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Jiang Y, Ge L, Lu G, Wan H, Chen Q, Zou R, Leng X, Xiang J, Zhang X. Wall enhancement predictive of abnormal hemodynamics and ischemia in vertebrobasilar non-saccular aneurysms: a pilot study. Front Neurol 2023; 14:1108904. [PMID: 37333010 PMCID: PMC10272805 DOI: 10.3389/fneur.2023.1108904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 05/09/2023] [Indexed: 06/20/2023] Open
Abstract
Objective To analyze how wall enhancement affects hemodynamics and cerebral ischemic risk factors in vertebrobasilar non-saccular intracranial aneurysms (VBNIAs). Materials and methods Ten consecutive non-saccular aneurysms were collected, including three transitional vertebrobasilar dolichoectasia (TVBD). A wall enhancement model was quantitatively constructed to analyze how wall enhancement interacts with hemodynamics and cerebral ischemic factors. Results Enhanced area revealed low wall shear stress (WSS) and wall shear stress gradient (WSSG), with high oscillatory shear index (OSI), relative residence time (RRT), and gradient oscillatory number (GON) while the vortex and slow flow region in fusiform aneurysms are similar to TVBD fusiform aneurysms. With low OSI, high RRT and similar GON in the dilated segment, the enhanced area still manifests low WSS and WSSG in the slow flow area with no vortex. In fusiform aneurysms, wall enhancement was negatively correlated with WSS (except for case 71, all p values < 0.05, r = -0.52 ~ -0.95), while wall enhancement was positively correlated with OSI (except for case 5, all p values < 0.05, r = 0.50 ~ 0.83). For the 10 fusiform aneurysms, wall enhancement is significantly positively correlated with OSI (p = 0.0002, r = 0.75) and slightly negatively correlated with WSS (p = 0.196, r = -0.30) throughout the dataset. Aneurysm length, width, low wall shear stress area (LSA), high OSI, low flow volume (LFV), RRT, and high aneurysm-to-pituitary stalk contrast ratio (CRstalk) area plus proportion may be predictive of cerebral ischemia. Conclusion A wall enhancement quantitative model was established for vertebrobasilar non-saccular aneurysms. Low WSS was negatively correlated with wall enhancement, while high OSI was positively correlated with wall enhancement. Fusiform aneurysm hemodynamics in TVBD are similar to simple fusiform aneurysms. Cerebral ischemia risk appears to be correlated with large size, high OSI, LSA, and RRT, LFV, and wall enhancement.
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Affiliation(s)
- Yeqing Jiang
- Huashan Hospital, Fudan University, Shanghai, China
| | - Liang Ge
- Huashan Hospital, Fudan University, Shanghai, China
| | - Gang Lu
- Huashan Hospital, Fudan University, Shanghai, China
| | - Hailin Wan
- Huashan Hospital, Fudan University, Shanghai, China
| | - Qi Chen
- ArteryFlow Technology Co., Ltd, Hangzhou, China
| | - Rong Zou
- ArteryFlow Technology Co., Ltd, Hangzhou, China
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Raghuram A, Galloy A, Nino M, Sanchez S, Hasan D, Raghavan S, Samaniego EA. Comprehensive morphomechanical analysis of brain aneurysms. Acta Neurochir (Wien) 2023; 165:461-470. [PMID: 36595056 DOI: 10.1007/s00701-022-05476-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/21/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Brain aneurysms comprise different compartments that undergo unique biological processes. A detailed multimodal analysis incorporating 3D aneurysm wall enhancement (AWE), computational fluid dynamics (CFD), and finite element analysis (FEA) data can provide insights into the aneurysm wall biology. METHODS Unruptured aneurysms were prospectively imaged with 7 T high-resolution MRI (HR-MRI). 3D AWE color maps of the entire aneurysm wall were generated and co-registered with contour plots of morphomechanical parameters derived from CFD and FEA. A multimodal analysis of the entire aneurysm was performed using 3D circumferential AWE (3D-CAWE), wall tension (WT), time-averaged wall shear stress (TAWSS), wall shear stress gradient (WSSG), and oscillatory shear index (OSI). A detailed compartmental analysis of each aneurysm's dome, bleb, and neck was also performed. RESULTS Twenty-six aneurysms were analyzed. 3D-CAWE + aneurysms had higher WT (p = 0.03) and higher TAWSS (p = 0.045) than 3D-CAWE- aneurysms. WT, TAWSS, and WSSG were lower in areas of focal AWE in the aneurysm dome compared to the neck (p = 0.009, p = 0.049, and p = 0.040, respectively), whereas OSI was higher in areas of focal AWE compared to the neck (p = 0.020). When compared to areas of no AWE of the aneurysm sac (AWE = 0.92 vs. 0.49, p = 0.001), blebs exhibited lower WT (1.6 vs. 2.45, p = 0.010), lower TAWSS (2.6 vs. 6.34), lower OSI (0.0007 vs. 0.0010), and lower WSSG (2900 vs. 5306). Fusiform aneurysms had a higher 3D-CAWE and WT than saccular aneurysms (p = 0.046 and p = 0.003, respectively). CONCLUSIONS Areas of focal high AWE in the sac and blebs are associated with low wall tension, low wall shear stress, and low flow conditions (TAWSS and WSSG). Conversely, the neck had average AWE, high wall tension, high wall shear stress, and high flow conditions. The aneurysm dome and the aneurysm neck have different morphomechanical environments, with increased mechanical load at the neck.
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Affiliation(s)
| | - Adam Galloy
- Roy J Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
| | - Marco Nino
- Roy J Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
| | | | - David Hasan
- Department of Neurosurgery, Duke University, Durham, NC, USA
| | - Suresh Raghavan
- Roy J Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
| | - Edgar A Samaniego
- Department of Neurology, University of Iowa, Iowa City, IA, USA. .,Department of Neurosurgery, University of Iowa, Iowa City, IA, USA. .,Department of Radiology, University of Iowa, Iowa City, IA, USA. .,Current Institution, The University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52246, USA.
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Hemodynamic Analysis Shows High Wall Shear Stress Is Associated with Intraoperatively Observed Thin Wall Regions of Intracranial Aneurysms. J Cardiovasc Dev Dis 2022; 9:jcdd9120424. [PMID: 36547421 PMCID: PMC9780790 DOI: 10.3390/jcdd9120424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/23/2022] [Accepted: 11/26/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Studying the relationship between hemodynamics and local intracranial aneurysm (IA) pathobiology can help us understand the natural history of IA. We characterized the relationship between the IA wall appearance, using intraoperative imaging, and the hemodynamics from CFD simulations. METHODS Three-dimensional geometries of 15 IAs were constructed and used for CFD. Two-dimensional intraoperative images were subjected to wall classification using a machine learning approach, after which the wall type was mapped onto the 3D surface. IA wall regions included thick (white), normal (purple-crimson), and thin/translucent (red) regions. IA-wide and local statistical analyses were performed to assess the relationship between hemodynamics and wall type. RESULTS Thin regions of the IA sac had significantly higher WSS, Normalized WSS, WSS Divergence and Transverse WSS, compared to both normal and thick regions. Thicker regions tended to co-locate with significantly higher RRT than thin regions. These trends were observed on a local scale as well. Regression analysis showed a significant positive correlation between WSS and thin regions and a significant negative correlation between WSSD and thick regions. CONCLUSION Hemodynamic simulation results were associated with the intraoperatively observed IA wall type. We consistently found that elevated WSS and WSSNorm were associated with thin regions of the IA wall rather than thick and normal regions.
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Veeturi SS, Rajabzadeh-Oghaz H, Pintér NK, Waqas M, Hasan DM, Snyder KV, Siddiqui AH, Tutino VM. Aneurysm risk metrics and hemodynamics are associated with greater vessel wall enhancement in intracranial aneurysms. ROYAL SOCIETY OPEN SCIENCE 2021; 8:211119. [PMID: 34804573 PMCID: PMC8580418 DOI: 10.1098/rsos.211119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/27/2021] [Indexed: 06/13/2023]
Abstract
Vessel wall enhancement (VWE) in contrast-enhanced magnetic resonance imaging (MRI) is a potential biomarker for intracranial aneurysm (IA) risk stratification. In this study, we investigated the relationship between VWE features, risk metrics, morphology and hemodynamics in 41 unruptured aneurysms. We reconstructed the IA geometries from MR angiography and mapped pituitary stalk-normalized MRI intensity on the aneurysm surface using an in-house tool. For each case, we calculated the maximum intensity (CRstalk) and IA risk (via size and the rupture resemblance score (RRS)). We performed correlation analysis to assess relationships between CRstalk and IA risk metrics (size and RRS), as well as each parameter encompassed in RRS, i.e. aneurysmal size ratio (SR), normalized wall shear stress (WSS) and oscillatory shear index. We found that CRstalk had a strong correlation (Pearson correlation coefficient, PCC = 0.630) with size and a moderate correlation (PCC = 0.472) with RRS, indicating an association between VWE and IA risk. Furthermore, CRstalk had a weak negative correlation with normalized WSS (PCC = -0.320) and a weak positive correlation with SR (PCC = 0.390). Local voxel-based analysis showed only a weak negative correlation between normalized WSS and contrast-enhanced MRI signal intensity (PCC = -0.240), suggesting that if low-normalized WSS induces enhancement-associated pathobiology, the effect is not localized.
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Affiliation(s)
- Sricharan S. Veeturi
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Department of Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, NY, USA
| | - Hamidreza Rajabzadeh-Oghaz
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA
| | | | - Muhammad Waqas
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA
| | - David M. Hasan
- Department of Neurosurgery, University of Iowa Health Care, Iowa City, IA, USA
| | - Kenneth V. Snyder
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA
| | - Adnan H. Siddiqui
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA
| | - Vincent M. Tutino
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Department of Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, NY, USA
- Department of Pathology and Anatomical Sciences, University at Buffalo, Buffalo, NY, USA
- DENT Neurologic Institute, Buffalo, NY, USA
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