematic review and meta-analysis to assess the correlation of individual 3D morphometric measures with cerebral aneurysm rupture status. METHODS Two independent reviewers performed a PRISMA (preferred reporting items of systematic reviews and meta-analysis)-guided literature search to identify articles reporting the association between 3D morphometric measures of intracranial aneurysms and rupture status. RESULTS A total of 15,122 articles were identified. After screening, 39 studies were included. We identified 17 3D morphometric measures, with 11 eligible for the meta-analysis. The meta-analysis showed a significant association with rupture status for the following measures: nonsphericity index (standardized mean difference [SMD], 0.66; 95% confidence interval [CI], 0.53-0.79; P < 0.0001; I2 = 55.2%), undulation index (SMD, 0.55; 95% CI, 0.26-0.85; P = 0.0017; I2 = 68.1%), ellipticity index (SMD, 0.53; 95% CI, 0.29-0.77; P = 0.0005; I2 = 70.8%), volume (SMD, 0.18; 95% CI, 0.02-0.35; P = 0.0320; I2 = 82.3%), volume/ostium ratio (SMD, 0.43; 95% CI, 0.16-0.71; P = 0.0075; I2 = 90.4%), elongation (SMD, -0.94; 95% CI, -1.12 to -0.76; P = 0.0005; I2 = 0%), flatness (SMD, -0.87; 95% CI, -1.04 to -0.71; P = 0.0005; I2 = 0%), and sphericity (SMD, -0.62; 95% CI, -1.06 to -0.17; P = 0.0215; I2 = 67.9%). A significant risk of publication bias was estimated for the ellipticity index (P = 0.0360) and volume (P = 0.0030). CONCLUSIONS Based on the results of a meta-analysis containing 39 studies, the nonsphericity index, undulation index, elongation, flatness, and sphericity demonstrated the most consistent correlation with rupture status.
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Affiliation(s)
- Mark D Johnson
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA; Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA.
| | - Paolo Palmisciano
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA; Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Ali S Yamani
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Samer S Hoz
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA; Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Charles J Prestigiacomo
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA; Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA
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Yi X, Zhang S, Han Q, Hong W, He B, Liu Y, Zheng R. Quantitative Evaluation of Hemodynamic Changes After Multiple Intracranial Aneurysms Occlusion Using Computational Fluid Dynamics. World Neurosurg 2024; 181:e918-e924. [PMID: 37949299 DOI: 10.1016/j.wneu.2023.11.014] [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: 09/18/2023] [Revised: 11/03/2023] [Accepted: 11/04/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE Multiple intracranial aneurysms (MIA) are prevalent. This study conducted hemodynamic calculations on MIA to analyze the effects of occlusion of the internal carotid artery (ICA) and middle cerebral artery (MCA) aneurysms on the hemodynamics of other arteries, as well as the issue of the treatment order for these aneurysms. METHODS The models of 9 patients with MIA were selected for the study. A computational fluid dynamics model combining 1-dimension and 3-dimension was used to obtain the vascular flow pattern and wall pressure. RESULTS There was increased pressure at the MCA and anterior cerebral artery (ACA) after occlusion of the aneurysm at the ICA. However, the pressure at the ICA has hardly changed after the aneurysm occlusion at the MCA. Occlusion of the aneurysm of different sizes at the MCA had almost no impact on the pressure at the ICA and ACA. For small aneurysm, the pressure of the ACA and MCA increases with decreasing size of the aneurysm at the ICA. After occlusion of a large aneurysm at the ICA, the impact on the pressure of the ACA and MCA is almost the same as after occlusion of a medium-sized aneurysm. CONCLUSIONS If the treatment order of ICA and MCA aneurysms cannot be determined based on patient factors and aneurysm characteristics, the MCA aneurysm should be treated as a priority.
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Affiliation(s)
- Xu Yi
- School of Mechanical Engineering and Automation, Fuzhou University, Fuzhou, China
| | - Shuhua Zhang
- School of Mechanical Engineering and Automation, Fuzhou University, Fuzhou, China
| | - Qicheng Han
- School of Mechanical Engineering and Automation, Fuzhou University, Fuzhou, China
| | - Wenyao Hong
- Fujian Engineering Research Center of Joint Intelligent Medical Engineering, Fuzhou, China; Department of Neurosurgery, Fujian Provincial Hospital, Fuzhou, China
| | - Bingwei He
- School of Mechanical Engineering and Automation, Fuzhou University, Fuzhou, China; Fujian Engineering Research Center of Joint Intelligent Medical Engineering, Fuzhou, China
| | - Yuqing Liu
- Fujian Engineering Research Center of Joint Intelligent Medical Engineering, Fuzhou, China; Department of Neurosurgery, Fujian Provincial Hospital, Fuzhou, China
| | - Rongye Zheng
- School of Mechanical Engineering and Automation, Fuzhou University, Fuzhou, China; Fujian Engineering Research Center of Joint Intelligent Medical Engineering, Fuzhou, China.
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Zhu Y, Zou R, Sun X, Lei X, Xiang J, Guo Z, Su H. Assessing the risk of intracranial aneurysm rupture using computational fluid dynamics: a pilot study. Front Neurol 2023; 14:1277278. [PMID: 38187159 PMCID: PMC10771834 DOI: 10.3389/fneur.2023.1277278] [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: 08/16/2023] [Accepted: 12/07/2023] [Indexed: 01/09/2024] Open
Abstract
Objective This study compared 2 representative cases with ruptured aneurysms to explore the role of hemodynamic and morphological parameters in evaluating the rupture risk of intracranial aneurysms (IAs). Methods CTA and 3-dimensional rotational angiography (3DRA) of 3 IAs in 2 patients were retrospectively analyzed in this study. Hemodynamics and morphological parameters were compared between a ruptured IA and an unruptured IA in case1, and between before and after aneurysm rupture in case 2. Results In case 1, the ruptured aneurysm had larger morphological parameters including size ratio (SR), aspect ratio (AR), aneurysm vessel angle (θF), Aneurysm inclination angle (θA), Undulation index (UI), Ellipticity index (EI), and Non-sphericity Index (NSI) than the unruptured aneurysm. And oscillatory shear index (OSI) is also larger. Higher rupture resemblance score (RRS) was shown in the ruptured aneurysm. In case 2, the aneurysm had one daughter sac after 2 years. Partial morphological and hemodynamic parameters including SR, AR, θF, θA, UI, EI, NSI, OSI, and relative residence time (RRT) increased, and normalized wall shear stress (NWSS) was significantly reduced. RRS increased during this period. Conclusion SR and OSI may have predictive values for the risk of intracranial aneurysm rupture. It is possible that WSS Changes before and after IA rupture, yet the influence of high or low WSS on growth and rupture of IA remains unclear. RRS is promising to be used in the clinical assessment of the rupture risk of IAs and to guide the formulation of treatment plans.
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Affiliation(s)
- Yajun Zhu
- Department of Neurosurgery, 1st Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rong Zou
- ArteryFlow Technology Co., Ltd., Hangzhou, China
| | - Xiaochuan Sun
- Department of Neurosurgery, 1st Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xingwei Lei
- Department of Neurosurgery, 1st Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | | | - Zongduo Guo
- Department of Neurosurgery, 1st Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hai Su
- Yongchuan Hospital of Chongqing Medical University, Chongqing, China
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Lin M, Xia N, Lin R, Xu L, Chen Y, Zhou J, Lin B, Zheng K, Wang H, Jia X, Liu J, Zhu D, Chen C, Yang Y, Su N. Machine learning prediction model for the rupture status of middle cerebral artery aneurysm in patients with hypertension: a Chinese multicenter study. Quant Imaging Med Surg 2023; 13:4867-4878. [PMID: 37581038 PMCID: PMC10423353 DOI: 10.21037/qims-22-918] [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: 09/02/2022] [Accepted: 05/19/2023] [Indexed: 08/16/2023]
Abstract
Background Hypertension is a common comorbidity in patients with unruptured intracranial aneurysms and is closely associated with the rupture of aneurysms. However, only a few studies have focused on the rupture risk of aneurysms comorbid with hypertension. This retrospective study aimed to construct prediction models for the rupture of middle cerebral artery (MCA) aneurysm associated with hypertension using machine learning (ML) algorithms, and the constructed models were externally validated with multicenter datasets. Methods We included 322 MCA aneurysm patients comorbid with hypertension who were being treated in four hospitals. All participants underwent computed tomography angiography (CTA), and aneurysm morphological features were measured. Clinical characteristics included sex, age, smoking, and hypertension history. Based on the clinical and morphological characteristics, the training datasets (n=277) were used to fit the ML algorithms to construct prediction models, which were externally validated with the testing datasets (n=45). The prediction performances of the models were assessed by receiver operating characteristic (ROC) curves. Results The areas under the ROC curve (AUCs) of the k-nearest-neighbor (KNN), neural network (NNet), support vector machine (SVM) and logistic regression (LR) models in the training datasets were 0.83 [95% confidence interval (CI): 0.78-0.88], 0.87 (95% CI: 0.82-0.92), 0.91 (95% CI: 0.88-0.95), and 0.83 (95% CI: 0.77-0.88), respectively, and in the testing datasets were 0.74 (95% CI: 0.59-0.89), 0.82 (95% CI: 0.69-0.94), 0.73 (95% CI: 0.58-0.88), and 0.76 (95% CI: 0.61-0.90), respectively. The aspect ratio (AR) was ranked as the most important variable in the ML models except for NNet. Further analysis showed that the AR had good diagnostic performance, with AUC values of 0.75 in the training datasets and 0.77 in the testing datasets. Conclusions The ML models performed reasonably accurately in predicting MCA aneurysm rupture comorbid with hypertension. AR was demonstrated as the leading predictor for the rupture of MCA aneurysm with hypertension.
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Affiliation(s)
- Mengqi Lin
- 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
| | - Ru Lin
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Liuhui Xu
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yongchun Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jiafeng Zhou
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Boli Lin
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Kuikui Zheng
- 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
| | - Xiufen Jia
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jinjin Liu
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Dongqin Zhu
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chao Chen
- 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
| | - Na Su
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Yong-Wei H, Wang XY, Li ZP, Yin XS. The rupture risk factors of mirror intracranial aneurysms: A systematic review and meta-analysis based on morphological and hemodynamic parameters. PLoS One 2023; 18:e0286249. [PMID: 37352170 PMCID: PMC10289394 DOI: 10.1371/journal.pone.0286249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 05/11/2023] [Indexed: 06/25/2023] Open
Abstract
OBJECTIVE Intracranial aneurysms (IAs) are a prevalent form of vascular disease that can lead to fatal outcomes upon rupture. Mirror intracranial aneurysms (MIAs) are a specific type of multiple aneurysms situated symmetrically on both sides of the parent arteries. The factors contributing to the risk of MIA rupture, based on morphological and hemodynamic parameters, are currently controversial. Thus, we conducted a systematic review and meta-analysis to investigate the risk factors for MIA rupture. METHODS The study performed an electronic search of Chinese and English databases, including China national Knowledge Infrastructure (CNKI), WanFang, VIP, PubMed, Embase, Web of Science, Scopus, and the Cochrane Library databases, and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The morphological parameters (IA size, aspect ratio [AR], size ratio [SR], bottleneck factor [BNF], height-width ratio [HWR], irregular shape) and hemodynamic parameters (wall shear stress [WSS], low WSS area [LSA], oscillatory shear index [OSI]) were analyzed for their significance in determining the risk of MIA rupture. RESULTS The analysis comprised 18 retrospective studies involving 647 patients, with a total of 1294 IAs detected, including 605 ruptured and 689 unruptured. The meta-analysis revealed that IA size, AR, SR, and irregular shape exhibited significant differences between the ruptured and unruptured groups, but HWR did not. In terms of hemodynamic parameters, WSS, OSI, and LSA were found to have significant differences between the two groups. CONCLUSIONS Our results demonstrate that larger IAs, higher AR, SR, and BNF are associated with a higher risk of rupture in patients with MIAs, regardless of their location. there is no significant difference in HWR between the ruptured and unruptured groups. These preliminary findings offer valuable insights for clinical decision-making and a more comprehensive comprehension of the current MIA status. Nevertheless, larger and multi-center studies are indispensable for corroborating these findings. Systematic review registration: https://www.crd.york.ac.uk/prospero/ identifier: CRD42022345587.
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Affiliation(s)
- Huang Yong-Wei
- Department of Neurosurgery, Mian yang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mian yang, Sichuan, People’s Republic of China
| | - Xiao-Yi Wang
- Department of Neurosurgery, Mian yang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mian yang, Sichuan, People’s Republic of China
| | - Zong-Ping Li
- Department of Neurosurgery, Mian yang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mian yang, Sichuan, People’s Republic of China
| | - Xiao-Shuang Yin
- Department of Immunology, Mian yang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mian yang, Sichuan, People’s Republic of China
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Yang HH, Sayre J, Dinh H, Nael K, Colby G, Wang A, Villablanca P, Salamon N, Chien A. Image-derived Metrics Quantifying Hemodynamic Instability Predicted Growth of Unruptured Intracranial Aneurysms. STROKE (HOBOKEN, N.J.) 2023; 3:e000426. [PMID: 37090136 PMCID: PMC10118203 DOI: 10.1161/svin.122.000426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Background While image-derived predictors of intracranial aneurysm (IA) rupture have been well-explored, current understanding of IA growth is limited. Pulsatility index (PI) and wall shear stress pulsatility index (WSSPI) are important metrics measuring temporal hemodynamic instability. However, they have not been investigated in IA growth research. The present study seeks to verify reliable predictors of IA growth with comparative analyses of several important morphological and hemodynamic metrics between stable and growing cases among a group of unruptured IAs. Methods Using 3D images, vascular models of 16 stable and 20 growing cases were constructed and verified using Geodesic techniques. With an overall mean follow-up period of 25 months, cases exhibiting a 10% or higher increase in diameter were considered growing. Patient-specific, pulsatile simulations were performed, and hemodynamic calculations were computed at 5 important regions of each aneurysm (inflow artery, aneurysm neck, body, dome, and outflow artery). Index values were compared between growing and stable IAs using ANCOVA controlling for aneurysm diameter. Stepwise multiple logistic regression and ROC analyses were conducted to investigate predictive models of IA growth. Results Compared to stable IAs, growing IAs exhibited significantly higher intrasaccular PI, intrasaccular WSSPI, intrasaccular spatial flow rate deviation, and intrasaccular spatial wall shear stress (WSS) deviation. Stepwise logistic regression analysis revealed a significant predictive model involving PI at aneurysm body, WSSPI at inflow artery, and WSSPI at aneurysm body. Conclusions Our results showed that high degree of hemodynamic variations within IAs is linked to growth, even after controlling for morphological parameters. Further, evaluation of PI in conjunction with WSSPI yielded a highly accurate predictive model of IA growth. Upon validation in future cohorts, these metrics may aid in early identification of IA growth and current understanding of IA remodeling mechanism.
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Affiliation(s)
- Hong-Ho Yang
- David Geffen School of Medicine at UCLA, Department of Radiology, Los Angeles, California, USA
| | - James Sayre
- David Geffen School of Medicine at UCLA, Department of Radiology, Los Angeles, California, USA
| | - Huy Dinh
- David Geffen School of Medicine at UCLA, Department of Radiology, Los Angeles, California, USA
| | - Kambiz Nael
- David Geffen School of Medicine at UCLA, Department of Radiology, Los Angeles, California, USA
| | - Geoffrey Colby
- David Geffen School of Medicine at UCLA, Department of Neurosurgery, Los Angeles, California, USA
| | - Anthony Wang
- David Geffen School of Medicine at UCLA, Department of Neurosurgery, Los Angeles, California, USA
| | - Pablo Villablanca
- David Geffen School of Medicine at UCLA, Department of Radiology, Los Angeles, California, USA
| | - Noriko Salamon
- David Geffen School of Medicine at UCLA, Department of Radiology, Los Angeles, California, USA
| | - Aichi Chien
- David Geffen School of Medicine at UCLA, Department of Radiology, Los Angeles, California, USA
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Murakami M, Jiang F, Kageyama N, Chen X. Computational Fluid Dynamics Analysis of Blood Flow Changes during the Growth of Saccular Abdominal Aortic Aneurysm. Ann Vasc Dis 2022; 15:260-267. [PMID: 36644268 PMCID: PMC9816029 DOI: 10.3400/avd.oa.22-00098] [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: 09/02/2022] [Accepted: 09/24/2022] [Indexed: 11/06/2022] Open
Abstract
Computational fluid dynamics analysis of the growth process of saccular abdominal aortic aneurysm was performed. A 3D model of aortic aneurysm was created based on CT images. Properties in terms of wall shear stress, mean flow velocity, mean pressure, energy loss, and pressure loss coefficient were calculated using thermal fluid analysis software "ANSYS CFX." As the aneurysm expanded, the mean flow velocity decreased and the wall shear stress, mean pressure, energy loss, and pressure loss coefficient increased. Wall shear stress increased when the aneurysm was small, suggesting that is related to the development and growth of the aneurysm. (This is secondary publication from J Jpn Coll Angiol 2021; 61: 3-10.).
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Affiliation(s)
- Masanori Murakami
- Department of Cardiovascular Surgery, National Hospital Organization, Kanmon Medical Center, Shimonoseki, Yamaguchi, Japan,Corresponding author: Masanori Murakami, MD, PhD. Department of Cardiovascular Surgery, National Hospital Organization, Kanmon Medical Center, 1-1 Choufusotoura-chou, Shimonoseki, Yamaguchi 752-8510, Japan Tel: +81-83-241-1199, Fax: +81-83-241-1301, E-mail:
| | - Fei Jiang
- Department of Mechanical Engineering, Graduate School of Sciences and Technology for Innovation, Yamaguchi University, Yamaguchi, Yamaguchi, Japan
| | - Nobuyasu Kageyama
- Department of Mechanical Engineering, Graduate School of Sciences and Technology for Innovation, Yamaguchi University, Yamaguchi, Yamaguchi, Japan
| | - Xian Chen
- Department of Mechanical Engineering, Graduate School of Sciences and Technology for Innovation, Yamaguchi University, Yamaguchi, Yamaguchi, Japan
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11
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Hu SQ, Chen RD, Xu WD, Li H, Yu JS. A predictive hemodynamic model based on risk factors for ruptured mirror aneurysms. Front Neurol 2022; 13:998557. [PMID: 36158942 PMCID: PMC9502008 DOI: 10.3389/fneur.2022.998557] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To identify hemodynamic risk factors for intracranial aneurysm rupture and establish a predictive model to aid evaluation. Methods We analyzed the hemodynamic parameters of 91 pairs of ruptured mirror aneurysms. A conditional univariate analysis was used for the continuous variables. A conditional multivariate logistic regression analysis was performed to identify the independent risk factors. Differences where p < 0.05 were statistically significant. A predictive model was established based on independent risk factors. Odds ratios (ORs) were used to score points. The validation cohort consisted of 189 aneurysms. Receiver operating characteristic curves were generated to determine the cutoff values and area under the curves (AUCs) of the predictive model and independent risk factors. Results The conditional multivariate logistic analysis showed that the low shear area (LSA) (OR = 70.322, p = 0.044, CI = 1.112–4,445.256), mean combined hemodynamic parameter (CHP) (>0.087) (OR = 3.171, p = 0.034, CI = 1.089–9.236), and wall shear stress gradient (WSSG) ratio (>893.180) (OR = 5.740, p = 0.003, CI = 1.950–16.898) were independent risk factors. A prediction model was established: 23*LSA + 1*CHP mean (>0.087: yes = 1, no = 0) + 2 * WSSG ratio (>893.180: yes = 1, no = 0). The AUC values of the predictive model, LSA, mean CHP (>0.087), and WSSG ratio (>893.180) were 0.748, 0.700, 0.654, and 0.703, respectively. The predictive model and LSA cutoff values were 1.283 and 0.016, respectively. In the validation cohort, the predictive model, LSA, CHP (>0.087), and WSSG ratio (>893.180) were 0.736, 0.702, 0.689, and 0.706, respectively. Conclusions LSA, CHP (>0.087), and WSSG ratio (>893.180) were independent risk factors for aneurysm rupture. Our predictive model could aid practical evaluation.
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Liu Q, Leng X, Yang J, Yang Y, Jiang P, Li M, Mo S, Yang S, Wu J, He H, Wang S. Stability of unruptured intracranial aneurysms in the anterior circulation: nomogram models for risk assessment. J Neurosurg 2022; 137:675-684. [PMID: 35061990 DOI: 10.3171/2021.10.jns211709] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/26/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The probable stability of the lesion is critical in guiding treatment decisions in unruptured intracranial aneurysms (IAs). The authors aimed to develop multidimensional predictive models for the stability of unruptured IAs. METHODS Patients with unruptured IAs in the anterior circulation were prospectively enrolled and regularly followed up. Clinical data were collected, IA morphological features were assessed, and adjacent hemodynamic features were quantified with patient-specific computational fluid dynamics modeling. Based on multivariate logistic regression analyses, nomograms incorporating these factors were developed in a primary cohort (patients enrolled between January 2017 and February 2018) to predict aneurysm rupture or growth within 2 years. The predictive accuracies of the nomograms were compared with the population, hypertension, age, size, earlier rupture, and site (PHASES) and earlier subarachnoid hemorrhage, location, age, population, size, and shape (ELAPSS) scores and validated in the validation cohort (patients enrolled between March and October 2018). RESULTS Among 231 patients with 272 unruptured IAs in the primary cohort, hypertension, aneurysm location, irregular shape, size ratio, normalized wall shear stress average, and relative resident time were independently related to the 2-year stability of unruptured IAs. The nomogram including clinical, morphological, and hemodynamic features (C+M+H nomogram) had the highest predictive accuracy (c-statistic 0.94), followed by the nomogram including clinical and morphological features (C+M nomogram; c-statistic 0.89), PHASES score (c-statistic 0.68), and ELAPSS score (c-statistic 0.58). Similarly, the C+M+H nomogram had the highest predictive accuracy (c-statistic 0.94) in the validation cohort (85 patients with 97 unruptured IAs). CONCLUSIONS Hemodynamics have predictive values for 2-year stability of unruptured IAs treated conservatively. Multidimensional nomograms have significantly higher predictive accuracies than conventional risk prediction scores.
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Affiliation(s)
- Qingyuan Liu
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
- 2China National Clinical Research Center for Neurological Diseases, Beijing
| | - Xinyi Leng
- 4Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Junhua Yang
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
- 2China National Clinical Research Center for Neurological Diseases, Beijing
| | - Yi Yang
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
- 2China National Clinical Research Center for Neurological Diseases, Beijing
| | - Pengjun Jiang
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
- 2China National Clinical Research Center for Neurological Diseases, Beijing
| | - Maogui Li
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
- 2China National Clinical Research Center for Neurological Diseases, Beijing
| | - Shaohua Mo
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
- 2China National Clinical Research Center for Neurological Diseases, Beijing
| | - Shuzhe Yang
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
- 2China National Clinical Research Center for Neurological Diseases, Beijing
| | - Jun Wu
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
| | - Hongwei He
- 3Department of Neurointervention, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; and
| | - Shuo Wang
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
- 2China National Clinical Research Center for Neurological Diseases, Beijing
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Tang X, Zhou L, Wen L, Wu Q, Leng X, Xiang J, Zhang X. Morphological and Hemodynamic Characteristics Associated With the Rupture of Multiple Intracranial Aneurysms. Front Neurol 2022; 12:811281. [PMID: 35126301 PMCID: PMC8812485 DOI: 10.3389/fneur.2021.811281] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose The objective of this study was to identify the morphological and hemodynamic factors associated with the rupture of multiple intracranial aneurysms regardless of patient-related factors and establish a statistical model for aneurysm rupture risk assessment. Methods The digital subtraction angiography (DSA) data of 104 mirror intracranial aneurysms in 52 consecutive patients were retrospectively analyzed in this study. 21 morphological parameters and hemodynamic parameters were calculated by 3-dimensional reconstruction and computational fluid dynamics (CFD) simulation. Significant differences (p < 0.05) between the two groups were subsequently tested with the multivariate logistic regression to identify the independent risk factors. A prediction model was established based on the independent risk factors. The receiver operating characteristics (ROCs) were generated to estimate the prediction performance. A cohort of patients with multiple intracranial aneurysms admitted in our institute from January 2021 to October 2021 was introduced to verify the value of the model. Results Significant differences between the ruptured and unruptured aneurysms were found in 15 out of 19 parameters. Bleb formation, neck width, and size ratio were independent factors in the multivariate logistic regression. A prediction model based on the three independent risk factors was established: Odds = −1.495 – 0.707 × (Neckwidth) + 3.061 × (Blebformation) + 2.1 × (SR) (bleb formation: Yes = 1, No = 0). The area under the curve (AUC) value of the model was 0.901. In the validation cohort, the prediction model showed satisfying performance in assessing multiple aneurysm rupture risk with a sensitivity of 100% and specificity of 88.46%. Conclusion Bleb formation, neck width, and size ratio were independently associated with aneurysm rupture status. The prediction model may help in identifying the aneurysm with high rupture risk.
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Affiliation(s)
- Xiaoyu Tang
- Department of Neurosurgery, Jinling School of Clinical Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Longjiang Zhou
- Medical Imaging Center, The Affiliated Hosptial of Yangzhou University, Yangzhou, China
| | - Lili Wen
- Department of Neurosurgery, Jinling School of Clinical Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Qi Wu
- Department of Neurosurgery, Jinling School of Clinical Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | | | | | - Xin Zhang
- Department of Neurosurgery, Jinling School of Clinical Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China
- *Correspondence: Xin Zhang
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Yin JH, Su SX, Zhang X, Bi YM, Duan CZ, Huang WM, Wang XL. U-Shaped Association of Aspect Ratio and Single Intracranial Aneurysm Rupture in Chinese Patients: A Cross-Sectional Study. Front Neurol 2021; 12:731129. [PMID: 34803880 PMCID: PMC8598388 DOI: 10.3389/fneur.2021.731129] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 09/27/2021] [Indexed: 01/02/2023] Open
Abstract
Background: Previous studies have analyzed the association of aspect ratio (AR) on the ruptured intracranial aneurysm (IA), but the findings are inconclusive and controversial. Therefore, the study aimed to derive a more detailed estimation of this association between AR and ruptured IA in Chinese IA patients. Methods: The present work was a cross-sectional study. We retrospectively collected 1,588 Chinese patients with a single IA from January 2010 to November 2017. The relationship was examined between AR at diagnosis and ruptured IA. Covariates included data of demographics, morphological parameters, lifestyle habits, clinical features, and comorbidities. Binary logistic regression and two-piecewise linear models were used to analyze independent associations of AR with ruptured IA. Results: The results suggest that the association between AR and IA rupture was U-shaped. In the AR range of 1.08-1.99, the prevalence of IA rupture was 13% lower for each 0.1-unit increment in AR [odds ratio 0.87, 95% confidence interval (CI) 0.80-0.98]. Conversely, for every 0.1-unit increase in AR, the prevalence of IA rupture increased by ~3% (odds ratio 1.03, 95% CI 1.01-1.06) in the AR range of 3.42-4.08. Conclusion: The relationship between AR and ruptured IA was U-shaped, with the negative association at AR of 1.08-1.99 and positive association at AR of 3.42-4.08.
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Affiliation(s)
- Jia-He Yin
- National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shi-Xing Su
- National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xin Zhang
- National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yi-Ming Bi
- National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,Department of Interventional Treatment, Southern Medical University, Guangzhou, China
| | - Chuan-Zhi Duan
- National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Wei-Mei Huang
- Department of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Xi-Long Wang
- Department of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
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Futami K, Misaki K, Uno T, Nambu I, Kamide T, Nakada M. Morphological factors affecting vortex core instability on 4D flow MRI of unruptured cerebral aneurysms. Neurol Res 2021; 44:455-462. [PMID: 34791984 DOI: 10.1080/01616412.2021.2004365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The spatiotemporal instability of intra-aneurysmal vortex flow may be associated with unruptured cerebral aneurysm rupture. We identified morphological factors that affect intra-aneurysmal vortex core patterns classified based on the instability on four-dimensional (4D) flow magnetic resonance imaging (MRI) and determined cutoff values for the factors to discriminate unstable core patterns. METHODS We classified vortex core patterns of 40 unruptured aneurysms on 4D flow MRI into stable, stable with a flapping tip, continuously deforming wave-or-coil-like, and non-visualized. We statistically compared nine morphological parameters among aneurysm groups with individual patterns. RESULTS The vortex cores were stable (n = 16) (group A), stable with a flapping tip (n = 15) (group B), wave-or-coil-like (n = 7) (group C), and non-visualized (n = 2) (group D). Since there were no statistically significant differences between groups A and B, we compared the difference between the groups A and B and the other groups. Multivariate logistic regression analyses found that size ratio (SR) was an only independently significant parameter (p < 0.05). The receiver-operating characteristic analysis between groups A and B and group C and between groups A and B and groups C and D revealed that the area under the curve value for SR was the highest (0.829 [95% CI, 0.642-1.0]; 0.867 [95% CI, 0.715-1.0], respectively) among morphological factors; the cutoff value for SR was 1.72 (specificity 0.714, sensitivity 0.756; specificity 0.806, sensitivity 0.778, respectively). CONCLUSION SR was an independent morphological factor contributing to vortex core instability based on the vortex core patterns on 4D flow MRI.Abbreviations: CFD: computational fluid dynamics; 3D: three-dimensional; 4D: four-dimensional; MRI: magnetic resonance imaging; MRA: magnetic resonance angiography; ICA: internal carotid artery; AR: aspect ratio; SR: size ratio; CI: confidence interval; AUC: area under the curve; ROC: receiver-operating characteristic.
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Affiliation(s)
- Kazuya Futami
- Department of Neurosurgery, Hokuriku Central Hospital of Japan Mutual Aid Association of Public School Teachers, Oyabe, Japan
| | - Kouichi Misaki
- Department of Neurosurgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Takehiro Uno
- Department of Neurosurgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Iku Nambu
- Department of Neurosurgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Tomoya Kamide
- Department of Neurosurgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Kanazawa University School of Medicine, Kanazawa, Japan
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Yuan J, Huang C, Li Z, Jiang X, Zhao X, Wu D, Lai N, Liu J, Zhang B, Qin F, Xia D, Fang X. Hemodynamic and Morphological Parameters of Ruptured Mirror Posterior Communicating Artery Aneurysms. Front Neurol 2021; 12:653589. [PMID: 34646225 PMCID: PMC8504488 DOI: 10.3389/fneur.2021.653589] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 08/19/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Morphological and hemodynamic parameters might predict rupture of intracranial aneurysms (IAs). A practical model for the study is patients with ruptured mirror IAs in which one is ruptured and the other is unruptured. Although there have been analyses of the morphology and hemodynamics of ruptured mirror posterior communicating artery aneurysms (PComAAs), the sample sizes in these studies were small and only considered hemodynamics or morphological characters. Therefore, this study aimed to investigate the morphological and hemodynamic parameters associated with ruptured mirror PComAAs. Methods: We considered 72 patients with ruptured mirror PComAAs using computational fluid dynamics (CFDs). Ruptured mirror PComAAs were divided into ruptured and unruptured groups. Fourteen morphological and eight hemodynamic parameters were calculated and compared. Significant parameters were analyzed by the multivariate logistic regression to identify independent risk factors. Receiver operating characteristic (ROC) analysis was performed, and the area under the ROC curve (AUC) was calculated for all independent risk factors to determine the predictability and identify the optimal threshold. Results: Four hemodynamic and three morphological parameters were significantly different between ruptured and unruptured groups: normalized wall shear stress (NWSS), mean WSS, low wall shear WSS area (LSA%), size, aspect ratio (AR), size ratio (SR), and inflow angle (IA). Multivariate logistic regression analysis showed that AR, SR, NWSS, mean WSS, and LSA% were all independent factors significantly associated with PComAAs rupture. The ROC analysis for independent risk factors indicated that AR (0.751), NWSS (0.755), mean WSS (0.69), and LSA (0.778) had merely acceptable AUC values. Only SR (0.803) had a high acceptable AUC value. The threshold value of SR was 1.96. Conclusions: SR (>1.96) was the most significant parameter associated with IA rupture, whereas AR, NWSS, mean WSS, and LSA independently characterized the status of IA rupture.
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Affiliation(s)
- Jinlong Yuan
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, China
| | - Chenlei Huang
- Department of Clinical Laboratory, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, China
| | - Zhenbao Li
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, China
| | - Xiaochun Jiang
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, China
| | - Xintong Zhao
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, China
| | - Degang Wu
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, China
| | - Nianshen Lai
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, China
| | - Jiaqiang Liu
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, China
| | - Bingbing Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, China
| | - Feiyun Qin
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, China
| | - Dayong Xia
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, China
| | - Xinggen Fang
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, China
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Complex and continuous change in hypothetic risk of rupture of intracranial cerebral aneurysms – Bleb mandala –. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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18
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Sunderland K, Wang M, Pandey AS, Gemmete J, Huang Q, Goudge A, Jiang J. Quantitative analysis of flow vortices: differentiation of unruptured and ruptured medium-sized middle cerebral artery aneurysms. Acta Neurochir (Wien) 2021; 163:2339-2349. [PMID: 33067690 DOI: 10.1007/s00701-020-04616-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 10/09/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Surgical intervention for unruptured intracranial aneurysms (IAs) carries inherent health risks. The analysis of "patient-specific" IA geometric and computational fluid dynamics (CFD) simulated wall shear stress (WSS) data has been investigated to differentiate IAs at high and low risk of rupture to help clinical decision making. Yet, outcomes vary among studies, suggesting that novel analysis could improve rupture characterization. The authors describe a CFD analytic method to assess spatiotemporal characteristics of swirling flow vortices within IAs to improve characterization. METHODS CFD simulations were performed for 47 subjects harboring one medium-sized (4-10 mm) middle cerebral artery (MCA) aneurysm with available 3D digital subtraction angiography data. Alongside conventional indices, quantified IA flow vortex spatiotemporal characteristics were applied during statistical characterization. Statistical supervised machine learning using a support vector machine (SVM) method was run with cross-validation (100 iterations) to assess flow vortex-based metrics' strength toward rupture characterization. RESULTS Relying solely on vortex indices for statistical characterization underperformed compared with established geometric characteristics (total accuracy of 0.77 vs 0.80) yet showed improvements over wall shear stress models (0.74). However, the application of vortex spatiotemporal characteristics into the combined geometric and wall shear stress parameters augmented model strength for assessing the rupture status of middle cerebral artery aneurysms (0.85). CONCLUSIONS This preliminary study suggests that the spatiotemporal characteristics of flow vortices within MCA aneurysms are of value to improve the differentiation of ruptured aneurysms from unruptured ones.
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Analysis of Morphological-Hemodynamic Risk Factors for Aneurysm Rupture Including a Newly Introduced Total Volume Ratio. J Pers Med 2021; 11:jpm11080744. [PMID: 34442388 PMCID: PMC8399007 DOI: 10.3390/jpm11080744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 12/27/2022] Open
Abstract
The purpose of this study was to evaluate morphological and hemodynamic factors, including the newly developed total volume ratio (TVR), in evaluating rupture risk of cerebral aneurysms using ≥7 mm sized aneurysms. Twenty-three aneurysms (11 unruptured and 12 ruptured) ≥ 7 mm were analyzed from 3-dimensional rotational cerebral angiography and computational fluid dynamics (CFD). Ten morphological and eleven hemodynamic factors of the aneurysms were qualitatively and quantitatively compared. Correlation analysis between morphological and hemodynamic factors was performed, and the relationship among the hemodynamic factors was analyzed. Morphological factors (ostium diameter, ostium area, aspect ratio, and bottleneck ratio) and hemodynamic factors (TVR, minimal wall shear stress of aneurysms, time-averaged wall shear stress of aneurysms, oscillatory shear index, relative residence time, low wall shear stress area, and ratio of low wall stress area) were statistically different between ruptured and unruptured aneurysms (p < 0.05). By simple regression analysis, the morphological factor aspect ratio and the hemodynamic factor TVR were significantly correlated (r2 = 0.602, p = 0.001). Ruptured aneurysms had complex and unstable flow. In ≥7 mm ruptured aneurysms, high aspect ratio, bottleneck ratio, complex flow, unstable flow, low TVR, wall shear stress at aneurysm, high oscillatory shear index, relative resistance time, low wall shear stress area, and ratio of low wall stress area were significant in determining the risk of aneurysm rupture.
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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.
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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
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Zhang M, Peng F, Tong X, Feng X, Li Y, Chen H, Niu H, Zhang B, Song G, Li Y, Liu P, Liu A, Li R. Associations between haemodynamics and wall enhancement of intracranial aneurysm. Stroke Vasc Neurol 2021; 6:467-475. [PMID: 33637615 PMCID: PMC8485248 DOI: 10.1136/svn-2020-000636] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/30/2020] [Accepted: 01/04/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND AND PURPOSE Previous studies have reported about inflammation processes (IPs) that play important roles in aneurysm formation and rupture, which could be driven by blood flow. IPs can be identified using aneurysmal wall enhancement (AWE) on high-resolution black-blood MRI (BB-MRI) and blood flow haemodynamics can be demonstrated by four-dimensional-flow MRI (4D-flow MRI). Thus, this study investigated the associations between AWE and haemodynamics in unruptured intracranial aneurysms (IA) by combining 4D-flow MRI and high-resolution BB-MRI. MATERIALS AND METHODS Between April 2014 and October 2017, 48 patients with 49 unruptured IA who underwent both 4D-flow MRI and high-resolution BB-MRI were retrospectively included in this study. The haemodynamic parameters demonstrated using 4D-flow MRI were compared between different AWE patterns using the Kruskal-Wallis test and ordinal regression. RESULTS The results of Kruskal-Wallis test showed that the average wall shear stress in the IA (WSSavg-IA), maximum through-plane velocity in the adjacent parent artery, inflow jet patterns and the average vorticity in IA (vorticityavg-IA) were significantly associated with the AWE patterns. Ordinal regression analysis identified WSSavg-IA (p=0.002) and vorticityavg-IA (p=0.033) as independent predictors of AWE patterns. CONCLUSION A low WSS and low average vorticity were independently associated with a high AWE grade for IAs larger than 4 mm. Therefore, WSS and average vorticity could predict AWE and circumferential AWE.
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Affiliation(s)
- Miaoqi Zhang
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Fei Peng
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | - Xin Tong
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | - Xin Feng
- Department of Neurosurgery, Beijing Hospital, Beijing, China
| | - Yunduo Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Huijun Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Hao Niu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | - Baorui Zhang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | - Guangrong Song
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | - Youxiang Li
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | - Peng Liu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | - Aihua Liu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
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22
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Han P, Jin D, Wei W, Song C, Leng X, Liu L, Yu J, Li X. The prognostic effects of hemodynamic parameters on rupture of intracranial aneurysm: A systematic review and meta-analysis. Int J Surg 2021; 86:15-23. [DOI: 10.1016/j.ijsu.2020.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/13/2020] [Accepted: 12/28/2020] [Indexed: 12/26/2022]
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23
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Mahrous SA, Sidik NAC, Saqr KM. Numerical study on the energy cascade of pulsatile Newtonian and power-law flow models in an ICA bifurcation. PLoS One 2021; 16:e0245775. [PMID: 33493237 PMCID: PMC7833255 DOI: 10.1371/journal.pone.0245775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 01/07/2021] [Indexed: 11/18/2022] Open
Abstract
The complex physics and biology underlying intracranial hemodynamics are yet to be fully revealed. A fully resolved direct numerical simulation (DNS) study has been performed to identify the intrinsic flow dynamics in an idealized carotid bifurcation model. To shed the light on the significance of considering blood shear-thinning properties, the power-law model is compared to the commonly used Newtonian viscosity hypothesis. We scrutinize the kinetic energy cascade (KEC) rates in the Fourier domain and the vortex structure of both fluid models and examine the impact of the power-law viscosity model. The flow intrinsically contains coherent structures which has frequencies corresponding to the boundary frequency, which could be associated with the regulation of endothelial cells. From the proposed comparative study, it is found that KEC rates and the vortex-identification are significantly influenced by the shear-thinning blood properties. Conclusively, from the obtained results, it is found that neglecting the non-Newtonian behavior could lead to underestimation of the hemodynamic parameters at low Reynolds number and overestimation of the hemodynamic parameters by increasing the Reynolds number. In addition, we provide physical insight and discussion onto the hemodynamics associated with endothelial dysfunction which plays significant role in the pathogenesis of intracranial aneurysms.
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Affiliation(s)
- Samar A. Mahrous
- Department of Thermo-Fluid Universiti Teknologi Malaysia, Skudai, Malaysia
- College of Engineering and Technology, Arab Academy for Science, Technology and Maritime Transport, Alexandria, Egypt
- * E-mail:
| | - Nor Azwadi Che Sidik
- Department of Thermo-Fluid Universiti Teknologi Malaysia, Skudai, Malaysia
- Malaysia–Japan International Institute of Technology (MJIIT), University Teknologi Malaysia Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Khalid M. Saqr
- College of Engineering and Technology, Arab Academy for Science, Technology and Maritime Transport, Alexandria, Egypt
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24
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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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25
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Neurovascular disease, diagnosis, and therapy: Brain aneurysms. HANDBOOK OF CLINICAL NEUROLOGY 2020; 176:121-134. [PMID: 33272392 DOI: 10.1016/b978-0-444-64034-5.00001-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Unruptured intracranial aneurysms (UIAs) have a prevalence of 3% in the adult population worldwide. The majority of UIAs are incidental findings, but some UIAs cause cranial nerve palsies, brainstem compression, ischemic events, or epileptic seizures. The most frequent clinical presentation of intracranial aneurysms is, however, rupture and thereby subarachnoid hemorrhage (SAH). To avoid SAH with its fatal consequences, patients with UIAs require counseling by dedicated and interdisciplinary neurovascular specialists. For the purpose of assessment and decision-making for the management of patients with UIAs, numerous aspects have to be considered: radiological characteristics, clinical symptoms, estimated rupture risk of an individual aneurysm as well as patient- and aneurysm-related risks of preventive repair. Generally, two management options exist: observation with follow-up imaging or preventive repair. This chapter discusses current data on pathogenesis, clinical presentation, diagnostics, risk factors for rupture and preventive repair, and guidance tools for the management of patients with UIAs according to current evidence.
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26
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Perera R, Isoda H, Ishiguro K, Mizuno T, Takehara Y, Terada M, Tanoi C, Naito T, Sakahara H, Hiramatsu H, Namba H, Izumi T, Wakabayashi T, Kosugi T, Onishi Y, Alley M, Komori Y, Ikeda M, Naganawa S. Assessing the Risk of Intracranial Aneurysm Rupture Using Morphological and Hemodynamic Biomarkers Evaluated from Magnetic Resonance Fluid Dynamics and Computational Fluid Dynamics. Magn Reson Med Sci 2020; 19:333-344. [PMID: 31956175 PMCID: PMC7809142 DOI: 10.2463/mrms.mp.2019-0107] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Evaluate in vivo hemodynamic and morphological biomarkers of intracranial aneurysms, using magnetic resonance fluid dynamics (MRFD) and MR-based patient specific computational fluid dynamics (CFD) in order to assess the risk of rupture. METHODS Forty-eight intracranial aneurysms (10 ruptured, 38 unruptured) were scrutinized for six morphological and 10 hemodynamic biomarkers. Morphological biomarkers were calculated based on 3D time-of-flight magnetic resonance angiography (3D TOF MRA) in MRFD analysis. Hemodynamic biomarkers were assessed using both MRFD and CFD analyses. MRFD was performed using 3D TOF MRA and 3D cine phase-contrast magnetic resonance imaging (3D cine PC MRI). CFD was performed utilizing patient specific inflow-outflow boundary conditions derived from 3D cine PC MRI. Univariate analysis was carried out to identify statistically significant biomarkers for aneurysm rupture and receiver operating characteristic (ROC) analysis was performed for the significant biomarkers. Binary logistic regression was performed to identify independent predictive biomarkers. RESULTS Morphological biomarker analysis revealed that aneurysm size [P = 0.021], volume [P = 0.035] and size ratio [P = 0.039] were statistically significantly different between the two groups. In hemodynamic biomarker analysis, MRFD results indicated that ruptured aneurysms had higher oscillatory shear index (OSI) [OSI.max, P = 0.037] and higher relative residence time (RRT) [RRT.ave, P = 0.035] compared with unruptured aneurysms. Correspondingly CFD analysis demonstrated significant differences for both average and maximum OSI [OSI.ave, P = 0.008; OSI.max, P = 0.01] and maximum RRT [RRT.max, P = 0.045]. ROC analysis revealed AUC values greater than 0.7 for all significant biomarkers. Aneurysm volume [AUC, 0.718; 95% CI, 0.491-0.946] and average OSI obtained from CFD [AUC, 0.774; 95% CI, 0.586-0.961] were retained in the respective logistic regression models. CONCLUSION Both morphological and hemodynamic biomarkers have significant influence on intracranial aneurysm rupture. Aneurysm size, volume, size ratio, OSI and RRT could be potential biomarkers to assess aneurysm rupture risk.
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Affiliation(s)
- Roshani Perera
- Department of Radiological and Medical Laboratory Sciences, Nagoya University Graduate School of Medicine
| | - Haruo Isoda
- Department of Radiological and Medical Laboratory Sciences, Nagoya University Graduate School of Medicine.,Brain & Mind Research Center, Nagoya University
| | - Kenta Ishiguro
- Department of Radiological and Medical Laboratory Sciences, Nagoya University Graduate School of Medicine.,Department of Radiological Technology, Kariya Toyota General Hospital
| | - Takashi Mizuno
- Department of Radiological and Medical Laboratory Sciences, Nagoya University Graduate School of Medicine.,Department of Medical Technology, Nagoya University Hospital
| | - Yasuo Takehara
- Department of Fundamental Development for Advanced Low Invasive Diagnostic Imaging, Nagoya University, Graduate School of Medicine.,Department of Radiology, Nagoya University Graduate School of Medicine
| | - Masaki Terada
- Department of Diagnostic Radiological Technology, Iwata City Hospital
| | | | - Takehiro Naito
- Department of Neurosurgery, Iwata City Hospital.,Department of Neurosurgery, Komaki City Hospital
| | - Harumi Sakahara
- Department of Diagnostic Radiology & Nuclear Medicine, Hamamatsu University School of Medicine.,Hamamatsu Medical Imaging Center, Hamamatsu Medical Photonics Foundation
| | - Hisaya Hiramatsu
- Department of Neurosurgery, Hamamatsu University School of Medicine
| | - Hiroki Namba
- Department of Neurosurgery, Hamamatsu University School of Medicine
| | - Takashi Izumi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
| | | | | | - Yuki Onishi
- Department of Systems and Control Engineering, School of Engineering, Tokyo Institute of Technology
| | - Marcus Alley
- Department of Radiology, Stanford University School of Medicine
| | | | - Mitsuru Ikeda
- Department of Radiological and Medical Laboratory Sciences, Nagoya University Graduate School of Medicine
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine
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27
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Leemans EL, Cornelissen BMW, Said M, van den Berg R, Slump CH, Marquering HA, Majoie CBLM. Intracranial aneurysm growth: consistency of morphological changes. Neurosurg Focus 2020; 47:E5. [PMID: 31261128 DOI: 10.3171/2019.4.focus1987] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 04/11/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Previous studies have shown a relation between growth and rupture of intracranial aneurysms. Additionally, several morphological characteristics are frequently measured to estimate rupture risk. Little is known about how the rupture risk is associated with morphological characteristic changes during growth. The aim of this study was to provide insights into how morphological characteristics, associated with rupture, change during an aneurysm's growth. METHODS The authors retrospectively identified patients with longitudinal MRA images of unruptured growing aneurysms. The MRA images had an in-plane resolution of 0.2-0.5 mm and a slice thickness of 0.2-0.75 mm. Therefore, growth was defined as an increase of at least 0.5 mm in two directions or 1 mm in one direction. Using the MRA images, the authors semiautomatically segmented the aneurysm and the perianeurysmal vasculature. Twelve morphological characteristics were automatically measured. These characteristics were related to size (diameter, height, width, neck diameter, volume, surface area, aspect ratio, height-width ratio, and bottleneck factor) and shape (ellipticity index, nonsphericity index, and undulation index) of the aneurysm. Morphological characteristics before and after growth were compared using the Wilcoxon signed-rank test. RESULTS The authors included 31 patients with 38 growing aneurysms. The aneurysms' growth was detected after a mean of 218 weeks (range 23-567 weeks). A significant increase was seen in all size-related characteristics, and the bottleneck factor also significantly increased (from a median of 1.00 [IQR 0.85-1.04] to 1.03 [IQR 0.93-1.18]), while the ellipticity index decreased (from a median of 0.26 [IQR 0.25-0.28] to 0.25 [IQR 0.24-0.26]). The changes in size ratios and shape indices varied largely among patients. Larger aneurysms more often showed an increase in shape ratios. CONCLUSIONS Although aneurysm growth, size-related characteristics, bottleneck factor, and ellipticity index changed significantly during growth, most size ratios and shape indices showed inconsistent changes among aneurysms. This suggests that, for an accurate rupture prediction, morphological parameters need to be reassessed after growth.
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Affiliation(s)
- Eva L Leemans
- Departments of1Biomedical Engineering and Physics, and.,2Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam; and
| | - Bart M W Cornelissen
- Departments of1Biomedical Engineering and Physics, and.,2Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam; and.,3Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
| | - Miran Said
- Departments of1Biomedical Engineering and Physics, and
| | - René van den Berg
- 2Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam; and
| | - Cornelis H Slump
- 3Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
| | - Henk A Marquering
- Departments of1Biomedical Engineering and Physics, and.,2Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam; and
| | - Charles B L M Majoie
- 2Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam; and
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28
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Murayama Y, Fujimura S, Suzuki T, Takao H. Computational fluid dynamics as a risk assessment tool for aneurysm rupture. Neurosurg Focus 2020; 47:E12. [PMID: 31261116 DOI: 10.3171/2019.4.focus19189] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 04/23/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors reviewed the clinical role of computational fluid dynamics (CFD) in assessing the risk of intracranial aneurysm rupture. METHODS A literature review was performed to identify reports on CFD assessment of aneurysms using PubMed. The usefulness of various hemodynamic parameters, such as wall shear stress (WSS) and the Oscillatory Shear Index (OSI), and their role in aneurysm rupture risk analysis, were analyzed. RESULTS The authors identified a total of 258 published articles evaluating rupture risk, growth, and endovascular device assessment. Of these 258 articles, 113 matching for CFD and hemodynamic parameters that contribute to the risk of rupture (such as WSS and OSI) were identified. However, due to a lack of standardized methodology, controversy remains on each parameter's role. CONCLUSIONS Although controversy continues to exist on which risk factors contribute to predict aneurysm rupture, CFD can provide additional parameters to assess this rupture risk. This technology can contribute to clinical decision-making or evaluation of efficacy for endovascular methods and devices.
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Affiliation(s)
- Yuichi Murayama
- Departments of1Neurosurgery and.,2Innovation for Medical Information Technology, The Jikei University School of Medicine, Tokyo
| | - Soichiro Fujimura
- 2Innovation for Medical Information Technology, The Jikei University School of Medicine, Tokyo.,3Graduate School of Mechanical Engineering, Tokyo University of Science, Tokyo; and
| | - Tomoaki Suzuki
- 4Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
| | - Hiroyuki Takao
- Departments of1Neurosurgery and.,2Innovation for Medical Information Technology, The Jikei University School of Medicine, Tokyo.,3Graduate School of Mechanical Engineering, Tokyo University of Science, Tokyo; and
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29
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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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30
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Tsunoda S, Yoshikawa G, Ishikawa O. A predictive score for identification of rupture site in subarachnoid haemorrhage with multiple intracranial aneurysm. Br J Neurosurg 2020; 35:145-150. [PMID: 32510237 DOI: 10.1080/02688697.2020.1775783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE The rigid method of identifying the rupture site in cases of subarachnoid haemorrhage (SAH) with multiple intracranial aneurysms (MIAs) is still unclear. Here we present a reliable method by using a combination of six predictors. MATERIALS AND METHODS Concerning the 48 SAH patients with MIAs who visited the Showa General Hospital during the period from January 2005 to March 2016, several predictors of rupture site such as the aneurysm-related morphologic features (size, aspect ratio, shape, bleb), aneurysm location, and the distribution of SAH were investigated. Compared with other coexisting aneurysms in each predictor, each aneurysm was categorized into 'suspicion' or 'non-suspicion', and we analyzed the association between 'suspicion' and rupture. RESULTS In the first analysis, all variables were associated with rupture and included in the multivariate logistic regression analysis. The presence of bleb (OR, 20.7; CI, 2.3-186; p = .007) and the aneurysm location (OR, 23.5; CI, 5.2-106; p < .001) were significantly associated with rupture in multivariate logistic regression analysis. Based on the results, a predictive score for rupture was created and calculated for each aneurysm, and the aneurysm with highest predictive score in each patient was categorized into 'suspicion'. 'Suspicion' in the predictive score was significantly associated with rupture (OR, 412.5; CI, 52.2-16384; p < .001). The sensitivity (0.90), specificity (0.98) and the accuracy (0.94) of identifying the rupture site by the predictive score were quite satisfactory. CONCLUSION Our results suggest that the predictive score may be an excellent parameter to identify the rupture site in cases of SAH with MIAs.
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Affiliation(s)
- Sho Tsunoda
- Department of Neurosurgery, Showa General Hospital, Tokyo, Japan.,Department of Neurosurgery, NTT Medical Center Tokyo, Tokyo, Japan
| | | | - Osamu Ishikawa
- Department of Neurosurgery, Showa General Hospital, Tokyo, Japan.,Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
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31
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Rayz VL, Cohen-Gadol AA. Hemodynamics of Cerebral Aneurysms: Connecting Medical Imaging and Biomechanical Analysis. Annu Rev Biomed Eng 2020; 22:231-256. [PMID: 32212833 DOI: 10.1146/annurev-bioeng-092419-061429] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In the last two decades, numerous studies have conducted patient-specific computations of blood flow dynamics in cerebral aneurysms and reported correlations between various hemodynamic metrics and aneurysmal disease progression or treatment outcomes. Nevertheless, intra-aneurysmal flow analysis has not been adopted in current clinical practice, and hemodynamic factors usually are not considered in clinical decision making. This review presents the state of the art in cerebral aneurysm imaging and image-based modeling, discussing the advantages and limitations of each approach and focusing on the translational value of hemodynamic analysis. Combining imaging and modeling data obtained from different flow modalities can improve the accuracy and fidelity of resulting velocity fields and flow-derived factors that are thought to affect aneurysmal disease progression. It is expected that predictive models utilizing hemodynamic factors in combination with patient medical history and morphological data will outperform current risk scores and treatment guidelines. Possible future directions include novel approaches enabling data assimilation and multimodality analysis of cerebral aneurysm hemodynamics.
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Affiliation(s)
- Vitaliy L Rayz
- Weldon School of Biomedical Engineering and School of Mechanical Engineering, Purdue University, West Lafayette, Indiana 47907, USA;
| | - Aaron A Cohen-Gadol
- Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.,Goodman Campbell Brain and Spine, Carmel, Indiana 46032, USA
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Tanioka S, Ishida F, Yamamoto A, Shimizu S, Sakaida H, Toyoda M, Kashiwagi N, Suzuki H. Machine Learning Classification of Cerebral Aneurysm Rupture Status with Morphologic Variables and Hemodynamic Parameters. Radiol Artif Intell 2020; 2:e190077. [PMID: 33937812 DOI: 10.1148/ryai.2019190077] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/31/2019] [Accepted: 09/18/2019] [Indexed: 12/11/2022]
Abstract
Purpose To construct a classification model of rupture status and to clarify the importance of morphologic variables and hemodynamic parameters on rupture status by applying a machine learning (ML) algorithm to morphologic and hemodynamic data of cerebral aneurysms. Materials and Methods Between 2011 and 2019, 226 (112 ruptured and 114 unruptured) cerebral aneurysms in 188 consecutive patients were retrospectively analyzed with computational fluid dynamics (CFD). A random forest ML algorithm was applied to the results to create three classification models consisting of only morphologic variables (model 1), only hemodynamic parameters (model 2), and both morphologic variables and hemodynamic parameters (model 3). The accuracy of rupture status classification and the importance of each variable or parameter in the models were computed. Results The accuracy was 77.0% in model 1, 71.2% in model 2, and 78.3% in model 3. The three most important features were projection ratio, size ratio, and aspect ratio in model 1; low shear area ratio, oscillatory shear index, and oscillatory velocity index in model 2; and projection ratio, irregular shape, and size ratio in model 3. Conclusion Classification models of rupture status of cerebral aneurysms were constructed by applying an ML algorithm to morphologic variables and hemodynamic parameters. The model worked with relatively high accuracy, in which projection ratio, irregular shape, and size ratio were important for the discrimination of ruptured aneurysms.Supplemental material is available for this article.© RSNA, 2020.
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Affiliation(s)
- Satoru Tanioka
- Department of Neurosurgery, Mie Chuo Medical Center, 2158-5 Myojin-cho, Hisai, Tsu, Mie 514-1101, Japan (S.T., F.I.); Department of Neurosurgery, Kuwana City Medical Center, Kuwana, Japan (A.Y., H. Sakaida); Department of Neurosurgery, Suzuka Central General Hospital, Suzuka, Japan (S.S.); School of Statistical Thinking, The Institute of Statistical Mathematics, Tachikawa, Japan (M.T., N.K.); and Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan (H. Suzuki)
| | - Fujimaro Ishida
- Department of Neurosurgery, Mie Chuo Medical Center, 2158-5 Myojin-cho, Hisai, Tsu, Mie 514-1101, Japan (S.T., F.I.); Department of Neurosurgery, Kuwana City Medical Center, Kuwana, Japan (A.Y., H. Sakaida); Department of Neurosurgery, Suzuka Central General Hospital, Suzuka, Japan (S.S.); School of Statistical Thinking, The Institute of Statistical Mathematics, Tachikawa, Japan (M.T., N.K.); and Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan (H. Suzuki)
| | - Atsushi Yamamoto
- Department of Neurosurgery, Mie Chuo Medical Center, 2158-5 Myojin-cho, Hisai, Tsu, Mie 514-1101, Japan (S.T., F.I.); Department of Neurosurgery, Kuwana City Medical Center, Kuwana, Japan (A.Y., H. Sakaida); Department of Neurosurgery, Suzuka Central General Hospital, Suzuka, Japan (S.S.); School of Statistical Thinking, The Institute of Statistical Mathematics, Tachikawa, Japan (M.T., N.K.); and Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan (H. Suzuki)
| | - Shigetoshi Shimizu
- Department of Neurosurgery, Mie Chuo Medical Center, 2158-5 Myojin-cho, Hisai, Tsu, Mie 514-1101, Japan (S.T., F.I.); Department of Neurosurgery, Kuwana City Medical Center, Kuwana, Japan (A.Y., H. Sakaida); Department of Neurosurgery, Suzuka Central General Hospital, Suzuka, Japan (S.S.); School of Statistical Thinking, The Institute of Statistical Mathematics, Tachikawa, Japan (M.T., N.K.); and Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan (H. Suzuki)
| | - Hiroshi Sakaida
- Department of Neurosurgery, Mie Chuo Medical Center, 2158-5 Myojin-cho, Hisai, Tsu, Mie 514-1101, Japan (S.T., F.I.); Department of Neurosurgery, Kuwana City Medical Center, Kuwana, Japan (A.Y., H. Sakaida); Department of Neurosurgery, Suzuka Central General Hospital, Suzuka, Japan (S.S.); School of Statistical Thinking, The Institute of Statistical Mathematics, Tachikawa, Japan (M.T., N.K.); and Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan (H. Suzuki)
| | - Mitsuru Toyoda
- Department of Neurosurgery, Mie Chuo Medical Center, 2158-5 Myojin-cho, Hisai, Tsu, Mie 514-1101, Japan (S.T., F.I.); Department of Neurosurgery, Kuwana City Medical Center, Kuwana, Japan (A.Y., H. Sakaida); Department of Neurosurgery, Suzuka Central General Hospital, Suzuka, Japan (S.S.); School of Statistical Thinking, The Institute of Statistical Mathematics, Tachikawa, Japan (M.T., N.K.); and Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan (H. Suzuki)
| | - Nobuhisa Kashiwagi
- Department of Neurosurgery, Mie Chuo Medical Center, 2158-5 Myojin-cho, Hisai, Tsu, Mie 514-1101, Japan (S.T., F.I.); Department of Neurosurgery, Kuwana City Medical Center, Kuwana, Japan (A.Y., H. Sakaida); Department of Neurosurgery, Suzuka Central General Hospital, Suzuka, Japan (S.S.); School of Statistical Thinking, The Institute of Statistical Mathematics, Tachikawa, Japan (M.T., N.K.); and Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan (H. Suzuki)
| | - Hidenori Suzuki
- Department of Neurosurgery, Mie Chuo Medical Center, 2158-5 Myojin-cho, Hisai, Tsu, Mie 514-1101, Japan (S.T., F.I.); Department of Neurosurgery, Kuwana City Medical Center, Kuwana, Japan (A.Y., H. Sakaida); Department of Neurosurgery, Suzuka Central General Hospital, Suzuka, Japan (S.S.); School of Statistical Thinking, The Institute of Statistical Mathematics, Tachikawa, Japan (M.T., N.K.); and Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan (H. Suzuki)
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Hackenberg KAM, Algra A, Salman RAS, Frösen J, Hasan D, Juvela S, Langer D, Meyers P, Morita A, Rinkel G, Etminan N. Definition and Prioritization of Data Elements for Cohort Studies and Clinical Trials on Patients with Unruptured Intracranial Aneurysms: Proposal of a Multidisciplinary Research Group. Neurocrit Care 2020; 30:87-101. [PMID: 31102238 DOI: 10.1007/s12028-019-00729-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Variability in usage and definition of data characteristics in previous cohort studies on unruptured intracranial aneurysms (UIA) complicated pooling and proper interpretation of these data. The aim of the National Institute of Health/National Institute of Neurological Disorders and Stroke UIA and Subarachnoid Hemorrhage (SAH) Common Data Elements (CDE) Project was to provide a common structure for data collection in future research on UIA and SAH. METHODS This paper describes the development and summarization of the recommendations of the working groups (WGs) on UIAs, which consisted of an international and multidisciplinary panel of cerebrovascular specialists on research and treatment of UIAs. Consensus recommendations were developed by review of previously published CDEs for other neurological diseases and the literature on UIAs. Recommendations for CDEs were classified by priority into 'Core,' 'Supplemental-Highly Recommended,' 'Supplemental,' and 'Exploratory.' RESULTS Ninety-one CDEs were compiled; 69 were newly created and 22 were existing CDEs. The CDEs were assigned to eight subcategories and were classified as Core (8), Supplemental-Highly Recommended (23), Supplemental (25), and Exploratory (35) elements. Additionally, the WG developed and agreed on a classification for aneurysm morphology. CONCLUSION The proposed CDEs have been distilled from a broad pool of characteristics, measures, or outcomes. The usage of these CDEs will facilitate pooling of data from cohort studies or clinical trials on patients with UIAs.
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Affiliation(s)
- Katharina A M Hackenberg
- Department of Neurosurgery, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany.
| | - Ale Algra
- Brain Center Rudolph Magnus, Department of Neurology and Neurosurgery, and the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rustam Al-Shahi Salman
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, Edinburgh, UK
| | - Juhana Frösen
- Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - David Hasan
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Seppo Juvela
- Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - David Langer
- Department of Neurosurgery, Hofstra Northwell School of Medicine, and Northwell Health, Lenox-Hill Hospital, New York, NY, USA
| | - Philip Meyers
- Departments of Neurosurgery and Radiology, Columbia University Medical Center, New York, NY, USA
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Gabriel Rinkel
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nima Etminan
- Department of Neurosurgery, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
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Futami K, Uno T, Misaki K, Tamai S, Nambu I, Uchiyama N, Nakada M. Identification of Vortex Cores in Cerebral Aneurysms on 4D Flow MRI. AJNR Am J Neuroradiol 2019; 40:2111-2116. [PMID: 31753836 DOI: 10.3174/ajnr.a6322] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 08/13/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The complexity and instability of the vortex flow in aneurysms are factors related to the rupture risk of unruptured cerebral aneurysms. We identified aneurysm vortex cores on 4D flow MR imaging and examined the relationship of these factors with the characteristics of cerebral aneurysms. MATERIALS AND METHODS We subjected 40 aneurysms (37 unruptured, 3 ruptured) to 4D flow MR imaging. We visualized streamlines with velocities below the threshold-that is, a percentage value of the aneurysm maximum inflow velocity-and progressively decreased the threshold to identify vortex cores as thin, streamline bundles with minimum velocities. Complexity and stability were compared in aneurysms with a smooth surface and those with blebs or daughter sacs. RESULTS The threshold for visualizing vortex cores ranged from 3% to 13% of the maximum inflow velocity. Vortex cores could be visualized in 38 aneurysms; in 2, they were not visualized through the cardiac cycle. A simple flow pattern (single vortex core) was identified in 27 aneurysms; the other 13 exhibited a complex flow pattern. The cores were stable in 32 and unstable in 8 aneurysms. Significantly more aneurysms with-than-without blebs or daughter sacs had a complex flow pattern (P = .006). Of the 3 ruptured aneurysms, 1 aneurysm had an unstable vortex core; in the other 2, the vortex core was not visualized. CONCLUSIONS The identification of vortex cores on 4D flow MR imaging may help to stratify the rupture risk of unruptured cerebral aneurysms.
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Affiliation(s)
- K Futami
- From the Department of Neurosurgery (K.F.), Hokuriku Central Hospital, Toyama, Japan
| | - T Uno
- Department of Neurosurgery (T.U., K.M., S.T., I.N., N.U., M.N.), Kanazawa University School of Medicine, Ishikawa, Japan
| | - K Misaki
- Department of Neurosurgery (T.U., K.M., S.T., I.N., N.U., M.N.), Kanazawa University School of Medicine, Ishikawa, Japan
| | - S Tamai
- Department of Neurosurgery (T.U., K.M., S.T., I.N., N.U., M.N.), Kanazawa University School of Medicine, Ishikawa, Japan
| | - I Nambu
- Department of Neurosurgery (T.U., K.M., S.T., I.N., N.U., M.N.), Kanazawa University School of Medicine, Ishikawa, Japan
| | - N Uchiyama
- Department of Neurosurgery (T.U., K.M., S.T., I.N., N.U., M.N.), Kanazawa University School of Medicine, Ishikawa, Japan
| | - M Nakada
- Department of Neurosurgery (T.U., K.M., S.T., I.N., N.U., M.N.), Kanazawa University School of Medicine, Ishikawa, Japan
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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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Affiliation(s)
- Katharina A M Hackenberg
- From the Department of Neurosurgery, University Hospital Mannheim, University of Heidelberg, Germany
| | - Daniel Hänggi
- From the Department of Neurosurgery, University Hospital Mannheim, University of Heidelberg, Germany
| | - Nima Etminan
- From the Department of Neurosurgery, University Hospital Mannheim, University of Heidelberg, Germany
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37
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Stevens RRF, Donders WP, Quicken S, van de Vosse FN, Mess WH, Delhaas T, Huberts W. The Role of One-Dimensional Model-Generated Inter-Subject Variations in Systemic Properties on Wall Shear Stress Indices of Intracranial Aneurysms. IEEE Trans Biomed Eng 2019; 67:1030-1039. [PMID: 31329544 DOI: 10.1109/tbme.2019.2928416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Variations in systemic properties of the arterial tree, such as aging-induced vessel stiffness, can alter the shape of pressure and flow waveforms. As a consequence, the hemodynamics around a cerebral aneurysm change, and therefore, also the corresponding in- and outlet boundary conditions (BCs) used for three-dimensional (3D) calculations of hemodynamic indices. In this study, we investigate the effects of variations in systemic properties on wall shear stress (WSS) indices of a cerebral aneurysm. We created a virtual patient database by varying systemic properties within physiological ranges. BCs for 3D-CFD simulations were derived using a pulse wave propagation model for each realization of the virtual database. WSS indices were derived from the 3D simulations and their variabilities quantified. Variations in BCs, caused by changes in systemic properties, yielded variabilities in the WSS indices that were of the same order of magnitude as differences in these WSS indices between ruptured and unruptured aneurysms. Sensitivity analysis showed that the systemic properties impacted both in- and outlet BCs simultaneously and altered the WSS indices. We conclude that the influence of variations in patient-specific systemic properties on WSS indices should be evaluated when using WSS indices in multidisciplinary rupture prediction models.
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ARANDA ALFREDO, VALENCIA ALVARO. COMPUTATIONAL STUDY ON THE RUPTURE RISK IN REAL CEREBRAL ANEURYSMS WITH GEOMETRICAL AND FLUID-MECHANICAL PARAMETERS USING FSI SIMULATIONS AND MACHINE LEARNING ALGORITHMS. J MECH MED BIOL 2019. [DOI: 10.1142/s0219519419500143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Fluid-mechanical and morphological parameters are recognized as major factors in the rupture risk of human aneurysms. On the other hand, it is well known that a lot of machine learning tools are available to study a variety of problems in many fields. In this work, fluid–structure interaction (FSI) simulations were carried out to examine a database of 60 real saccular cerebral aneurysms (30 ruptured and 30 unruptured) using reconstructions by angiography images. With the results of the simulations and geometric analyses, we studied the analysis of variance (ANOVA) statistic test in many variables and we obtained that aspect ratio (AR), bottleneck factor (BNF), maximum height of the aneurysms (MH), relative residence time (RRT), Womersley number (WN) and Von-Mises strain (VMS) are statically significant and good predictors for the models. In consequence, these ones were used in five machine learning algorithms to determine the rupture risk predictions of the aneurysms, where the adaptative boosting (AdaBoost) was calculated with the highest area under the curve (AUC) in the receiver operating characteristic (ROC) curve (AUC 0.944).
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Affiliation(s)
- ALFREDO ARANDA
- Department of Mechanical Engineering, Universidad de Chile, Beauchef 851, Santiago 8370456, Chile
| | - ALVARO VALENCIA
- Department of Mechanical Engineering, Universidad de Chile, Beauchef 851, Santiago 8370456, Chile
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Liu HJ, Zhou H, Lu DL, Jiao YB, Chen SF, Cheng J, Yao XJ, Ren JY, Li SF, Liu W, Gao JC, Yue Y, Xu JX, Zhang PN, Feng YG. Intracranial Mirror Aneurysm: Epidemiology, Rupture Risk, New Imaging, Controversies, and Treatment Strategies. World Neurosurg 2019; 127:165-175. [PMID: 30954748 DOI: 10.1016/j.wneu.2019.03.275] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/26/2019] [Accepted: 03/27/2019] [Indexed: 12/27/2022]
Abstract
There are some controversies about the surgical treatment strategy of mirror aneurysms. Whether to choose 1-stage or 2-stage surgery, bilateral or unilateral craniotomy, or surgical or interventional treatment are the main points in dispute. In this review, the different surgery strategies faced by patients are discussed. Different surgical methods are adopted based on the patient's individual state and the location and size of the aneurysm. A new imaging method is introduced using 3D Slicer, which clearly recognizes the relationship among aneurysm, brain tissue, skull, and nerve. The 3D Slicer can help surgeons undertake adequate preoperative preparation. In addition, we also introduce some ruptured factors (e.g., age, gender, hypertension, morphologic, and hemodynamic) concerning mirror aneurysm. Systematic discussion of the controversies and methods in surgical treatment of mirror aneurysms may provide new perspectives in future research for the prevention and treatment of mirror aneurysms.
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Affiliation(s)
| | - Han Zhou
- Qingdao University, Qingdao, China
| | | | - Ying-Bin Jiao
- Department of Neurosurgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | | | - Jing Cheng
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | | | | | - Shi-Fang Li
- Department of Neurosurgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wei Liu
- Department of Neurosurgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | | | - Yong Yue
- Qingdao University, Qingdao, China
| | | | - Pi-Ning Zhang
- Department of Radiology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yu-Gong Feng
- Department of Neurosurgery, Affiliated Hospital of Qingdao University, Qingdao, China.
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40
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Tanioka S, Ishida F, Kishimoto T, Tsuji M, Tanaka K, Shimosaka S, Toyoda M, Kashiwagi N, Sano T, Suzuki H. Quantification of hemodynamic irregularity using oscillatory velocity index in the associations with the rupture status of cerebral aneurysms. J Neurointerv Surg 2019; 11:614-617. [PMID: 30670624 DOI: 10.1136/neurintsurg-2018-014489] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/01/2018] [Accepted: 12/09/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Complex and unstable flow patterns are reported to be associated with the rupture status of cerebral aneurysms, while their evaluation depends on qualitative analysis of streamlines of bloodflow. Oscillatory velocity index (OVI) is a hemodynamic parameter to quantify flow patterns. The aim of this study is to elucidate the associations between OVI and the rupture status of cerebral aneurysms. METHODS One hundred and twenty-nine ruptured and unruptured cerebral aneurysms were analyzed with computational fluid dynamics under pulsatile flow conditions. With the use of median value of OVI, all aneurysms were divided into high and low OVI groups. Statistical analysis was performed to compare rupture status, and morphological and hemodynamic parameters between the two groups. RESULTS The median value of OVI was 0.006. High OVI was more likely observed in ruptured aneurysms (P=0.028) and associated with irregular shape, complex flow patterns, and unstable flow patterns (P<0.001, respectively). In morphological parameters, maximum size, aspect, projection, size, and volume-to-ostium area ratios were significantly higher in the high OVI group (P<0.001, respectively). In hemodynamic parameters, wall shear stress and wall shear stress gradient were significantly lower, and oscillatory shear index and gradient oscillatory number were significantly higher in the high OVI group (P<0.001, respectively). CONCLUSION High OVI was associated with rupture status, and morphological and hemodynamic characteristics of ruptured aneurysms. These results indicate that OVI may serve as a valuable hemodynamic parameter for diagnosing rupture status and risks of aneurysms.
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Affiliation(s)
- Satoru Tanioka
- Department of Neurosurgery, Mie Chuo Medical Center, Tsu, Japan
| | - Fujimaro Ishida
- Department of Neurosurgery, Mie Chuo Medical Center, Tsu, Japan
| | - Tomoyuki Kishimoto
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Masanori Tsuji
- Department of Neurosurgery, Mie Chuo Medical Center, Tsu, Japan
| | | | | | - Mitsuru Toyoda
- School of Statistical Thinking, The Institute of Statistical Mathematics, Tachikawa, Japan
| | - Nobuhisa Kashiwagi
- School of Statistical Thinking, The Institute of Statistical Mathematics, Tachikawa, Japan
| | - Takanori Sano
- Department of Neurosurgery, Japanese Red Cross Ise Hospital, Ise, Japan
| | - Hidenori Suzuki
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan
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Detmer FJ, Chung BJ, Jimenez C, Hamzei-Sichani F, Kallmes D, Putman C, Cebral JR. Associations of hemodynamics, morphology, and patient characteristics with aneurysm rupture stratified by aneurysm location. Neuroradiology 2018; 61:275-284. [PMID: 30456458 DOI: 10.1007/s00234-018-2135-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 11/12/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE The mechanisms of cerebral aneurysm rupture are not fully understood. We analyzed the associations of hemodynamics, morphology, and patient age and gender with aneurysm rupture stratifying by location. METHODS Using image-based models, 20 hemodynamic and 17 morphological parameters were compared in 1931 ruptured and unruptured aneurysms with univariate logistic regression. Rupture rates were compared between males and females as well as younger and older patients and bifurcation versus sidewall aneurysms for different aneurysm locations. Subsequently, associations between hemodynamics and morphology and patient as well as aneurysm characteristics were analyzed for aneurysms at five locations. RESULTS Compared to unruptured aneurysms, ruptured aneurysms were characterized by a more irregular shape and were exposed to a more adverse hemodynamic environment described by faster flow, higher wall shear stress, more oscillatory shear, and more unstable and complex flows. These associations with rupture status were consistent for different aneurysm locations. Rupture rates were significantly higher in males at the internal carotid artery (ICA) bifurcation, ophthalmic ICA, and the middle cerebral artery (MCA) bifurcation. At the anterior communicating artery (ACOM) and MCA bifurcation, they were significantly higher for younger patients. Bifurcation aneurysms had significantly larger rupture rates at the MCA and posterior communicating artery (PCOM). In these groups with higher rupture rates, aneurysms were characterized by adverse hemodynamics and more complex shapes. CONCLUSION Hemodynamic and morphological differences between ruptured and unruptured aneurysms are consistent across locations. Adverse morphology and hemodynamics are related to rupture as well as younger age, male gender, and bifurcation aneurysms.
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Affiliation(s)
- Felicitas J Detmer
- Bioengineering Department, Volgenau School of Engineering, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA.
| | - Bong Jae Chung
- Bioengineering Department, Volgenau School of Engineering, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
| | - Carlos Jimenez
- Neurosurgery Department, University of Antioquia, Medellin, Colombia
| | - Farid Hamzei-Sichani
- Department of Neurological Surgery, University of Massachusetts, Worcester, MA, USA
| | - David Kallmes
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Christopher Putman
- Interventional Neuroradiology Unit, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Juan R Cebral
- Bioengineering Department, Volgenau School of Engineering, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
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42
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Hemodynamic findings associated with intraoperative appearances of intracranial aneurysms. Neurosurg Rev 2018; 43:203-209. [DOI: 10.1007/s10143-018-1027-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 08/04/2018] [Accepted: 08/28/2018] [Indexed: 10/28/2022]
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43
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Anatomical evaluation of intracranial aneurysm rupture risk in patients with multiple aneurysms. Neurosurg Rev 2018; 42:539-547. [DOI: 10.1007/s10143-018-0998-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 05/28/2018] [Accepted: 06/15/2018] [Indexed: 11/27/2022]
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44
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Wang GX, Liu J, Chen YQ, Wen L, Yang MG, Gong MF, Zhang D. Morphological characteristics associated with the rupture risk of mirror posterior communicating artery aneurysms. J Neurointerv Surg 2018; 10:995-998. [DOI: 10.1136/neurintsurg-2017-013553] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/21/2017] [Accepted: 01/16/2018] [Indexed: 11/03/2022]
Abstract
ObjectivePatient related clinical factors and intracranial aneurysms (IAs) at different locations may lead to statistical bias when investigating the rupture risk of IAs. Thus the purpose of this study was to identify the morphological parameters that are related to the rupture of mirror posterior communicating artery aneurysms (PComAAs).MethodsBetween August 2011 and July 2017, 68 patients with mirror PComAAs and aneurysmal subarachnoid hemorrhage were diagnosed by CT angiography at three medical centers. Morphological characteristics for PComAAs included bifurcation, shape, neck width, width, depth, maximum size, flow angle, parent vessel diameter, aspect ratio (AR), depth/width ratio, bottleneck factor, and size ratio (SR). Multiple logistic regression analysis was performed to determine the independent risk factors for rupture. Receiver operating characteristic curve analysis was performed to obtain the optimal thresholds.ResultsAR (OR 5.623) and SR (OR 5.570) were more commonly observed in the ruptured cohort. The threshold values of AR and SR were 0.98 and 1.21, respectively.ConclusionsMirror PComAAs are a useful model to investigate the rupture risk of PComAAs. AR (≥0.98) and SR (≥1.21) are better predictors of ruptured PComAAs.
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45
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Suzuki T, Takao H, Suzuki T, Suzuki T, Masuda S, Dahmani C, Watanabe M, Mamori H, Ishibashi T, Yamamoto H, Yamamoto M, Murayama Y. Variability of hemodynamic parameters using the common viscosity assumption in a computational fluid dynamics analysis of intracranial aneurysms. Technol Health Care 2017; 25:37-47. [PMID: 27497460 DOI: 10.3233/thc-161245] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In most simulations of intracranial aneurysm hemodynamics, blood is assumed to be a Newtonian fluid. However, it is a non-Newtonian fluid, and its viscosity profile differs among individuals. Therefore, the common viscosity assumption may not be valid for all patients. OBJECTIVE This study aims to test the suitability of the common viscosity assumption. METHODS Blood viscosity datasets were obtained from two healthy volunteers. Three simulations were performed for three different-sized aneurysms, two using measured value-based non-Newtonian models and one using a Newtonian model. The parameters proposed to predict an aneurysmal rupture obtained using the non-Newtonian models were compared with those obtained using the Newtonian model. RESULTS The largest difference (25%) in the normalized wall shear stress (NWSS) was observed in the smallest aneurysm. Comparing the difference ratio to the NWSS with the Newtonian model between the two Non-Newtonian models, the difference of the ratio was 17.3%. CONCLUSIONS Irrespective of the aneurysmal size, computational fluid dynamics simulations with either the common Newtonian or non-Newtonian viscosity assumption could lead to values different from those of the patient-specific viscosity model for hemodynamic parameters such as NWSS.
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Affiliation(s)
- Takashi Suzuki
- Graduate School of Mechanical Engineering, Tokyo University of Science, Tokyo, Japan
| | - Hiroyuki Takao
- Graduate School of Mechanical Engineering, Tokyo University of Science, Tokyo, Japan.,Division of Endovascular Neurosurgery, Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan.,Department of Innovation for Medical Information Technology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takamasa Suzuki
- Department of Chemical, Energy and Environment Engineering, Kansai University, Osaka, Japan
| | - Tomoaki Suzuki
- Division of Endovascular Neurosurgery, Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Shunsuke Masuda
- Division of Endovascular Neurosurgery, Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Chihebeddine Dahmani
- Division of Endovascular Neurosurgery, Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan.,Siemens Japan K.K., Shinagawa-ku, Tokyo, Japan
| | - Mitsuyoshi Watanabe
- Division of Endovascular Neurosurgery, Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroya Mamori
- Department of Mechanical Engineering, Tokyo University of Science, Tokyo, Japan
| | - Toshihiro Ishibashi
- Division of Endovascular Neurosurgery, Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Hideki Yamamoto
- Department of Chemical, Energy and Environment Engineering, Kansai University, Osaka, Japan
| | - Makoto Yamamoto
- Department of Mechanical Engineering, Tokyo University of Science, Tokyo, Japan
| | - Yuichi Murayama
- Division of Endovascular Neurosurgery, Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
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46
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Morphological characteristics associated with rupture risk of multiple intracranial aneurysms. ASIAN PAC J TROP MED 2017; 10:1011-1014. [DOI: 10.1016/j.apjtm.2017.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 08/30/2017] [Accepted: 09/11/2017] [Indexed: 11/18/2022] Open
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47
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Cai W, Hu C, Gong J, Lan Q. Anterior Communicating Artery Aneurysm Morphology and the Risk of Rupture. World Neurosurg 2017; 109:119-126. [PMID: 28958928 DOI: 10.1016/j.wneu.2017.09.118] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 09/16/2017] [Accepted: 09/18/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recently, with improvements in computed tomography angiography and digital subtraction angiography, the assessment of certain morphologic traits of anterior communicating artery aneurysms (ACoAA) has drawn great attention. The determination of specific factors associated with rupture would provide much-needed guidance for the treatment of unruptured intracranial aneurysms, such as surgical clipping or endovascular coiling. Morphologic factors include, but are not limited to, aneurysm size, number, shape, dome direction, neck/dome ratio, and relationship of the aneurysm to the surrounding vessels. However, the results of previous investigations concerning morphologic parameters have yielded inconsistent results. METHODS This review presents and analyzes the literature on the morphology of ACoAAs and risk of rupture. RESULTS This literature review reveals that the strongest predictors of ACoAA rupture are size ratio, direction of the dome, and fenestration. These were the only factors that were either unanimously or near unanimously found to be predictive of rupture across multiple studies. CONCLUSIONS The size ratio, direction of the dome, and fenestration should be examined most meticulously when deciding when to treat an ACoAA.
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Affiliation(s)
- Wu Cai
- Department of Radiology, Second Affiliated Hospital of Soochow University, Suzhou, People's Republic of China; Department of Radiology, First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Chunhong Hu
- Department of Radiology, First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.
| | - Jianping Gong
- Department of Radiology, Second Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Qing Lan
- Department of Neurosurgery, Second Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
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48
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Longo M, Granata F, Racchiusa S, Mormina E, Grasso G, Longo GM, Garufi G, Salpietro FM, Alafaci C. Role of Hemodynamic Forces in Unruptured Intracranial Aneurysms: An Overview of a Complex Scenario. World Neurosurg 2017; 105:632-642. [DOI: 10.1016/j.wneu.2017.06.035] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/04/2017] [Accepted: 06/05/2017] [Indexed: 12/16/2022]
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49
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Association of wall shear stress with intracranial aneurysm rupture: systematic review and meta-analysis. Sci Rep 2017; 7:5331. [PMID: 28706287 PMCID: PMC5509692 DOI: 10.1038/s41598-017-05886-w] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 05/31/2017] [Indexed: 11/24/2022] Open
Abstract
To evaluate the relationship between wall shear stress (WSS) magnitude and cerebral aneurysm rupture and provide new insight into the disparate computational fluid dynamics (CFD) findings concerning the role of WSS in intracranial aneurysm (IA) rupture. A systematic electronic database (PubMed, Medline, Springer, and EBSCO) search was conducted for all accessible published articles up to July 1, 2016, with no restriction on the publication year. Abstracts, full-text manuscripts, and the reference lists of retrieved articles were analyzed. Random effects meta-analysis was used to pool the complication rates across studies. Twenty-two studies containing CFD data on 1257 patients with aneurysms were included in the analysis. A significantly higher rate of low WSS (0–1.5 Pa) was found in ruptured aneurysms (odds ratio [OR] 2.17; 95% confidence interval [CI], 1.73–2.62). The pooled analyses across 14 studies with low WSS showed significantly lower mean WSS (0.64 vs. 1.4 Pa) (p = 0.037) in the ruptured group. This meta-analysis provides evidence that decreased local WSS may be an important predictive parameter of IA rupture.
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50
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Sano T, Ishida F, Tsuji M, Furukawa K, Shimosaka S, Suzuki H. Hemodynamic Differences Between Ruptured and Unruptured Cerebral Aneurysms Simultaneously Existing in the Same Location: 2 Case Reports and Proposal of a Novel Parameter Oscillatory Velocity Index. World Neurosurg 2017; 98:868.e5-868.e10. [DOI: 10.1016/j.wneu.2016.12.047] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 12/13/2016] [Accepted: 12/14/2016] [Indexed: 10/20/2022]
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