Abstract
Background and PurposeThe objective of this study was to identify the morphological and hemodynamic factors associated with the rupture of multiple intracranial aneurysms regardless of patient-related factors and establish a statistical model for aneurysm rupture risk assessment.MethodsThe digital subtraction angiography (DSA) data of 104 mirror intracranial aneurysms in 52 consecutive patients were retrospectively analyzed in this study. 21 morphological parameters and hemodynamic parameters were calculated by 3-dimensional reconstruction and computational fluid dynamics (CFD) simulation. Significant differences (p < 0.05) between the two groups were subsequently tested with the multivariate logistic regression to identify the independent risk factors. A prediction model was established based on the independent risk factors. The receiver operating characteristics (ROCs) were generated to estimate the prediction performance. A cohort of patients with multiple intracranial aneurysms admitted in our institute from January 2021 to October 2021 was introduced to verify the value of the model.ResultsSignificant differences between the ruptured and unruptured aneurysms were found in 15 out of 19 parameters. Bleb formation, neck width, and size ratio were independent factors in the multivariate logistic regression. A prediction model based on the three independent risk factors was established: Odds = −1.495 – 0.707 × (Neckwidth) + 3.061 × (Blebformation) + 2.1 × (SR) (bleb formation: Yes = 1, No = 0). The area under the curve (AUC) value of the model was 0.901. In the validation cohort, the prediction model showed satisfying performance in assessing multiple aneurysm rupture risk with a sensitivity of 100% and specificity of 88.46%.ConclusionBleb formation, neck width, and size ratio were independently associated with aneurysm rupture status. The prediction model may help in identifying the aneurysm with high rupture risk.
Highlights
Intracranial aneurysms (IAs) occur in about 2–3% of the general population [1]
We demonstrated that formation of bleb, size ratio (SR), and neck width were independently associated with the rupture of IA
We chose mirror IAs to identify the morphological and hemodynamic characteristics of ruptured IAs, which may be helpful in evaluation of rupture risk
Summary
Intracranial aneurysms (IAs) occur in about 2–3% of the general population [1]. Subarachnoid hemorrhage (SAH) due to the ruptured IAs (RIAs) is associated with a high risk of mortality and disability [45% mortality in the first year [2] and 64% disability among the survivors [3]]. Hemodynamic changes play an important role in the process of formation, development, and rupture of the aneurysm. These characteristics could help to determine which IA is prone to rupture and should be treated with priority. To extensively investigate the potential predictive factors for aneurysm rupture, which will not be influenced by the characteristics of patient, we calculated and analyzed 21 morphological and hemodynamic parameters in 52 SAH patients with ruptured intracranial mirror aneurysms. The objective of this study was to identify the morphological and hemodynamic factors associated with the rupture of multiple intracranial aneurysms regardless of patient-related factors and establish a statistical model for aneurysm rupture risk assessment
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