1
|
Sohrabi-Ashlaghi A, Azizi N, Abbastabar H, Shakiba M, Zebardast J, Firouznia K. Accuracy of radiomics-Based models in distinguishing between ruptured and unruptured intracranial aneurysms: A systematic review and meta-Analysis. Eur J Radiol 2024; 181:111739. [PMID: 39293240 DOI: 10.1016/j.ejrad.2024.111739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 08/13/2024] [Accepted: 09/14/2024] [Indexed: 09/20/2024]
Abstract
INTRODUCTION Intracranial aneurysms (IAs) pose a severe health risk due to the potential for subarachnoid hemorrhage upon rupture. This study aims to conduct a systematic review and meta-analysis on the accuracy of radiomics features derived from computed tomography angiography (CTA) in differentiating ruptured from unruptured IAs. MATERIALS AND METHODS A systematic search was performed across multiple databases for articles published up to January 2024. Observational studies analyzing CTA using radiomics features were included. The area under the curve (AUC) for classifying ruptured vs. unruptured IAs was pooled using a random-effects model. Subgroup analyses were conducted based on the use of radiomics-only features versus radiomics plus additional image-based features, as well as the type of filters used for image processing. RESULTS Six studies with 4,408 patients were included. The overall pooled AUC for radiomics features in differentiating ruptured from unruptured IAs was 0.86 (95% CI: 0.84-0.88). The AUC was 0.85 (95% CI: 0.82-0.88) for studies using only radiomics features and 0.87 (95% CI: 0.83-0.91) for studies incorporating radiomics plus additional image-based features. Subgroup analysis based on filter type showed an AUC of 0.87 (95% CI: 0.83-0.90) for original filters and 0.86 (95% CI: 0.81-0.90) for studies using additional filters. CONCLUSION Radiomics-based models demonstrate very good diagnostic accuracy in classifying ruptured and unruptured IAs, with AUC values exceeding 0.8. This highlights the potential of radiomics as a useful tool in the non-invasive assessment of aneurysm rupture risk, particularly in the management of patients with multiple aneurysms.
Collapse
Affiliation(s)
- Ahmadreza Sohrabi-Ashlaghi
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science, Tehran, Iran
| | - Narges Azizi
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science, Tehran, Iran
| | - Hedayat Abbastabar
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science, Tehran, Iran
| | - Madjid Shakiba
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science, Tehran, Iran
| | - Jayran Zebardast
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science, Tehran, Iran
| | - Kavous Firouznia
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science, Tehran, Iran.
| |
Collapse
|
2
|
Wang X, Huang X. Risk factors and predictive indicators of rupture in cerebral aneurysms. Front Physiol 2024; 15:1454016. [PMID: 39301423 PMCID: PMC11411460 DOI: 10.3389/fphys.2024.1454016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 08/23/2024] [Indexed: 09/22/2024] Open
Abstract
Cerebral aneurysms are abnormal dilations of blood vessels in the brain that have the potential to rupture, leading to subarachnoid hemorrhage and other serious complications. Early detection and prediction of aneurysm rupture are crucial for effective management and prevention of rupture-related morbidities and mortalities. This review aims to summarize the current knowledge on risk factors and predictive indicators of rupture in cerebral aneurysms. Morphological characteristics such as aneurysm size, shape, and location, as well as hemodynamic factors including blood flow patterns and wall shear stress, have been identified as important factors influencing aneurysm stability and rupture risk. In addition to these traditional factors, emerging evidence suggests that biological and genetic factors, such as inflammation, extracellular matrix remodeling, and genetic polymorphisms, may also play significant roles in aneurysm rupture. Furthermore, advancements in computational fluid dynamics and machine learning algorithms have enabled the development of novel predictive models for rupture risk assessment. However, challenges remain in accurately predicting aneurysm rupture, and further research is needed to validate these predictors and integrate them into clinical practice. By elucidating and identifying the various risk factors and predictive indicators associated with aneurysm rupture, we can enhance personalized risk assessment and optimize treatment strategies for patients with cerebral aneurysms.
Collapse
Affiliation(s)
- Xiguang Wang
- Department of Research & Development Management, Shanghai Aohua Photoelectricity Endoscope Co., Ltd., Shanghai, China
| | - Xu Huang
- Department of Research & Development Management, Shanghai Aohua Photoelectricity Endoscope Co., Ltd., Shanghai, China
| |
Collapse
|
3
|
Rajendran K, Madhavan AA. Optimizing Photon-Counting Detector CT for Imaging Intracranial Aneurysms. AJNR Am J Neuroradiol 2024:ajnr.A8400. [PMID: 39122465 DOI: 10.3174/ajnr.a8400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
|
4
|
Jones ED, Kaoutzani L, Walker SE, Kollapaneni SS, Giurgiutiu DV, Rahimi SY. High Rate of Angiogram-Negative Subarachnoid Hemorrhage in a Rural Population: Role of Venous Drainage. World Neurosurg 2024; 188:e491-e496. [PMID: 38821401 DOI: 10.1016/j.wneu.2024.05.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 06/02/2024]
Affiliation(s)
- Earl D Jones
- Department of Neurosurgery, Medical College of Georgia, Augusta, GA, USA
| | - Lydia Kaoutzani
- Department of Neurosurgery, Medical College of Georgia, Augusta, GA, USA.
| | - Samantha E Walker
- Department of Neurosurgery, Medical College of Georgia, Augusta, GA, USA
| | | | | | - Scott Y Rahimi
- Department of Neurosurgery, Medical College of Georgia, Augusta, GA, USA
| |
Collapse
|
5
|
Abdollahifard S, Farrokhi A, Kheshti F, Jalali M, Mowla A. Application of convolutional network models in detection of intracranial aneurysms: A systematic review and meta-analysis. Interv Neuroradiol 2023; 29:738-747. [PMID: 35549574 PMCID: PMC10680951 DOI: 10.1177/15910199221097475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/11/2022] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Intracranial aneurysms have a high prevalence in human population. It also has a heavy burden of disease and high mortality rate in the case of rupture. Convolutional neural network(CNN) is a type of deep learning architecture which has been proven powerful to detect intracranial aneurysms. METHODS Four databases were searched using artificial intelligence, intracranial aneurysms, and synonyms to find eligible studies. Articles which had applied CNN for detection of intracranial aneurisms were included in this review. Sensitivity and specificity of the models and human readers regarding modality, size, and location of aneurysms were sought to be extracted. Random model was the preferred model for analyses using CMA 2 to determine pooled sensitivity and specificity. RESULTS Overall, 20 studies were used in this review. Deep learning models could detect intracranial aneurysms with a sensitivity of 90/6% (CI: 87/2-93/2%) and specificity of 94/6% (CI: 0/914-0/966). CTA was the most sensitive modality (92.0%(CI:85/2-95/8%)). Overall sensitivity of the models for aneurysms more than 3 mm was above 98% (98%-100%) and 74.6 for aneurysms less than 3 mm. With the aid of AI, the clinicians' sensitivity increased to 12/8% and interrater agreement to 0/193. CONCLUSION CNN models had an acceptable sensitivity for detection of intracranial aneurysms, surpassing human readers in some fields. The logical approach for application of deep learning models would be its use as a highly capable assistant. In essence, deep learning models are a groundbreaking technology that can assist clinicians and allow them to diagnose intracranial aneurysms more accurately.
Collapse
Affiliation(s)
- Saeed Abdollahifard
- Research center for neuromodulation and pain, Shiraz, Iran
- Student research committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amirmohammad Farrokhi
- Research center for neuromodulation and pain, Shiraz, Iran
- Student research committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Kheshti
- Research center for neuromodulation and pain, Shiraz, Iran
- Student research committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahtab Jalali
- Research center for neuromodulation and pain, Shiraz, Iran
- Student research committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ashkan Mowla
- Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA
| |
Collapse
|
6
|
Raghuram A, Patel R, Varon A, Sabotin R, Sanchez S, Derdeyn CP, Jabbour P, Hasan DM, Samaniego EA. Volumetric surveillance of brain aneurysms: Pitfalls of MRA. Interv Neuroradiol 2023; 29:532-539. [PMID: 35549745 PMCID: PMC10549707 DOI: 10.1177/15910199221100619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/26/2022] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Untreated brain aneurysms are usually surveilled with serial MR imaging and evaluated with 2D multiplanar measurements. The assessment of aneurysm growth may be more accurate with volumetric analysis. We evaluated the accuracy of a magnetic resonance angiography (MRA) segmentation pipeline for aneurysm volume measurement and surveillance. METHODS A pipeline to determine aneurysm volume was developed and tested on two aneurysm phantoms imaged with time-of flight (TOF) MRA and 3D rotational angiography (3DRA). The accuracy of the pipeline was then evaluated by reconstructing 10 aneurysms imaged with contrast enhanced-MRA (CE-MRA) and 3DRA. This calibrated and refined post-processing pipeline was subsequently used to analyse aneurysms from our prospectively acquired database. Volume changes above the threshold of error were considered true volume changes. The accuracy of these measurements was analysed. RESULTS TOF-MRA reconstructions were not as accurate as CE-MRA reconstructions. When compared to 3DRA, CE-MRA underestimated aneurysm volume by 7.8% and did not accurately register the presence of blebs. Eighteen aneurysms (13 saccular and 5 fusiform) were analysed with the optimized 3D volume reconstruction pipeline, with a mean follow-up time of 11 months. Artifact accounted for 10.2% error in volume measurements using serial CE-MRA. When this margin of error was used to assess aneurysms volume in serial imaging with CE-MRA, only two fusiform aneurysms changed in volume. The variations in volume of these two fusiform aneurysms were caused by intra-mural and intrasaccular thrombosis. CONCLUSIONS CE-MRA and TOF-MRA 3D volume reconstructions may not register minor morphological changes such as the appearance of blebs. CE-MRA underestimates volume by 7.8% compared to 3DRA. Serial CE-MRA volume measurements had a larger margin of error of approximately 10.2%. MRA-based volumetric measurements may not be appropriate for aneurysm surveillance.
Collapse
Affiliation(s)
- Ashrita Raghuram
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Rishi Patel
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Alberto Varon
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Ryan Sabotin
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Sebastian Sanchez
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Colin P Derdeyn
- Department of Radiology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - David M. Hasan
- Department of Neurosurgery, Duke University, Durham, NC, USA
| | - Edgar A. Samaniego
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
- Department of Radiology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| |
Collapse
|
7
|
Naboulsi WK, Lantz R, Khan A. From Eardrum to Cranium: Pneumocephalus Secondary to Acute Otitis Media. Cureus 2023; 15:e43756. [PMID: 37727174 PMCID: PMC10506660 DOI: 10.7759/cureus.43756] [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] [Accepted: 08/17/2023] [Indexed: 09/21/2023] Open
Abstract
Pneumocephalus, or air entrapment within the cranium, is a rare but dangerous condition with a variety of causes, including trauma, surgery, or predisposing infection. Trauma is the most common etiology, as fractures provide easy access for air to become entrapped in the cranium. However, access such as via the central nervous system with leak exists. Though not as common as traumatic pneumocephalus, pneumocephalus secondary to infection is a dangerous condition. The literature is sparse on this example of ear-nose-throat infection, making it difficult to form and ascertain guidelines for the management of infectious pneumocephalus and its complications. A 58-year-old man with a history of hypertension, obesity, type 2 diabetes mellitus, and obstructive sleep apnea who presented with a complicated case of acute otitis media associated with subdural empyema, pneumocephalus, and group A Streptococcus is presented in this case report. We describe the course of his hospital stay, management, and current infectious disease guidelines. Given the paucity of cases of infectious pneumocephalus secondary to otitis media, we aim to provide further representation for this important illness as well as encourage the use of a multimodal team of providers. In our case, it was necessary to involve the ear-nose-throat specialist as well as infectious disease and neurocritical care services.
Collapse
Affiliation(s)
- Waseem K Naboulsi
- Internal Medicine, Wright State University Boonshoft School of Medicine, Dayton, USA
| | - Rebekah Lantz
- Internal Medicine, Miami Valley Hospital, Dayton, USA
| | - Asif Khan
- Infectious Diseases, Dartmouth Hitchcock Medical Center, Dartmouth, USA
| |
Collapse
|
8
|
Shang W, Jin H, Vastani A, Mirza AB, Fisher B, Kalra N, Anderson I, Kailaya-Vasan A. Cost-effectiveness of repeat delayed imaging for spontaneous subarachnoid hemorrhage. PLoS One 2023; 18:e0289144. [PMID: 37494367 PMCID: PMC10370759 DOI: 10.1371/journal.pone.0289144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 07/12/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND In patients with intracranial aneurysm presenting with spontaneous subarachnoid hemorrhage (SAH), 15% of them could be missed by the initial diagnostic imaging. Repeat delayed imaging can help to identify previously undetected aneurysms, however, the cost-effectiveness of this strategy remains uncertain. OBJECTIVE The aim of this study is to assess the cost-effectiveness of repeat delayed imaging in patients with SAH who had a negative result during their initial imaging. METHODS A Markov model was developed to estimate the lifetime costs and quality-adjusted life-year (QALY) for patients who received or not received repeat delayed imaging. The analyses were conducted from a healthcare perspective, with costs reported in UK pounds and expressed in 2020 values. Extensive sensitivity analyses were performed to assess the robustness of the results. RESULTS The base case incremental cost-effectiveness ratio (ICER) of repeat delayed imaging is £9,314 per QALY compared to no-repeat delayed imaging. This ICER is below the National Institute for Health and Care Excellence (NICE) £20,000 per QALY willingness-to-pay threshold. At the NICE willingness-to-pay threshold of £20,000 per QALY, the probability that repeat delayed imaging is most cost-effective is 0.81. The results are sensitive to age, the utility of survived patients with a favorable outcome, the sensitivity of repeat delayed imaging, and the prevalence of aneurysm. CONCLUSIONS This study showed that, in the UK, it is cost-effective to provide repeat delayed imaging using computed tomographic angiography (CTA) for patients with SAH who had a negative result in their initial imaging.
Collapse
Affiliation(s)
- Wenru Shang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou University, Lanzhou, China
- King's Health Economics (KHE), Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, United Kingdom
| | - Huajie Jin
- King's Health Economics (KHE), Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, United Kingdom
| | - Amisha Vastani
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Asfand Baig Mirza
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Benjamin Fisher
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Neeraj Kalra
- Department of Neurosurgery, Leeds Centre for Neurosciences, Leeds General Infirmary, Leeds, United Kingdom
| | - Ian Anderson
- Department of Neurosurgery, Leeds Centre for Neurosciences, Leeds General Infirmary, Leeds, United Kingdom
| | - Ahilan Kailaya-Vasan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
9
|
Hoh BL, Ko NU, Amin-Hanjani S, Chou SHY, Cruz-Flores S, Dangayach NS, Derdeyn CP, Du R, Hänggi D, Hetts SW, Ifejika NL, Johnson R, Keigher KM, Leslie-Mazwi TM, Lucke-Wold B, Rabinstein AA, Robicsek SA, Stapleton CJ, Suarez JI, Tjoumakaris SI, Welch BG. 2023 Guideline for the Management of Patients With Aneurysmal Subarachnoid Hemorrhage: A Guideline From the American Heart Association/American Stroke Association. Stroke 2023; 54:e314-e370. [PMID: 37212182 DOI: 10.1161/str.0000000000000436] [Citation(s) in RCA: 146] [Impact Index Per Article: 146.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
AIM The "2023 Guideline for the Management of Patients With Aneurysmal Subarachnoid Hemorrhage" replaces the 2012 "Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage." The 2023 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with aneurysmal subarachnoid hemorrhage. METHODS A comprehensive search for literature published since the 2012 guideline, derived from research principally involving human subjects, published in English, and indexed in MEDLINE, PubMed, Cochrane Library, and other selected databases relevant to this guideline, was conducted between March 2022 and June 2022. In addition, the guideline writing group reviewed documents on related subject matter previously published by the American Heart Association. Newer studies published between July 2022 and November 2022 that affected recommendation content, Class of Recommendation, or Level of Evidence were included if appropriate. Structure: Aneurysmal subarachnoid hemorrhage is a significant global public health threat and a severely morbid and often deadly condition. The 2023 aneurysmal subarachnoid hemorrhage guideline provides recommendations based on current evidence for the treatment of these patients. The recommendations present an evidence-based approach to preventing, diagnosing, and managing patients with aneurysmal subarachnoid hemorrhage, with the intent to improve quality of care and align with patients' and their families' and caregivers' interests. Many recommendations from the previous aneurysmal subarachnoid hemorrhage guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
Collapse
|
10
|
Elmokadem AH, Elged BA, Abdel Razek A, El-Serougy LG, Kasem MA, EL-Adalany MA. Interobserver reliability of computed tomography angiography in the assessment of ruptured intracranial aneurysm and impact on patient management. World J Radiol 2023; 15:201-215. [PMID: 37424734 PMCID: PMC10324495 DOI: 10.4329/wjr.v15.i6.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/17/2023] [Accepted: 05/31/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Aneurysmal subarachnoid hemorrhage is an emergency that can lead to a high mortality rate and many severe complications. It is critical to make a rapid radiological evaluation of ruptured intracranial aneurysms (RIAs) to determine the appropriate surgical treatment.
AIM To assess the reliability of computed tomography angiography (CTA) in assessing different features of ruptured intracranial aneurysm and its impact on patient management.
METHODS The final cohort of this study consisted of 146 patients with RIAs (75 male and 71 female) who underwent cerebral CTA. Their age ranged from 25 to 80, and the mean age ± SD was 57 ± 8.95 years. Two readers were asked to assess different features related to the aneurysm and perianeurysmal environment. Inter-observer agreement was measured using kappa statistics. Imaging data extracted from non-contrast computed tomography and CTA were considered to categorize the study population into two groups according to the recommended therapeutic approach.
RESULTS The inter-observer agreement of both reviewers was excellent for the detection of aneurysms (K = 0.95, P = 0.001), aneurysm location (K = 0.98, P = 0.001), and (K = 0.98, P = 0.001), morphology (K = 0.92, P = 0.001) and margins (K = 0.95, P = 0.001). There was an excellent interobserver agreement for the measurement of aneurysm size (K = 0.89, P = 0.001), neck (K = 0.85, P = 0.001), and dome-to-neck ratio (K = 0.98, P = 0.001). There was an excellent inter-observer agreement for the detection of other aneurysm-related features such as thrombosis (K = 0.82, P = 0.001), calcification (K = 1.0, P = 0.001), bony landmark (K = 0.89, P = 0.001) and branch incorporation (K = 0.91, P = 0.001) as well as perianeurysmal findings including vasospasm (K = 0.91, P = 0.001), perianeurysmal cyst (K = 1.0, P = 0.001) and associated vascular lesions (K = 0.83, P = 0.001). Based on imaging features, 87 patients were recommended to have endovascular treatment, while surgery was recommended in 59 patients. 71.2% of the study population underwent the recommended therapy.
CONCLUSION CTA is a reproducible promising diagnostic imaging modality for detecting and characterizing cerebral aneurysms.
Collapse
Affiliation(s)
- Ali H Elmokadem
- Department of Radiology, Mansoura University, Mansoura 35516, Egypt
| | | | | | | | - Mohamed Ali Kasem
- Department of Neurosurgery, Mansoura University, Mansoura 35516, Egypt
| | | |
Collapse
|
11
|
Tsukada A, Yanaka K, Takeda H, Onuma K, Takada M, Nakamura K, Ishikawa E. Fenestrated Anterior Communicating Artery Complex Mimicking an Unruptured Aneurysm: Diagnostic Pitfall. Asian J Neurosurg 2023; 18:201-205. [PMID: 37056876 PMCID: PMC10089750 DOI: 10.1055/s-0043-1764119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
AbstractAnatomical variations often occur in the anterior communicating artery (AComA) complex, and a careful preoperative evaluation is required before repair of this lesion. We report a case of a fenestrated AComA complex mimicking an unruptured cerebral aneurysm. A 49-year-old woman was referred to our hospital under suspicion of unruptured aneurysms of the AComA and the left middle cerebral artery on magnetic resonance angiography (MRA). Additional three-dimensional computed tomographic angiography (CTA) showed the lesion arising from the AComA complex with a maximum diameter of 4.2 mm. Intraoperative findings showed that the putative aneurysm was actually a fenestrated AComA complex as the blood vessels that formed the AComA complex were dilated and meandering. After the operation, MRA and CTA three-dimensional images were reviewed again but we could still not diagnose the lesion as a fenestrated AComA complex rather than an aneurysm. However, in the MRA source image, a secant line in the lesion was the only finding suggestive of a fenestration. The AComA complex is often associated with various vascular malformations, and it is essential to consider this association in the preoperative evaluation. The interpretation of source images may be helpful for accurate diagnosis and surgical planning.
Collapse
|
12
|
Cayron AF, Morel S, Allémann E, Bijlenga P, Kwak BR. Imaging of intracranial aneurysms in animals: a systematic review of modalities. Neurosurg Rev 2023; 46:56. [PMID: 36786880 PMCID: PMC9928939 DOI: 10.1007/s10143-023-01953-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/28/2022] [Accepted: 01/23/2023] [Indexed: 02/15/2023]
Abstract
Intracranial aneurysm (IA) animal models are paramount to study IA pathophysiology and to test new endovascular treatments. A number of in vivo imaging modalities are available to characterize IAs at different stages of development in these animal models. This review describes existing in vivo imaging techniques used so far to visualize IAs in animal models. We systematically searched for studies containing in vivo imaging of induced IAs in animal models in PubMed and SPIE Digital library databases between 1 January 1945 and 13 July 2022. A total of 170 studies were retrieved and reviewed in detail, and information on the IA animal model, the objective of the study, and the imaging modality used was collected. A variety of methods to surgically construct or endogenously induce IAs in animals were identified, and 88% of the reviewed studies used surgical methods. The large majority of IA imaging in animals was performed for 4 reasons: basic research for IA models, testing of new IA treatment modalities, research on IA in vivo imaging of IAs, and research on IA pathophysiology. Six different imaging techniques were identified: conventional catheter angiography, computed tomography angiography, magnetic resonance angiography, hemodynamic imaging, optical coherence tomography, and fluorescence imaging. This review presents and discusses the advantages and disadvantages of all in vivo IA imaging techniques used in animal models to help future IA studies finding the most appropriate IA imaging modality and animal model to answer their research question.
Collapse
Affiliation(s)
- Anne F Cayron
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, CH-1211, Geneva, Switzerland
- Geneva Center for Inflammation Research, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Sandrine Morel
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, CH-1211, Geneva, Switzerland
- Geneva Center for Inflammation Research, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Clinical Neurosciences - Division of Neurosurgery, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Eric Allémann
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Philippe Bijlenga
- Department of Clinical Neurosciences - Division of Neurosurgery, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Brenda R Kwak
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, CH-1211, Geneva, Switzerland.
- Geneva Center for Inflammation Research, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| |
Collapse
|
13
|
Mandel D, Moody S, Pan K, Subramaniam T, Thompson BB, Wendell LC, Reznik ME, Furie KL, Mahta A. A quantitative model to differentiate nonaneurysmal perimesencephalic subarachnoid hemorrhage from aneurysmal etiology. J Neurosurg 2023; 138:165-172. [PMID: 35523263 DOI: 10.3171/2022.3.jns22157] [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: 01/20/2022] [Accepted: 03/21/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Nonaneurysmal perimesencephalic subarachnoid hemorrhage (pmSAH) is considered to have a lower-risk pattern than other types of subarachnoid hemorrhage (SAH). However, a minority of patients with pmSAH may harbor a causative posterior circulation aneurysm. To exclude this possibility, many institutions pursue exhaustive imaging. In this study the authors aimed to develop a novel predictive model based on initial noncontrast head CT (NCHCT) features to differentiate pmSAH from aneurysmal causes. METHODS The authors retrospectively reviewed patients admitted to an academic center for treatment of a suspected aneurysmal SAH (aSAH) during the period from 2016 to 2021. Patients with a final diagnosis of pmSAH or posterior circulation aSAH were included. Using NCHCT, the thickness (continuous variable) and location of blood in basal cisterns and sylvian fissures (categorical variables) were compared between groups. A scoring system was created using features that were significantly different between groups. Receiver operating characteristic curve analysis was used to measure the accuracy of this model in predicting aneurysmal etiology. A separate patient cohort was used for external validation of this model. RESULTS Of 420 SAH cases, 48 patients with pmSAH and 37 with posterior circulation aSAH were identified. Blood thickness measurements in the crural and ambient cisterns and interhemispheric and sylvian fissures and degree of extension into the sylvian fissure were all significantly different between groups (all p < 0.001). The authors developed a 10-point scoring model to predict aneurysmal causes with high accuracy (area under the curve [AUC] 0.99; 95% CI 0.98-1.00; OR per point increase 10; 95% CI 2.18-46.4). External validation resulted in persistently high accuracy (AUC 0.97; 95% CI 0.92-1.00) of this model. CONCLUSIONS A risk stratification score using initial blood clot burden may accurately differentiate between aneurysmal and nonaneurysmal pmSAH. Larger prospective studies are encouraged to further validate this quantitative tool.
Collapse
Affiliation(s)
- Daniel Mandel
- 1Department of Neurology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Scott Moody
- 1Department of Neurology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- 2Department of Physician Assistant Studies, Massachusetts General Hospital Institute of Health Professions, Boston, Massachusetts
| | - Kelly Pan
- 3Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Thanujaa Subramaniam
- 4Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Bradford B Thompson
- 1Department of Neurology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- 5Department of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
| | - Linda C Wendell
- 1Department of Neurology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- 5Department of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
- 6Section of Medical Education, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Michael E Reznik
- 1Department of Neurology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- 5Department of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
| | - Karen L Furie
- 1Department of Neurology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Ali Mahta
- 1Department of Neurology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- 5Department of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
- 6Section of Medical Education, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| |
Collapse
|
14
|
Matsumoto Y, Nagata Y, Nakagawa S, Hashikawa T, Sakai H, Takahashi S, Hashimoto Y, Goto S, Sugita Y, Takahashi K. New aneurysm formation and regrowth associated with rebleeding of residual pediatric ruptured arteriovenous malformation: patient series. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE22205. [PMID: 36317238 PMCID: PMC9624159 DOI: 10.3171/case22205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/09/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND If complete obliteration of ruptured pediatric arteriovenous malformation (AVM) cannot be achieved, the appropriate follow-up duration and predictors of rebleeding remain unknown. OBSERVATIONS Pediatric patients with ruptured AVMs admitted to the authors' hospital within the past 30 years were evaluated. Rebleeding was confirmed in two patients. The first patient was a 5-year-old boy who experienced right thalamic hemorrhage. AVM was found in the bilateral thalamus and treated with stereotactic radiosurgery (SRS). New aneurysm formation and residual AVM regrowth were confirmed 21 years after the SRS. Eight months later, rebleeding occurred. The second patient was a 5-year-old boy who underwent removal of a left cerebellar hemorrhage and AVM. The residual AVM was treated with SRS. Residual AVM regrowth was detected at 6 years 7 months after SRS. Five months later, new aneurysm formation was confirmed. Two additional days later, rebleeding occurred. LESSONS New aneurysm formation and residual AVM regrowth may predict rebleeding and can occur >20 years after the initial rupture and treatment. If AVM obliteration is not achieved, long-term follow-up is needed, even in adulthood, with attention to new aneurysm formation and residual AVM regrowth. Further treatment is recommended if these findings are confirmed.
Collapse
Affiliation(s)
| | - Yui Nagata
- Department of Neurosurgery, St. Mary’s Hospital, Fukuoka, Japan; and
| | - Setsuko Nakagawa
- Department of Neurosurgery, St. Mary’s Hospital, Fukuoka, Japan; and
| | - Takuro Hashikawa
- Department of Neurosurgery, St. Mary’s Hospital, Fukuoka, Japan; and
| | - Hideki Sakai
- Department of Neurosurgery, St. Mary’s Hospital, Fukuoka, Japan; and
| | - Shinji Takahashi
- Department of Neurosurgery, St. Mary’s Hospital, Fukuoka, Japan; and
| | - Yosuke Hashimoto
- Department of Neurosurgery, St. Mary’s Hospital, Fukuoka, Japan; and
| | - Shin Goto
- Department of Neurosurgery, Tanushimaru Central Hospital, Fukuoka, Japan
| | - Yasuo Sugita
- Department of Neurosurgery, St. Mary’s Hospital, Fukuoka, Japan; and
| | - Kenji Takahashi
- Department of Neurosurgery, St. Mary’s Hospital, Fukuoka, Japan; and
| |
Collapse
|
15
|
Chowdhury SS, See AP, Eriksson LP, Boulouis G, Lehman LL, Hararr DB, Zabih V, Dlamini N, Fox C, Waak M. Closing the Gap in Pediatric Hemorrhagic Stroke: A Systematic Review. Semin Pediatr Neurol 2022; 43:101001. [PMID: 36344021 DOI: 10.1016/j.spen.2022.101001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/07/2022] [Accepted: 09/12/2022] [Indexed: 10/14/2022]
Abstract
Pediatric hemorrhagic stroke (HS) accounts for a large proportion of childhood strokes, 1 of the top 10 causes of pediatric deaths. Morbidity and mortality lead to significant socio-economic and psychosocial burdens. To understand published data on recognizing and managing children with HS, we conducted a systematic review of the literature presented here. We searched PubMed, Embase, CINAHL and the Cochrane Library databases limited to English language and included 174 studies, most conducted in the USA (52%). Terminology used interchangeably for HS included intraparenchymal/intracranial hemorrhage, spontaneous ICH, and cerebrovascular accident (CVA). Key assessments informing prognosis and management included clinical scoring (Glasgow coma scale), and neuroimaging. HS etiologies reported were systemic coagulopathy (genetic, acquired pathologic, or iatrogenic), or focal cerebrovascular lesions (brain arteriovenous malformations, cavernous malformations, aneurysms, or tumor vascularity). Several scales were used to measure outcome: Glasgow outcome score (GOS), Kings outcome score for head injury (KOSCHI), modified Rankin scale (mRS) and pediatric stroke outcome measure (PSOM). Most studies described treatments of at-risk lesions. Few studies described neurocritical care management including raised ICP, seizures, vasospasm, or blood pressure. Predictors of poor outcome included ethnicity, comorbidity, location of bleed, and hematoma >2% of total brain volume. Motor and cognitive outcomes followed independent patterns. Few studies reported on cognitive outcomes, rehabilitation, and transition of care models. Interdisciplinary approach to managing HS is urgently needed, informed by larger cohort studies targeting key clinical question (eg development of a field-guide for the clinician managing patients with HS that is reproducible internationally).
Collapse
Affiliation(s)
| | | | | | | | | | | | - Veda Zabih
- The Hospital for Sick Children, Toronto, Canada
| | | | | | - Michaela Waak
- The University of Queensland, Australia; Children's Health Queensland Hospital, Brisbane, Australia
| |
Collapse
|
16
|
Necarsulmer J, Reed S, Arhin M, Shastri D, Quig N, Yap E, Ho J, Sasaki-Adams D. Cumulative Radiation Exposure in Aneurysmal Subarachnoid Hemorrhage: A Single-Institution Analysis. World Neurosurg 2022; 165:e432-e437. [PMID: 35738532 DOI: 10.1016/j.wneu.2022.06.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Diagnosis and management of aneurysmal subarachnoid hemorrhage (aSAH) depend heavily on imaging modalities that repeatedly expose patients to ionizing radiation. There is limited literature on cumulative radiation exposure in this patient population, which is a problem compounded by wide variation among institutions. The present study quantifies the cumulative cranial exposure to ionizing radiation resulting from diagnostic medical imaging and medical procedures during initial hospitalization for ruptured aSAH at a single academic institution and estimates the risk of future adverse events related to radiation injury. METHODS We performed a retrospective observational study of adults who presented to our institution during a nearly 3-year period with acute-onset aSAH, which was confirmed with diagnostic imaging, and had the aneurysm treated with either surgical clip ligation or endovascular embolization. RESULTS A total of 131 patients met the inclusion criteria. Eighty-eight patients (67%) were treated with endovascular embolization and 43 (32%) were treated with clip ligation. We found the average radiation dose to the head during the incident hospitalization for aSAH to be 4.40 Gy (95% confidence interval, 3.91-4.89). Angiography and interventional radiology procedures accounted for most of this exposure. CONCLUSIONS Most patients were exposed to levels of ionizing radiation that put them at considerable risk of deterministic radiation injury. Providers should be aware of the potential consequences of acute and long-term radiation exposure in this patient population, so they can monitor and counsel individuals accordingly and take steps to safely limit radiation exposure during aSAH management.
Collapse
Affiliation(s)
- Julie Necarsulmer
- Department of Neurosurgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA; Department of Neurology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Samuel Reed
- Department of Neurosurgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Martin Arhin
- Department of Neurosurgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Darshan Shastri
- Department of Neurosurgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Nathan Quig
- Department of Neurosurgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Edward Yap
- Department of Neurosurgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - James Ho
- Department of Neurology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA; Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Deanna Sasaki-Adams
- Department of Neurosurgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA.
| |
Collapse
|
17
|
Deep Learning-Based Magnetic Resonance Imaging in Diagnosis and Treatment of Intracranial Aneurysm. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:1683475. [PMID: 35734777 PMCID: PMC9208965 DOI: 10.1155/2022/1683475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/15/2022] [Accepted: 05/17/2022] [Indexed: 11/20/2022]
Abstract
This study was focused on the positioning of the intracranial aneurysm in the magnetic resonance imaging (MRI) images using the deep learning-based U-Net model, to realize the computer-aided diagnosis of the intracranial aneurysm. First, a network was established based on the three-dimensional (3D) U-Net model, and the collected image data were input into the network to realize the automatic location and segmentation of the aneurysm. The 3D convolutional neural network (CNN) network can extract the aneurysm blood vessels to locate and identify the areas of possible aneurysms. Next, 40 patients highly suspected of intracranial aneurysm were selected as research subjects, and they were subjected to magnetic resonance angiography (MRA) and digital subtraction angiography (DSA) examinations. The results showed that based on the U-Net algorithm model, 40 patients' hemangiomas were completely contained in the labeling bounding box, one patient's hemangioma was at the edge of the labeling bounding box, and 4 patients' hemangiomas were outside the labeling box. The final accuracy coefficient was 88.9%, and it was in good agreement with the doctor's manual labelling results. Under the 3D CNN network test, the sensitivity, specificity, and accuracy of DSA for intracranial aneurysm were 91.46%, 86.01%, and 90.2%, respectively; the sensitivity, specificity, and accuracy of MRA for intracranial aneurysm were 95.87%, 100%, and 97.19%, respectively. In conclusion, the 3D CNN can successfully realize the positioning of intracranial aneurysm in MRA images, providing a certain theoretical basis for subsequent imaging diagnosis of aneurysm.
Collapse
|
18
|
Clinical Evaluation of an Innovative Metal-Artifact-Reduction Algorithm in FD-CT Angiography in Cerebral Aneurysms Treated by Endovascular Coiling or Surgical Clipping. Diagnostics (Basel) 2022; 12:diagnostics12051140. [PMID: 35626296 PMCID: PMC9140112 DOI: 10.3390/diagnostics12051140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 04/28/2022] [Accepted: 05/02/2022] [Indexed: 02/01/2023] Open
Abstract
Treated cerebral aneurysms (IA) require follow-up imaging to ensure occlusion. Metal artifacts complicate radiologic assessment. Our aim was to evaluate an innovative metal-artifact-reduction (iMAR) algorithm for flat-detector computed tomography angiography (FD-CTA) regarding image quality (IQ) and detection of aneurysm residua/reperfusion in comparison to 2D digital subtraction angiography (DSA). Patients with IAs treated by endovascular coiling or clipping underwent both FD-CTA and DSA. FD-CTA datasets were postprocessed with/without iMAR algorithm (MAR+/MAR−). Evaluation of all FD-CTA and DSA datasets regarding qualitative (IQ, MAR) and quantitative (coil package diameter/CPD) parameters was performed. Aneurysm occlusion was assessed for each dataset and compared to DSA findings. In total, 40 IAs were analyzed (ncoiling = 24; nclipping = 16). All iMAR+ datasets demonstrated significantly better IQ (pIQ coiling < 0.0001; pIQ clipping < 0.0001). iMAR significantly reduced the metal-artifact burden but did not affect the CPD. iMAR significantly improved the detection of aneurysm residua/reperfusion with excellent agreement with DSA (naneurysm detection MAR+/MAR−/DSA = 22/1/26). The iMAR algorithm significantly improves IQ by effective reduction of metal artifacts in FD-CTA datasets. The proposed algorithm enables reliable detection of aneurysm residua/reperfusion with good agreement to DSA. Thus, iMAR can help to reduce the need for invasive follow-up in treated IAs.
Collapse
|
19
|
Chung CY, Peterson RB, Howard BM, Zygmont ME. Imaging Intracranial Aneurysms in the Endovascular Era: Surveillance and Posttreatment Follow-up. Radiographics 2022; 42:789-805. [PMID: 35333634 DOI: 10.1148/rg.210131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
While most intracranial aneurysms (IAs) remain asymptomatic over a patient's lifetime, those that rupture can cause devastating outcomes. The increased usage and quality of neuroimaging has increased detection of unruptured IAs and driven an increase in surveillance and treatment of these lesions. Standard practice is to treat incidentally discovered unruptured IAs that confer high rupture risk as well as ruptured IAs to prevent rehemorrhage. IAs are increasingly treated with coil embolization instead of microsurgical clipping; more recently, flow diversion and intrasaccular flow disruption have further expanded the versatility and utility of endovascular IA treatment. Imaging is increasingly used for posttreatment IA follow-up in the endovascular era. While cerebral angiography remains the standard for IA characterization and treatment planning, advances in CT and CT angiography and MR angiography have improved the diagnostic accuracy of noninvasive imaging for initial diagnosis and surveillance. IA features including size, dome-to-neck ratio, location, and orientation allow rupture risk stratification and determination of optimal treatment strategy and timing. The radiologist should be familiar with the imaging appearance of common IA treatment devices and the expected imaging findings following treatment. In distinction to clipping and coil embolization, flow diversion and intrasaccular flow disruption induce progressive aneurysm obliteration over months to years. Careful assessment of the device; the treated IA; adjacent brain, bone, meninges; and involved extracranial and intracranial vasculature is crucial at posttreatment follow-up imaging to confirm aneurysm obliteration and identify short-term and long-term posttreatment complications. An invited commentary by Chatterjee is available online. Online supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article. ©RSNA, 2022.
Collapse
Affiliation(s)
- Charlotte Y Chung
- From the Departments of Radiology and Imaging Sciences (C.Y.C., R.B.P., B.M.H., M.E.Z.) and Neurosurgery (B.M.H.), Emory University School of Medicine, Atlanta, Ga
| | - Ryan B Peterson
- From the Departments of Radiology and Imaging Sciences (C.Y.C., R.B.P., B.M.H., M.E.Z.) and Neurosurgery (B.M.H.), Emory University School of Medicine, Atlanta, Ga
| | - Brian M Howard
- From the Departments of Radiology and Imaging Sciences (C.Y.C., R.B.P., B.M.H., M.E.Z.) and Neurosurgery (B.M.H.), Emory University School of Medicine, Atlanta, Ga
| | - Matthew E Zygmont
- From the Departments of Radiology and Imaging Sciences (C.Y.C., R.B.P., B.M.H., M.E.Z.) and Neurosurgery (B.M.H.), Emory University School of Medicine, Atlanta, Ga
| |
Collapse
|
20
|
Rahmani R, Baranoski JF, Albuquerque FC, Lawton MT, Hashimoto T. Intracranial aneurysm calcification – A narrative review. Exp Neurol 2022; 353:114052. [DOI: 10.1016/j.expneurol.2022.114052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/14/2022] [Accepted: 03/17/2022] [Indexed: 11/16/2022]
|
21
|
Maupu C, Lebas H, Boulaftali Y. Imaging Modalities for Intracranial Aneurysm: More Than Meets the Eye. Front Cardiovasc Med 2022; 9:793072. [PMID: 35242823 PMCID: PMC8885801 DOI: 10.3389/fcvm.2022.793072] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/17/2022] [Indexed: 11/21/2022] Open
Abstract
Intracranial aneurysms (IA) are often asymptomatic and have a prevalence of 3 to 5% in the adult population. The risk of IA rupture is low, however when it occurs half of the patients dies from subarachnoid hemorrhage (SAH). To avoid this fatal evolution, the main treatment is an invasive surgical procedure, which is considered to be at high risk of rupture. This risk score of IA rupture is evaluated mainly according to its size and location. Therefore, angiography and anatomic imaging of the intracranial aneurysm are crucial for its diagnosis. Moreover, it has become obvious in recent years that several other factors are implied in this complication, such as the blood flow complexity or inflammation. These recent findings lead to the development of new IA imaging tools such as vessel wall imaging, 4D-MRI, or molecular MRI to visualize inflammation at the site of IA in human and animal models. In this review, we will summarize IA imaging techniques used for the patients and those currently in development.
Collapse
|
22
|
Ota Y, Srinivasan A, Capizzano AA, Bapuraj JR, Kim J, Kurokawa R, Baba A, Moritani T. Central Nervous System Systemic Lupus Erythematosus: Pathophysiologic, Clinical, and Imaging Features. Radiographics 2022; 42:212-232. [PMID: 34990324 DOI: 10.1148/rg.210045] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Systemic lupus erythematosus (SLE) is a systemic autoimmune disease characterized by multiple immunologic abnormalities and has the potential to involve the central nervous system (CNS). The prevalence of SLE seems to be growing, possibly because of earlier diagnosis and improved survival; however, the associated mortality is still high. The mortality is associated with disease-related risk factors such as lupus disease activity, young age, and organ damage or with antiphospholipid syndrome (APS). Neuropsychiatric SLE (NPSLE), which is caused by SLE-related CNS involvement, comprises a broad range of neurologic and psychiatric manifestations with varying severity, which can make this disease indistinguishable from other conditions that are unrelated to SLE. No unifying pathophysiology has been found in the etiology of NPSLE, suggesting that this condition has multiple contributors such as various immune effectors and the brain-intrinsic neuroimmune interfaces that are breached by the immune effectors. The postulated neuroimmune interfaces include the blood-brain barrier, blood-cerebrospinal fluid barrier, meningeal barrier, and glymphatic system. On the basis of the immunologic, pathologic, and imaging features of NPSLE, the underlying pathophysiology can be classified as vasculitis and vasculopathy, APS, demyelinating syndrome, or autoimmune antibody-mediated encephalitis. Each pathophysiology has different imaging characteristics, although the imaging and pathophysiologic features may overlap. Moreover, there are complications due to the immunocompromised status caused by SLE per se or by SLE treatment. Radiologists and clinicians should become familiar with the underlying mechanisms, radiologic findings, and complications of NPSLE, as this information may aid in the diagnosis and treatment of NPSLE. Online supplemental material is available for this article. ©RSNA, 2022.
Collapse
Affiliation(s)
- Yoshiaki Ota
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109
| | - Ashok Srinivasan
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109
| | - Aristides A Capizzano
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109
| | - Jayapalli R Bapuraj
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109
| | - John Kim
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109
| | - Ryo Kurokawa
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109
| | - Akira Baba
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109
| | - Toshio Moritani
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109
| |
Collapse
|
23
|
Browne D, Simms H. Radiological investigations in non-aneurysmal subarachnoid haemorrhage: A 5-year review. BRAIN AND SPINE 2022; 2:100913. [PMID: 36248176 PMCID: PMC9560667 DOI: 10.1016/j.bas.2022.100913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/24/2022] [Accepted: 06/29/2022] [Indexed: 11/17/2022]
Abstract
All patients with a Fisher grade 2 bleed and a negative CT angiogram had catheter angiography negative for any abnormality. Neuroradiologists identified vascular abnormalities not reported by district general hospitals. Follow-up MRI may be a useful adjunct in subarachnoid haemorrhage.
Collapse
|
24
|
Roberts GS, Loecher MW, Spahic A, Johnson KM, Turski PA, Eisenmenger LB, Wieben O. Virtual injections using 4D flow MRI with displacement corrections and constrained probabilistic streamlines. Magn Reson Med 2021; 87:2495-2511. [PMID: 34971458 PMCID: PMC8884720 DOI: 10.1002/mrm.29134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 11/10/2022]
Abstract
PURPOSE Streamlines from 4D-flow MRI have been used clinically for intracranial blood-flow tracking. However, deterministic and stochastic errors degrade streamline quality. The purpose of this study is to integrate displacement corrections, probabilistic streamlines, and novel fluid constraints to improve selective blood-flow tracking and emulate "virtual bolus injections." METHODS Both displacement artifacts (deterministic) and velocity noise (stochastic) inherently occur during phase-contrast MRI acquisitions. Here, two displacement correction methods, single-step and iterative, were tested in silico with simulated displacements and were compared with ground-truth velocity fields. Next, the effects of combining displacement corrections and constrained probabilistic streamlines were performed in 10 healthy volunteers using time-averaged 4D-flow data. Measures of streamline length and depth into vasculature were then compared with streamlines generated with no corrections and displacement correction alone using one-way repeated-measures analysis of variance and Friedman's tests. Finally, virtual injections with improved streamlines were generated for three intracranial pathology cases. RESULTS Iterative displacement correction outperformed the single-step method in silico. In volunteers, the combination of displacement corrections and constrained probabilistic streamlines allowed for significant improvements in streamline length and increased the number of streamlines entering the circle of Willis relative to streamlines with no corrections and displacement correction alone. In the pathology cases, virtual injections with improved streamlines were qualitatively similar to dynamic arterial spin labeling images and allowed for forward/reverse selective flow tracking to characterize cerebrovascular malformations. CONCLUSION Virtual injections with improved streamlines from 4D-flow MRI allow for flexible, robust, intracranial flow tracking.
Collapse
Affiliation(s)
- Grant S Roberts
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Michael W Loecher
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Alma Spahic
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Kevin M Johnson
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Patrick A Turski
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Laura B Eisenmenger
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Oliver Wieben
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| |
Collapse
|
25
|
Joo B, Choi HS, Ahn SS, Cha J, Won SY, Sohn B, Kim H, Han K, Kim HP, Choi JM, Lee SM, Kim TG, Lee SK. A Deep Learning Model with High Standalone Performance for Diagnosis of Unruptured Intracranial Aneurysm. Yonsei Med J 2021; 62:1052-1061. [PMID: 34672139 PMCID: PMC8542476 DOI: 10.3349/ymj.2021.62.11.1052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/29/2021] [Accepted: 08/30/2021] [Indexed: 02/07/2023] Open
Abstract
PURPOSE This study aimed to investigate whether a deep learning model for automated detection of unruptured intracranial aneurysms on time-of-flight (TOF) magnetic resonance angiography (MRA) can achieve a target diagnostic performance comparable to that of human radiologists for approval from the Korean Ministry of Food and Drug Safety as an artificial intelligence-applied software. MATERIALS AND METHODS In this single-center, retrospective, confirmatory clinical trial, the diagnostic performance of the model was evaluated in a predetermined test set. After sample size estimation, the test set consisted of 135 aneurysm-containing examinations with 168 intracranial aneurysms and 197 aneurysm-free examinations. The target sensitivity and specificity were set as 87% and 92%, respectively. The patient-wise sensitivity and specificity of the model were analyzed. Moreover, the lesion-wise sensitivity and false-positive detection rate per case were also investigated. RESULTS The sensitivity and specificity of the model were 91.11% [95% confidence interval (CI): 84.99, 95.32] and 93.91% (95% CI: 89.60, 96.81), respectively, which met the target performance values. The lesion-wise sensitivity was 92.26%. The overall false-positive detection rate per case was 0.123. Of the 168 aneurysms, 13 aneurysms from 12 examinations were missed by the model. CONCLUSION The present deep learning model for automated detection of unruptured intracranial aneurysms on TOF MRA achieved the target diagnostic performance comparable to that of human radiologists. With high standalone performance, this model may be useful for accurate and efficient diagnosis of intracranial aneurysm.
Collapse
Affiliation(s)
- Bio Joo
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Seok Choi
- Department of Radiology, Seoul Medical Center, Seoul, Korea
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Image Data Science, Yonsei University College of Medicine, Seoul, Korea.
| | - Sung Soo Ahn
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Image Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jihoon Cha
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Image Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - So Yeon Won
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Image Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - Beomseok Sohn
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Image Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hwiyoung Kim
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Image Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - Kyunghwa Han
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Image Data Science, Yonsei University College of Medicine, Seoul, Korea
| | | | | | | | | | - Seung-Koo Lee
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Image Data Science, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
26
|
Li B, Zhuo J, Song G, Zhang J, Zhao W, Zhao Z, Wang L, Dong Y, Zhang X, Zhang G. Single-Center Analysis of Reliability of 3D-DSA Dual Volume Reconstruction for Evaluation of Endovascularly Treated Intracranial Aneurysms. World Neurosurg 2021; 155:e150-e155. [PMID: 34454070 DOI: 10.1016/j.wneu.2021.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To explore the applications of 3-dimensional digital subtraction angiography (3D-DSA) double-volume reconstruction technique (DVRT) in endovascular embolization for the treatment of intracranial aneurysm. METHODS A cohort of 112 patients with a total of 127 intracranial aneurysms admitted to the neurosurgery department from June 2018 to October 2019 were selected. Cerebrovascular angiographies were performed after admission. Patients were divided into observation group (56 of 112) and control group (56 of 112) randomly when endovascular embolization was performed. Individuals in the control group were treated with 2D-DSA technique, and patients in the observation group were treated with 3D-DSA DVRT. The Raymond method was used to determine the degree of embolism. RESULTS There was no significant difference in sex, blood pressure, cerebral atherosclerosis, aneurysm site or size, contrast agent dosage, x-ray dose, or surgical cost between the 2 groups. There was no postoperative recurrence in the observation group. However, the recurrence rate in the control group is 10.7% (6 of 56). Postoperative thrombosis occurred in 1 case (1 of 56, 1.8%) in the observation group and 7 cases (7 of 56, 12.5%) in the control group. No postoperative cerebral infarction was recorded in the observation group, while 5 cases (8.9%, 5 of 56) in the control group presented with postoperative cerebral infarction. CONCLUSIONS 3D-DVRT for intracranial aneurysm embolization provides the best working angle, clearly shows the process of aneurysm embolization and its relationship with peripheral vessels, and reduces the occurrence of surgical complications including postoperative recurrence, thrombosis, and cerebral infarction.
Collapse
Affiliation(s)
- Bo Li
- Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, Shandong, PR China
| | - Jun Zhuo
- Department of Interventional Radiology, Affiliated Hospital of Jining Medical University, Jining, Shandong, PR China
| | - Guohong Song
- Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, Shandong, PR China
| | - Junchen Zhang
- Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, Shandong, PR China
| | - Wanju Zhao
- Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, Shandong, PR China
| | - Zhongqing Zhao
- Department of Interventional Radiology, Affiliated Hospital of Jining Medical University, Jining, Shandong, PR China
| | - Lin Wang
- Department of Interventional Radiology, Affiliated Hospital of Jining Medical University, Jining, Shandong, PR China
| | - Yan Dong
- Department of Interventional Radiology, Affiliated Hospital of Jining Medical University, Jining, Shandong, PR China
| | - Xiang Zhang
- Department of Interventional Radiology, Affiliated Hospital of Jining Medical University, Jining, Shandong, PR China
| | - Guangning Zhang
- Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, Shandong, PR China.
| |
Collapse
|
27
|
Inci S, Karakaya D. Kissing Aneurysms: Radiological and Surgical Difficulties in 30 Operated Cases and a Proposed Classification. World Neurosurg 2021; 155:e83-e94. [PMID: 34384920 DOI: 10.1016/j.wneu.2021.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 07/31/2021] [Accepted: 08/02/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The first aim of this study is to bring up the radiological and surgical difficulties of kissing aneurysms and to present solutions. The second aim is to develop a classification that can help to predict the difficulties encountered during surgery. METHODS The records of 817 patients who were operated on for aneurysm were reviewed retrospectively to identify kissing aneurysms. The radiological and clinical databases of these patients were evaluated in detail. RESULTS Kissing aneurysms were detected in 30 patients (3.6%). Radiologically correct diagnosis rate of kissing aneurysms was 80% throughout the series. The most common locations were the anterior communicating artery (12 cases, 40%) and the middle cerebral artery (12 cases, 40.0%). The ruptured aneurysm could not be detected preoperatively in 24% of the patients. Intraoperative rupture occurred in 4 patients (13.3%). Accompanying vascular anomaly/variation was seen in 16 patients (53.3%). As detailed in the text, kissing aneurysms were divided into 3 types according to their position with each other on the parent artery from the surgeon's point of view during surgery: type I (proximal/distal), type II (superior/inferior), and type III (right/left). CONCLUSIONS Despite advanced angiographic techniques, even today, kissing aneurysms can be misinterpreted as a single bilobular aneurysm. The ruptured aneurysm may not be detectable preoperatively. These complex aneurysms have a high intraoperative rupture risk. Accompanying vascular anomalies are more common than expected. Clip selection and sequencing are important. Proposed classification helps the surgeon to be aware of intraoperative difficulties that he/she may encounter in advance.
Collapse
Affiliation(s)
- Servet Inci
- Department of Neurosurgery, Medical Faculty, Hacettepe University, Ankara, Turkey.
| | - Dicle Karakaya
- Department of Neurosurgery, Medical Faculty, Hacettepe University, Ankara, Turkey
| |
Collapse
|
28
|
Aneurysmal Subarachnoid Hemorrhage: Review of the Pathophysiology and Management Strategies. Curr Neurol Neurosci Rep 2021; 21:50. [PMID: 34308493 DOI: 10.1007/s11910-021-01136-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW Aneurysmal subarachnoid hemorrhage remains a devastating disease process despite medical advances made over the past 3 decades. Much of the focus was on prevention and treatment of vasospasm to reduce delayed cerebral ischemia and improve outcome. In recent years, there has been a shift of focus onto early brain injury as the precursor to delayed cerebral ischemia. This review will focus on the most recent data surrounding the pathophysiology of aneurysmal subarachnoid hemorrhage and current management strategies. RECENT FINDINGS There is a paucity of successful trials in the management of subarachnoid hemorrhage likely related to the targeting of vasospasm. Pathophysiological changes occurring at the time of aneurysmal rupture lead to early brain injury including cerebral edema, inflammation, and spreading depolarization. These events result in microvascular collapse, vasospasm, and ultimately delayed cerebral ischemia. Management of aneurysmal subarachnoid hemorrhage has remained the same over the past few decades. No recent trials have resulted in new treatments. However, our understanding of the pathophysiology is rapidly expanding and will advise future therapeutic targets.
Collapse
|
29
|
Zimelewicz Oberman D, Perez Akly MS, Rabelo NN, Elizondo C, Amorim Correa JL, Ajler P, Baccanelli MM. Morphologic Variations in the Circle of Willis as a Risk Factor for Aneurysm Rupture in the Anterior and Posterior Communicating Arteries. World Neurosurg 2021; 154:e155-e162. [PMID: 34273549 DOI: 10.1016/j.wneu.2021.06.151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Intracranial aneurysms are acquired abnormal vascular dilations. The most dangerous complication of a cerebral aneurysm is its rupture, with a high rate of mortality. This study aimed to determine whether there is an association between anatomic variations in the circle of Willis and ruptured aneurysms in the anterior and posterior communicating arteries. METHODS A cross-sectional study of adult patients with a diagnosis of intracranial aneurysm was carried out between March 2015 and March 2019. The patients were divided into groups of ruptured or unruptured aneurysm in the anterior and posterior communicating arteries. RESULTS A total of 132 patients with anterior and posterior communicating artery aneurysms were included. The presence of anatomic variation in the circle of Willis presented a statistically significant association with ruptured aneurysms (odds ratio [OR], 2.28; 95% confidence interval [CI], 1.11-4.65; P = 0.024). There was a statistically significant difference between the presence of nonspherical aneurysm and rupture (OR, 6.9; 95% CI, 3.12-15.48; P < 0.0001). Multivariate logistic regression observed smoking (OR, 2.4; 95% CI, 1.01-5.9; P = 0.4), anterior complex variations (OR, 2.68; 95% CI, 1.01-7.18; P < 0.04), and nonspherical morphology (OR, 4.7; 95% CI, 1.93-11.45; P = 0.001) presented a statistically significant association with the rupture. CONCLUSIONS Our results suggest that the studied variations of the circle of Willis and nonspherical morphology, in addition to playing a role in the development of cerebral aneurysms, may contribute to their rupture.
Collapse
Affiliation(s)
| | | | | | - Cristina Elizondo
- Department of Internal Medicine Research Area, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Pablo Ajler
- Department of Neurosurgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | |
Collapse
|
30
|
Re: Morphological risk model assessing anterior communicating artery aneurysm rupture: Development and validation. Clin Neurol Neurosurg 2021; 207:106756. [PMID: 34144831 DOI: 10.1016/j.clineuro.2021.106756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/04/2021] [Accepted: 06/05/2021] [Indexed: 11/20/2022]
|
31
|
Ascanio LC, Dmytriw AA, Chida K, Enriquez-Marulanda A, Mayeku J, Gupta R, Maragkos G, Alturki AY, Darbaz B, Thomas AJ, Ogilvy CS, Moore JM. Evaluation of the utility of early routine computed tomography angiography in subarachnoid hemorrhage patient outcomes. J Clin Neurosci 2021; 89:133-138. [PMID: 34119256 DOI: 10.1016/j.jocn.2021.04.003] [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: 02/07/2021] [Accepted: 04/04/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The role of an early CTA approach in neurologically stable patients with nontraumatic SAH has not been assessed. This study explored the use of CTA in clinically stable SAH patients to pre-emptively identify cerebral vasospasm, to evaluate whether this approach is associated with improved clinical outcomes. METHODS We conducted a retrospective chart review of SAH patients presenting between July 2007 and December 2016 in a single academic center. Patients were divided into two groups: (1) Early CTA (stable patients who underwent a CTA between days 5-8 post-SAH), and (2) Standard Protocol. The co-primary outcomes were a composite of the mRS at discharge and last clinical follow-up (good = 0-2; poor = 3-6). A multivariable binary logistic regression was conducted to compare both groups against outcomes, controlling for potential confounders. RESULTS A total of 415 patients were included, 103 (24.8%) with early CTA, and 312 (75.2%) undergoing the standard protocol; the mean age was 57 years and 248 (59.8%) patients were female. Patients in the early CTA group had a higher modified Fisher grade (3-4) (87.4% vs 63.1%; p < 0.02). The multivariable analysis showed that early CTA was independently associated with lower poor outcomes at discharge (OR = 0.21, 95% CI 0.07-0.61, p = 0.004). Plus, vasospasm detection was associated with an increased risk of poor outcomes (OR = 4.77, 95% CI 1.41 - 16.10, p = 0.01). Early CTA was not associated with outcomes at clinical follow-up. CONCLUSION The early CTA surveillance approach was associated with better functional outcomes at discharge when compared to the current imaging standard practice.
Collapse
Affiliation(s)
- Luis C Ascanio
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Adam A Dmytriw
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Kohei Chida
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Julie Mayeku
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Raghav Gupta
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Georgios Maragkos
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Abdulrahman Y Alturki
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, The National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Berkan Darbaz
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ajith J Thomas
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Christopher S Ogilvy
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Justin M Moore
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
32
|
Hoshika M. [4. Physical Evaluation of Ultra-high-resolution Computed Tomography -Cranial Region]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2021; 77:397-405. [PMID: 33883375 DOI: 10.6009/jjrt.2021_jsrt_77.4.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Minori Hoshika
- Division of Radiology, Department of Medical Technology, Okayama University Hospital
| |
Collapse
|
33
|
Larson AS, Brinjikji W. Subarachnoid Hemorrhage of Unknown Cause: Distribution and Role of Imaging. Neuroimaging Clin N Am 2021; 31:167-175. [PMID: 33902872 DOI: 10.1016/j.nic.2021.01.001] [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] [Indexed: 02/03/2023]
Abstract
Subarachnoid hemorrhage of unknown cause represents approximately 10% to 15% of nontraumatic subarachnoid hemorrhages. The key factors in determining the management strategy for a presumed nonaneurysmal subarachnoid hemorrhage are the distribution, location, and amount of subarachnoid blood. Hemorrhage distribution on computed tomography can be categorized as follows: perimesencephalic, diffuse, sulcal, and primary intraventricular. The extent of the workup required in determining the cause of hemorrhage depends on the distribution of blood. The authors review the potential causes, differential diagnoses, and acute and long-term follow-up strategies in patients with subarachnoid hemorrhage of unknown cause.
Collapse
Affiliation(s)
- Anthony S Larson
- Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA; Department of Neurosurgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| |
Collapse
|
34
|
Yan S, Liu Y, Liu C, Yang L, Qin Y, Liu R, Wang S, Li X, Yang W, Ma L, You C, Zhou L, Tian R. Sellar Region Lesions and Intracranial Aneurysms in the Era of Endoscopic Endonasal Approach. Front Endocrinol (Lausanne) 2021; 12:802426. [PMID: 35058885 PMCID: PMC8763682 DOI: 10.3389/fendo.2021.802426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022] Open
Abstract
In the clinical practice of neurosurgery, the endoscopic endonasal approach (EEA) has been the mainstream approach in the management of sellar region diseases. However, clinicians have come to realize that EEA procedure is associated with intraoperative hemorrhage. Due to the limited surgical field and poor proximal control under endoscope, massive hemorrhage always leads to severe complication or even perioperative death. Previously, intraoperative hemorrhage used to be attributed to endoscopic intervention of cavernous sinus or internal carotid artery, but our recent understanding of EEA indicated that preoperatively complicated intracranial aneurysms (IAs) may play a role. In this article, we retrospectively reviewed the baseline characteristics, treatment strategy, pathology, intraoperative findings, as well as radiological profiles of sellar region lesions complicated with IAs. With the focus put on the high comorbidity rate of sellar region lesions and IAs, we did further statistical analysis to sketch the outline of this coexisting circumstance and to emphasize the importance of computed tomography angiography (CTA) as routine EEA preoperative examination. Thorough patient-surgeon communication should be proceeded before the formulation of an individualized treatment strategy.
Collapse
Affiliation(s)
- Siyu Yan
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yifan Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chang Liu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Li Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yun Qin
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ran Liu
- 4Engineering Research Center of Medical Information Technology, Ministry of Education, West China Hospital, Sichuan University, Chengdu, China
| | - Shan Wang
- Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, China
| | - Xue Li
- Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, China
| | - Wenjie Yang
- Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, China
| | - Lu Ma
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Liangxue Zhou
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Rui Tian, ; Liangxue Zhou,
| | - Rui Tian
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Rui Tian, ; Liangxue Zhou,
| |
Collapse
|
35
|
Nishikawa A, Kakizawa Y, Wada N, Yamamoto Y, Katsuki M, Uchiyama T. Usefulness of Pointwise Encoding Time Reduction with Radial Acquisition and Subtraction-Based Magnetic Resonance Angiography after Cerebral Aneurysm Clipping. World Neurosurg X 2020; 9:100096. [PMID: 33426517 PMCID: PMC7776957 DOI: 10.1016/j.wnsx.2020.100096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/25/2020] [Indexed: 02/08/2023] Open
Abstract
Objective Time-of-flight magnetic resonance angiography (MRA) is limited by clip-induced artifacts after cerebral aneurysmal clipping. Recently, ultrashort echo time was shown to reduce metal artifacts. We assessed the pointwise encoding time reduction with radial acquisition (PETRA) sequence in subtraction-based MRA as an ultrashort echo time method during follow-up for clipping surgery. Methods We retrospectively evaluated 114 branches of 63 aneurysms in 56 patients treated with titanium clips using MRA and 3-dimensional computed tomography angiography. The appearance using each method was compared, and the associations between visibility on PETRA-MRA, clip number and shape, and amount of hematoma were examined. Furthermore, the visibility of the aneurysm remnants and 2 clipping cases with cobalt-chromium-nickel-molybdenum clips were evaluated. Results No branches were visible using time-of-flight-MRA, but 79 of 114 branches (69.3%) were visible on PETRA-MRA. PETRA-MRA was effective for follow-up imaging in 33 of 63 aneurysms (52.4%). The median vessel diameters were 1.67 mm (interquartile range, 1.24–2.62 mm) and 0.96 mm (interquartile range, 0.59–1.53 mm) in the visible and invisible groups, respectively. Only the vessel diameter correlated significantly (P < 0.001) with the visibility on PETRA-MRA. A receiver operating characteristic curve for the association between the vessel diameter and visibility on PETRA-MRA showed a cutoff value of 1.26 mm for vessel diameter. Cobalt-chromium-nickel-molybdenum clips produced a strong artifact, even on PETRA-MRA. All 4 residual aneurysms were visible on PETRA-MRA. Conclusions PETRA-MRA can be useful for follow-up aneurysm imaging when the diameter of vessels adjacent to the clip exceeds 1.26 mm. However, its usefulness is limited to titanium clips.
Collapse
Affiliation(s)
- Akihiro Nishikawa
- Department of Neurosurgery, Suwa Red Cross Hospital, Suwa, Nagano, Japan
| | - Yukinari Kakizawa
- Department of Neurosurgery, Suwa Red Cross Hospital, Suwa, Nagano, Japan
| | - Naomichi Wada
- Department of Neurosurgery, Suwa Red Cross Hospital, Suwa, Nagano, Japan
| | - Yasunaga Yamamoto
- Department of Neurosurgery, Suwa Red Cross Hospital, Suwa, Nagano, Japan
| | - Masahito Katsuki
- Department of Neurosurgery, Suwa Red Cross Hospital, Suwa, Nagano, Japan
| | - Toshiya Uchiyama
- Department of Neurosurgery, Suwa Red Cross Hospital, Suwa, Nagano, Japan
| |
Collapse
|
36
|
Porche K, Robinson C, Polifka A. Successful Use of Tissue Plasminogen Activator for Saddle Pulmonary Embolism in Perimesencephalic Nonaneurysmal Subarachnoid Hemorrhage. World Neurosurg 2020; 144:209-212. [DOI: 10.1016/j.wneu.2020.09.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
|
37
|
Mehta VA, Spears CA, Abdelgadir J, Wang TY, Sankey EW, Griffin A, Goodwin CR, Zomorodi A. Management of unruptured incidentally found intracranial saccular aneurysms. Neurosurg Rev 2020; 44:1933-1941. [PMID: 33025187 DOI: 10.1007/s10143-020-01407-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/22/2020] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
Abstract
Unruptured intracranial saccular aneurysms occur in 3-5% of the general population. As the use of diagnostic medical imaging has steadily increased over the past few decades with the increased availability of computed tomography (CT) and magnetic resonance imaging (MRI), so has the detection of incidental aneurysms. The management of an unruptured intracranial saccular aneurysm is challenging for both patients and physicians, as the decision to intervene must weigh the risk of rupture and resultant subarachnoid hemorrhage against the risk inherent to the surgical or endovascular procedure. The purpose of this paper is to provide an overview of factors to be considered in the decision to offer treatment for unruptured intracranial aneurysms in adults. In addition, we review aneurysm and patient characteristics that favor surgical clipping over endovascular intervention and vice versa. Finally, the authors propose a novel, simple, and clinically relevant algorithm for observation versus intervention in unruptured intracranial aneurysms based on the PHASES scoring system.
Collapse
Affiliation(s)
- Vikram A Mehta
- Department of Neurosurgery, Duke University Medical Center, 20 Duke Medicine Circle, Box 3807, Durham, NC, 27710, USA.
| | - Charis A Spears
- Department of Neurosurgery, Duke University Medical Center, 20 Duke Medicine Circle, Box 3807, Durham, NC, 27710, USA.,Duke University School of Medicine, Durham, NC, USA
| | - Jihad Abdelgadir
- Department of Neurosurgery, Duke University Medical Center, 20 Duke Medicine Circle, Box 3807, Durham, NC, 27710, USA
| | - Timothy Y Wang
- Department of Neurosurgery, Duke University Medical Center, 20 Duke Medicine Circle, Box 3807, Durham, NC, 27710, USA
| | - Eric W Sankey
- Department of Neurosurgery, Duke University Medical Center, 20 Duke Medicine Circle, Box 3807, Durham, NC, 27710, USA
| | - Andrew Griffin
- Department of Neurosurgery, Duke University Medical Center, 20 Duke Medicine Circle, Box 3807, Durham, NC, 27710, USA
| | - C Rory Goodwin
- Department of Neurosurgery, Duke University Medical Center, 20 Duke Medicine Circle, Box 3807, Durham, NC, 27710, USA
| | - Ali Zomorodi
- Department of Neurosurgery, Duke University Medical Center, 20 Duke Medicine Circle, Box 3807, Durham, NC, 27710, USA
| |
Collapse
|
38
|
Pedro KM, Sih IMY. Perianeurysmal parenchymal cyst of the pons: A case report and review of literature. INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT 2020. [DOI: 10.1016/j.inat.2020.100731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|