title: Risk Factors for the Rupture of Bifurcation Intracranial Aneurysms Using CT Angiography.
abstract: OBJECTIVE
  To investigate the clinical and morphological characteristics in relation to risk of bifurcation intracranial aneurysm rupture.
  
  
  METHODS
  Data from 202 consecutive patients with 219 bifurcation aneurysms (129 ruptured and 90 unruptured) managed at the authors' facility between August 2011 and July 2014 were retrospectively reviewed. Based on their clinical records and CT angiographic findings, the ability of risk factors to predict aneurysm rupture was assessed using statistical methods.
  
  
  RESULTS
  Age, hypertension, diabetes mellitus, and cerebral atherosclerosis were negatively correlated with aneurysm rupture. Aneurysms located in the middle cerebral artery, daughter artery ratio, lateral angle ratio (LA ratio), and neck width were negatively correlated with rupture. Aneurysms located in the anterior communicating artery, irregularity, with daughter sac, depth, width, maximum size, aspect ratio (AR), depth-to-width ratio, and bottleneck factor were significantly and positively correlated with rupture. Binary logistic regression model revealed that irregular shape [odds ratio (OR) 6.598] and AR (OR 3.507) strongly increased the risk of bifurcation aneurysm rupture, while age (OR 0.434), cerebral atherosclerosis (OR 0.125), neck width (OR 0.771), and LA ratio (OR 0.267) were negatively correlated with rupture (p<0.05). Receiver operating characteristic analysis revealed the threshold values of AR and LA ratio to be 1.18 and 1.50, respectively.
  
  
  CONCLUSIONS
  Age (≥60 yr), cerebral atherosclerosis, and aneurysms with a larger neck width and larger LA ratio are protective factors against bifurcation aneurysm rupture. An aneurysm with an irregular shape and an increased AR reflect the greater likelihood of a rupture.
authors.affiliation: Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China.
authors.forename: Guang Xian
authors.initials: GX
authors.lastname: Wang
authors.affiliation: Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China.
authors.forename: Dong
authors.initials: D
authors.lastname: Zhang
authors.affiliation: Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China.
authors.forename: Zhi Ping
authors.initials: ZP
authors.lastname: Wang
authors.affiliation: Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China.
authors.forename: Liu Qing
authors.initials: LQ
authors.lastname: Yang
authors.affiliation: Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China. xqwgxwl@163.com.
authors.forename: Li
authors.initials: L
authors.lastname: Wen
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography / Q000379:methods*; D000072226:Computed Tomography Angiography; D002658:Developmental Disabilities; D003925:Diabetic Angiopathies / Q000150:complications; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging*; D002537:Intracranial Arteriosclerosis / Q000150:complications; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging; D016017:Odds Ratio; D065840:Protective Factors; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Intracranial aneurysm; angiography; computed tomography; risk factors; rupture; subarachnoid hemorrhage