Inflow hemodynamics evaluated by using four-dimensional flow magnetic resonance imaging and the size ratio of unruptured cerebral aneurysms.

Abstract

Prediction of the rupture risk is critical for the identification of unruptured cerebral aneurysms (UCAs) eligible for invasive treatments. The size ratio (SR) is a strong morphological predictor for rupture. We investigated the relationship between the inflow hemodynamics evaluated on four-dimensional (4D) flow magnetic resonance (MR) imaging and the SR to identify specific characteristics related to UCA rupture. We evaluated the inflow jet patterns and inflow hemodynamic parameters of 70 UCAs on 4D flow MR imaging and compared them among 23 aneurysms with an SR ≧2.1 and 47 aneurysms with an SR ≦2.0. Based on the shape of inflow streamline bundles with a velocity ≧75% of the maximum flow velocity in the parent artery, the inflow jet patterns were classified as concentrated (C), diffuse (D), neck-limited (N), and unvisualized (U). The incidence of patterns C and N was significantly higher in aneurysms with an SR ≧2.1. The rate of pattern U was significantly higher in aneurysms with an SR ≦2.0. The maximum inflow rate and the inflow rate ratio were significantly higher in aneurysms with an SR ≧2.1. The SR affected the inflow jet pattern, the maximum inflow rate, and the inflow rate ratio of UCAs. In conjunction with the SR, inflow hemodynamic analysis using 4D flow MR imaging may contribute to the risk stratification for aneurysmal rupture.