Abstract
PurposeFor the status evaluation of intracranial aneurysms (IAs), morphological and hemodynamic parameters can provide valuable information. For their extraction, a separation of the aneurysm sac from its parent vessel is required that yields the neck curve and the ostium. However, manual and subjective neck curve and ostium definitions might lead to inaccurate IA assessments.MethodsThe research project VICTORIA was initiated, allowing users to interactively define the neck curve of five segmented IA models using a web application. The submitted results were qualitatively and quantitatively compared to identify the minimum, median and maximum aneurysm surface area. Finally, image-based blood flow simulations were carried out to assess the effect of variable neck curve definitions on relevant flow- and shear-related parameters.ResultsIn total, 55 participants (20 physicians) from 18 countries participated in VICTORIA. For relatively simple aneurysms, a good agreement with respect to the neck curve definition was found. However, differences among the participants increased with increasing complexity of the aneurysm. Furthermore, it was observed that the majority of participants excluded any small arteries occurring in the vicinity of an aneurysm. This can lead to non-negligible deviations among the flow- and shear-related parameters, which need to be carefully evaluated, if quantitative analysis is desired. Finally, no differences between participants with medical and non-medical background could be observed.ConclusionsVICTORIAs findings reveal the complexity of aneurysm neck curve definition, especially for bifurcation aneurysms. Standardization appears to be mandatory for future sac-vessel-separations. For hemodynamic simulations a careful neck curve definition is crucial to avoid inaccuracies during the quantitative flow analysis.
Highlights
Therapy planning requires a detailed knowledge of the individual Intracranial aneurysms (IAs) neck size to select an appropriate treatment strategy and device, respectively.[15,26]. To account for both clinical diagnosis and treatment planning, the patient-specific aneurysm can be segmented from high-resolution image data and the sac is separated from the corresponding parent vessel
Even if all or at least most of these steps are appropriately conducted, inaccuracies can even occur during the postprocessing, i.e., the separation of the aneurysm sac from the parent vessel
VICTORIAs findings reveal the complexity of aneurysm neck curve definition, especially for bifurcation aneurysms
Summary
Intracranial aneurysms (IAs) are complexly shaped malformations of the cerebral vasculature, which are exposed to the risk of a rupture with a subsequent subarachnoid hemorrhage.[6,7] For the assessment of the individual IA status, simple measurements of the size, easy clinical scores such as the PHASES score or more advanced morphological parameters are typically used.[16,24,25] therapy planning (e.g., using minimally-invasive flow diverter stents) requires a detailed knowledge of the individual IA neck size to select an appropriate treatment strategy and device, respectively.[15,26] To account for both clinical diagnosis and treatment planning, the patient-specific aneurysm can be segmented from high-resolution image data and the sac is separated from the corresponding parent vessel This requires a sufficient 3D model, which is clearly more suitable compared to 2D projected images that can suffer from potential interobserver variability and image-dependency (i.e. the viewing angle of the 2D projections).[29,35]. An increasing number of investigations focusing on the assessment of morphological and hemodynamic parameters with partly diverging conclusions was published.[9,21,23,32,37] Al-
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