Bifurcation Configuration Is an Independent Risk Factor for Aneurysm Rupture Irrespective of Location.

Qinglin Liu,Huijian Ge,Peng Jiang,Shaolin Li,Hengwei Jin,Yuhua Jiang,Youxiang Li

doi:10.3389/fneur.2019.00844

Qinglin Liu, Huijian Ge + Show 5 more

Open Access

https://doi.org/10.3389/fneur.2019.00844

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Abstract

Background: Bifurcation and sidewall aneurysms have different rupture risks, but whether this difference comes from the location of the aneurysm is not clear. The objective of this study is to illustrate the rationality of ranking bifurcation configuration as an independent risk factor for aneurysm rupture.Methods: Morphological features of 719 aneurysms (216 ruptured) were automatically extracted from a consecutive cohort of patients via PyRadiomics. Rupture risks and morphological features were compared between bifurcation and sidewall aneurysms, and lasso regression was applied to explore the morphological determinants for rupture in bifurcation and sidewall aneurysms. Rupture risks and morphological features of bifurcation aneurysms in different locations were analyzed. Multivariate regression was performed to explore the risk factors for aneurysm rupture.Results: Twelve morphological features were automatically extracted from PyRadiomics implemented in Python. The rupture risks were higher in bifurcation aneurysms (P < 0.01), and morphological features Elongation and Flatness were much lower in ruptured bifurcation than sidewall aneurysms (P = 0.036, 0.011, respectively). Elongation and Flatness were the morphological determinants for rupture in bifurcation aneurysms, whereas Elongation and SphericalDisproportion were determinants for sidewall aneurysms. Different rupture risks and morphological features were found between sidewall and bifurcation aneurysms of the same location, and among bifurcation aneurysms of different locations. In multivariate regression, bifurcation configuration was an independent risk factor for aneurysm rupture (OR 3.007, 95% CI 1.752–5.248, P < 0.001).Conclusions: Sidewall and bifurcation aneurysms and bifurcation aneurysms of different locations have different rupture risks and morphological features. Bifurcation configuration is an independent risk factor for aneurysm rupture irrespective of location.

Highlights

There are several controversies for determining the optimal treatment strategy for an incidentally detected unruptured intracranial aneurysm
Three hundred and fifty-three aneurysms were defined as sidewall aneurysms (48 ruptured) and the rest 366 as bifurcation aneurysms (168 ruptured)
Female sex was more predominant in sidewall than bifurcation aneurysms (74.2 vs. 59.6%, P < 0.01), and hypertension, hyperlipemia, smoking, and drinking were more prevalent in bifurcation aneurysms (P < 0.05)

Summary

Introduction

There are several controversies for determining the optimal treatment strategy for an incidentally detected unruptured intracranial aneurysm. No treatment comes without risks, the overall morbidity and mortality rate 30 days after treatment in patients without previous hemorrhage is 13.7 and 9.7%, in open surgical and endovascular groups, respectively [4]. All these controversies raised the issue of aneurysm rupture risk stratification. The regularity of the aneurysm was found to be closely related to aneurysm rupture risks and has been enrolled into the Japanese scoring system for predicting 3-year rupture risks [5]. More studies still were needed to illustrate the feasibility of these automatically calculated parameters for aneurysm rupture risk stratification. The objective of this study is to illustrate the rationality of ranking bifurcation configuration as an independent risk factor for aneurysm rupture

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