Geometric Parameter Analysis of Ruptured and Unruptured Aneurysms in Patients with Symmetric Bilateral Intracranial Aneurysms: A Multicenter CT Angiography Study.
Previous studies of geometric and morphologic parameters of intracranial aneurysms have been conducted to determine rupture risk, which remains incompletely defined due to patient-specific risk factors, such as sex, hypertension, and age. To this end, we compared characteristics of ruptured and unruptured aneurysms in the same patients with symmetric bilateral intracranial aneurysms.



Between January 2008 and March 2014, 2361 patients with 2674 aneurysms were diagnosed by CT angiography or surgical findings at 4 medical centers. Geometric and morphologic parameters examined for symmetric bilateral intracranial aneurysms comprised aneurysm wall regularity, size, neck width, aspect ratio, size ratio, neck-to-parent artery ratio, and area ratio. Univariate and multivariate statistical analyses were performed to determine independent risk factors for rupture.



Sixty-three patients (48 women, 15 men; mean age, 62.5 ± 9.8 years) with symmetric bilateral aneurysms were eligible for the study and were included. The most frequent aneurysm location was the posterior communicating artery. Univariate analysis disclosed that aneurysm size, aspect ratio, size ratio, area ratio, and irregular wall differed between patients with ruptured and unruptured aneurysms. Multivariate analysis indicated that aspect ratio of ≥1.6 (adjusted OR, 9.521; 95% CI, 2.182-41.535), area ratio of ≥1.5 (adjusted OR, 4.089; 95% CI, 1.247-13.406), and irregular shape (adjusted OR, 10.443; 95% CI 3.394-32.135) were significant predictive factors for aneurysm rupture after adjustment for aneurysm size.



An aspect ratio of ≥1.6, area ratio of ≥1.5, and irregular wall are associated with aneurysm rupture independent of aneurysm size and patient characteristics. These characteristics alone can help in distinguishing ruptured bilateral intracranial aneurysms from unruptured ones.
From the Medical Image Center (Z.-Q.H., H.Y., L.-J.F., Z.-B.W.) Medical Image Center (Z.-Q.H., Z.-H.M., J.-N.C.).
Z-Q
0000-0002-6623-5959
ZQ
Huang
Medical Image Center (Z.-Q.H., Z.-H.M., J.-N.C.).
Z-H
0000-0001-8897-937X
ZH
Meng
Department of Radiology (Z.-J.H.), The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China.
Z-J
0000-0001-8217-5901
ZJ
Hou
Department of Radiology (S.-Q.H.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China.
S-Q
0000-0003-0113-4943
SQ
Huang
Medical Image Center (Z.-Q.H., Z.-H.M., J.-N.C.).
J-N
0000-0002-0453-4136
JN
Chen
From the Medical Image Center (Z.-Q.H., H.Y., L.-J.F., Z.-B.W.).
H
0000-0001-8362-3358
H
Yu
From the Medical Image Center (Z.-Q.H., H.Y., L.-J.F., Z.-B.W.).
L-J
0000-0003-4128-0064
LJ
Feng
Department of Neurosurgery (Q.-J.W.), Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China.
Q-J
0000-0002-7091-6773
QJ
Wang
Department of Neurosurgery (P.-A.L.), Yuebei People's Hospital, Shantou University Medical College, Shantou, Guangdong Province, China.
P-A
0000-0002-2271-2151
PA
Li
From the Medical Image Center (Z.-Q.H., H.Y., L.-J.F., Z.-B.W.) zhibowen@163.com.
Z-B
0000-0002-0497-0923
ZB
Wen
D000368:Aged; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging* / Q000473:pathology*; D002533:Cerebral Angiography / Q000379:methods*; D000072226:Computed Tomography Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D008875:Middle Aged