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- Title
Geometric versus Hemodynamic Indexes for Rupture-Destined Aneurysms: A Retrospective Cohort and a Repeated-Measures Study.
- Authors
Lee, Chan-Hyuk; Kwak, Hyo Sung; Kang, Hyun-Seung; Jung, Keun-Hwa; Jeong, Seul-Ki
- Abstract
Introduction: A proper stratification of intracranial aneurysms is critical in identifying rupture-destined aneurysms and unruptured intracranial aneurysms. We aimed to determine the utility of geometric and hemodynamic indexes in differentiating two types of aneurysms and to examine the characteristics of natural evolutionary changes of unruptured aneurysms. Methods: Rupture-destined aneurysm refers to an aneurysm that undergoes subsequent aneurysmal subarachnoid hemorrhage (SAH). On the other hand, an unruptured intracranial aneurysm is characterized by an aneurysm that does not experience rupture during serial time-of-flight magnetic resonance angiography (TOF-MRA). In addition to geometric indexes, signal intensity gradient (SIG), an in vivo approximated wall shear stress from TOF-MRA, was measured in aneurysms. The difference between the maximum and minimum values of SIG in an aneurysm compared to parent arterial values was designated as the delta-SIG ratio. Results: This study analyzed 20 rupture-destined aneurysms in 20 patients and 45 unruptured intracranial aneurysms in 41 patients with follow-up TOF-MRA. While geometric indexes did not show differences between the two groups, the delta-SIG ratio was higher in the rupture-destined aneurysms (1.5 ± 0.6 vs. 1.1 ± 0.3, p = 0.032). The delta-SIG ratio showed a higher area under the receiver operating characteristic curve for SAH than the size ratio (0.72 [95% CI, 0.58–0.87] vs. 0.56 [95% CI, 0.41–0.72], p = 0.033). The longitudinal re-examination of TOF-MRA in the unruptured intracranial aneurysms revealed evidence of aneurysmal growth, while concurrently exhibiting hemodynamic stability. Conclusion: The delta-SIG ratio showed higher discriminatory results between the two groups compared to geometric indexes. Aneurysmal rupture risk should be assessed by considering both geometric and hemodynamic information. This study was registered on ClinicalTrials.gov (NCT05450939). Plain Language Summary: The incidence of intracranial aneurysm (IA) is 2–3% in the general population, and with the widespread use of neurovascular imaging techniques, more IAs are being diagnosed. IA management is crucial as it can lead to fatal subarachnoid hemorrhage, causing high mortality and neurological issues. About 1% of patients with IA experience severe hemorrhage annually, which raises questions about the best method to assess rupture risk. Past studies used geometric indexes and computational fluid dynamics to differentiate between ruptured and unruptured aneurysms. However, these studies mostly focused on cross-sectional data and did not analyze the evolutionary changes of ruptured aneurysms. In this study, we call such aneurysms rupture-destined aneurysms (RDAs) to differentiate from stable unruptured intracranial aneurysm (UIA). In the present study, the key findings could be summarized as below: (1) the RDA group showed a significantly higher hemodynamic instability than the UIA group; (2) the UIA group showed features of hemodynamic stability, even with geometric growth; (3) aneurysmal rupture risk should be assessed using both geometric and hemodynamic information.
- Subjects
INTRACRANIAL aneurysms; ANEURYSMS; RUPTURED aneurysms; MAGNETIC resonance angiography; RECEIVER operating characteristic curves
- Publication
Cerebrovascular Diseases, 2024, Vol 53, Issue 3, p327
- ISSN
1015-9770
- Publication type
Article
- DOI
10.1159/000533167