title: Additional Value of Intra-Aneurysmal Hemodynamics in Discriminating Ruptured versus Unruptured Intracranial Aneurysms.
abstract: OBJECTIVE
  Hemodynamics are thought to play an important role in the rupture of intracranial aneurysms. We tested whether hemodynamics, determined from computational fluid dynamics models, have additional value in discriminating ruptured and unruptured aneurysms. Such discriminative power could provide better prediction models for rupture.
  
  
  METHODS
  A cross-sectional study was performed on patients eligible for endovascular treatment, including 55 ruptured and 62 unruptured aneurysms. Association with rupture status was tested for location, aneurysm type, and 4 geometric and 10 hemodynamic parameters. Patient-specific spatiotemporal velocities measured with phase-contrast MR imaging were used as inflow conditions for computational fluid dynamics. To assess the additional value of hemodynamic parameters, we performed 1 univariate and 2 multivariate analyses: 1 traditional model including only location and geometry and 1 advanced model that included patient-specific hemodynamic parameters.
  
  
  RESULTS
  In the univariate analysis, high-risk locations (anterior cerebral arteries, posterior communicating artery, and posterior circulation), daughter sacs, unstable inflow jets, impingements at the aneurysm body, and unstable complex flow patterns were significantly present more often in ruptured aneurysms. In both multivariate analyses, only the high-risk location (OR, 3.92; 95% CI, 1.77-8.68) and the presence of daughter sacs (OR, 2.79; 95% CI, 1.25-6.25) remained as significant independent determinants.
  
  
  CONCLUSIONS
  In this study population of patients eligible for endovascular treatment, we found no independent additional value of aneurysmal hemodynamics in discriminating rupture status, despite high univariate associations. Only traditional parameters (high-risk location and the presence of daughter sacs) were independently associated with ruptured aneurysms.
authors.affiliation: From the Departments of Radiology (J.J.S., H.A.M., P.v.O., R.v.d.B., A.J.N., C.B.L.M.M.) j.j.schneiders@amc.uva.nl.
authors.forename: J J
authors.initials: JJ
authors.lastname: Schneiders
authors.affiliation: From the Departments of Radiology (J.J.S., H.A.M., P.v.O., R.v.d.B., A.J.N., C.B.L.M.M.) Biomedical Engineering and Physics (H.A.M., E.V.).
authors.forename: H A
authors.initials: HA
authors.lastname: Marquering
authors.affiliation: From the Departments of Radiology (J.J.S., H.A.M., P.v.O., R.v.d.B., A.J.N., C.B.L.M.M.).
authors.forename: P
authors.initials: P
authors.lastname: van Ooij
authors.affiliation: From the Departments of Radiology (J.J.S., H.A.M., P.v.O., R.v.d.B., A.J.N., C.B.L.M.M.).
authors.forename: R
authors.initials: R
authors.lastname: van den Berg
authors.affiliation: From the Departments of Radiology (J.J.S., H.A.M., P.v.O., R.v.d.B., A.J.N., C.B.L.M.M.).
authors.forename: A J
authors.initials: AJ
authors.lastname: Nederveen
authors.affiliation: Neurosurgery (D.V., W.P.V.), Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: Verbaan
authors.affiliation: Neurosurgery (D.V., W.P.V.), Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: W P
authors.initials: WP
authors.lastname: Vandertop
authors.affiliation: Department of Aero- and Hydrodynamics (M.P.), Delft University of Technology, Delft, the Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Pourquie
authors.affiliation: Department of Neurology and Neurosurgery (G.J.E.R.), Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Utrecht, the Netherlands.
authors.forename: G J E
authors.initials: GJ
authors.lastname: Rinkel
authors.affiliation: Biomedical Engineering and Physics (H.A.M., E.V.).
authors.forename: E
authors.initials: E
authors.lastname: vanBavel
authors.affiliation: From the Departments of Radiology (J.J.S., H.A.M., P.v.O., R.v.d.B., A.J.N., C.B.L.M.M.).
authors.forename: C B L M
authors.initials: CB
authors.lastname: Majoie
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000175:diagnosis* / Q000503:physiopathology*; D001783:Blood Flow Velocity / Q000502:physiology; D002533:Cerebral Angiography / Q000379:methods; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D057446:Hydrodynamics; D002532:Intracranial Aneurysm / Q000175:diagnosis* / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D066230:Patient-Specific Modeling; D011237:Predictive Value of Tests; D012307:Risk Factors