title: Size ratio performance in detecting cerebral aneurysm rupture status is insensitive to small vessel removal.
abstract: BACKGROUND
  The variable definition of size ratio (SR) for sidewall (SW) vs bifurcation (BIF) aneurysms raises confusion for lesions harboring small branches, such as carotid ophthalmic or posterior communicating locations. These aneurysms are considered SW by many clinicians, but SR methodology classifies them as BIF.
  
  
  OBJECTIVE
  To evaluate the effect of ignoring small vessels and SW vs stringent BIF labeling on SR ruptured aneurysm detection performance in borderline aneurysms with small branches, and to reconcile SR-based labeling with clinical SW/BIF classification.
  
  
  METHODS
  Catheter rotational angiographic datasets of 134 consecutive aneurysms (60 ruptured) were automatically measured in 3-dimensional. Stringent BIF labeling was applied to clinically labeled aneurysms, with 21 aneurysms switching label from SW to BIF. Parent vessel size was evaluated both taking into account, and ignoring, small vessels. SR was defined accordingly as the ratio between aneurysm and parent vessel sizes. Univariate and multivariate statistics identified significant features. The square of the correlation coefficient (R(2)) was reported for bivariate analysis of alternative SR calculations.
  
  
  RESULTS
  Regardless of SW/BIF labeling method, SR was equally significant in discriminating aneurysm ruptured status (P < .001). Bivariate analysis of alternative SR had a high correlation of R(2) = 0.94 on the whole dataset, and R = 0.98 on the 21 borderline aneurysms.
  
  
  CONCLUSIONS
  Ignoring small branches from SR calculation maintains rupture status detection performance, while reducing postprocessing complexity and removing labeling ambiguity. Aneurysms adjacent to these vessels can be considered SW for morphometric analysis. It is reasonable to use the clinical SW/BIF labeling when using SR for rupture risk evaluation.
authors.affiliation: Cerebrovascular and Endovascular Division, Department of Neurosurgery, Tufts Medical Center, and Tufts University School of Medicine, Boston, MA, USA.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Lauric
authors.forename: Merih I
authors.initials: MI
authors.lastname: Baharoglu
authors.forename: Adel M
authors.initials: AM
authors.lastname: Malek
mesh_terms: D017542:Aneurysm, Ruptured / Q000453:epidemiology / Q000601:surgery*; D002533:Cerebral Angiography / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D055806:Microvessels / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies