Hemodynamic-morphologic discriminants for intracranial aneurysm rupture.
OBJECTIVE
the purpose of this study was to identify significant morphological and hemodynamic parameters that discriminate intracranial aneurysm rupture status using 3-dimensional angiography and computational fluid dynamics.


METHODS
one hundred nineteen intracranial aneurysms (38 ruptured, 81 unruptured) were analyzed from 3-dimensional angiographic images and computational fluid dynamics. Six morphological and 7 hemodynamic parameters were evaluated for significance with respect to rupture. Receiver operating characteristic analysis identified area under the curve (AUC) and optimal thresholds separating ruptured from unruptured aneurysms for each parameter. Significant parameters were examined by multivariate logistic regression analysis in 3 predictive models-morphology only, hemodynamics only, and combined-to identify independent discriminants, and the AUC receiver operating characteristic of the predicted probability of rupture status was compared among these models.


RESULTS
morphological parameters (size ratio, undulation index, ellipticity index, and nonsphericity index) and hemodynamic parameters (average wall shear stress [WSS], maximum intra-aneurysmal WSS, low WSS area, average oscillatory shear index, number of vortices, and relative resident time) achieved statistical significance (P<0.01). Multivariate logistic regression analysis demonstrated size ratio to be the only independently significant factor in the morphology model (AUC, 0.83; 95% CI, 0.75 to 0.91), whereas WSS and oscillatory shear index were the only independently significant variables in the hemodynamics model (AUC, 0.85; 95% CI, 0.78 to 0.93). The combined model retained all 3 variables, size ratio, WSS, and oscillatory shear index (AUC, 0.89; 95% CI, 0.82 to 0.96).


CONCLUSIONS
all 3 models-morphological (based on size ratio), hemodynamic (based on WSS and oscillatory shear index), and combined-discriminate intracranial aneurysm rupture status with high AUC values. Hemodynamics is as important as morphology in discriminating aneurysm rupture status.
Toshiba Stroke Research Center, University at Buffalo, State University of New York, Buffalo, NY 14214, USA.
Jianping
J
Xiang
Sabareesh K
SK
Natarajan
Markus
M
Tremmel
Ding
D
Ma
J
J
Mocco
L Nelson
LN
Hopkins
Adnan H
AH
Siddiqui
Elad I
EI
Levy
Hui
H
Meng
D017542:Aneurysm, Ruptured / Q000473:pathology* / Q000503:physiopathology*; D002533:Cerebral Angiography / Q000379:methods; D003198:Computer Simulation; D005260:Female; D006439:Hemodynamics; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology* / Q000503:physiopathology*; D008297:Male; D008955:Models, Cardiovascular