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Chen S, Lv N, Qian Y, Zhang M, Zhang T, Cheng Y. Relationships between irregular pulsation and variations in morphological characteristics during the cardiac cycle in unruptured intracranial aneurysms by 4D-CTA. Front Neurol 2024; 15:1302874. [PMID: 38601339 PMCID: PMC11005792 DOI: 10.3389/fneur.2024.1302874] [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: 10/11/2023] [Accepted: 03/13/2024] [Indexed: 04/12/2024] Open
Abstract
Background and purpose Irregular pulsation of the aneurysmal wall has been suggested as a novel predictor for aneurysm rupture. Aneurysm volume variations during the cardiac cycle and the association between irregular pulsation and morphological features have been discussed, but the clinical significance remains unclear. The purpose of this study was to quantify changes in morphological characteristics over the cardiac cycle and examine their correlation with irregular pulsation to facilitate comprehension of aneurysm dynamics. Materials and methods Fourteen unruptured intracranial aneurysms (UIAs) from 11 patients were included in this study, and each of them underwent 4D-CTA after diagnosis by DSA. The R-R intervals were divided into 20-time phases at 5% intervals to determine whether an aneurysm had irregular pulsation throughout the cardiac cycle. CT images from the 20-time phases were used to reconstruct 3D aneurysm models, measure 14 morphological parameters, and quantify each parameter's absolute change and relative rates of change during the cardiac cycle. Results Seven of 14 UIAs exhibited irregular pulsation over the cardiac cycle by 4D-CTA, 5 of which were small aneurysms (< 7 mm). The UIAs with irregular pulsation exhibited greater changes in morphological characteristics. As aneurysm size increased, the absolute change in aneurysm volume increased (p = 0.035), but the relative rates of change in aneurysm size (p = 0.013), height (p = 0.014), width (p = 0.008), height-to-width ratio (p = 0.009), dome-to-neck ratio (p = 0.019) and bottleneck factor (p = 0.012) decreased. Conclusion Although the larger the aneurysm, the greater the amplitude of its volumetric variation, small aneurysms are prone to irregular pulsation during the cardiac cycle and have more pronounced and dramatic morphological changes during the cardiac cycle that may increase the risk of rupture. This proof-of-concept study could help to explain the importance of dynamic changes using 4D-CTA in assessing the rupture risk of UIAs.
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Affiliation(s)
- Shiyao Chen
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Nan Lv
- Cerebrovascular Disease Center, First Affiliated Hospital of Naval Military Medical University, Changhai Hospital of Shanghai, Shanghai, China
| | - Yu Qian
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Mingwei Zhang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Tianyi Zhang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Yunzhang Cheng
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
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Ramsay IA, Fountain H, Elarjani T, Govindarajan V, Silva M, Abdelsalam A, Burks JD, Starke RM, Luther E. Outcomes in patients with large vessel occlusion strokes undergoing mechanical thrombectomy with concurrent COVID-19: a nationwide retrospective analysis. J Neurointerv Surg 2024; 16:342-346. [PMID: 37263776 DOI: 10.1136/jnis-2023-020263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/15/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Preliminary studies show that patients with large vessel occlusion (LVO) acute ischemic strokes have worse outcomes with concurrent COVID-19 infection. We investigated the outcomes for patients with LVO strokes undergoing mechanical thrombectomy (MT) with concurrent COVID-19 infection. METHODS The National Inpatient Database (NIS) was used for our analysis. Patients in the year 2020 with an ICD-10 diagnosis code for acute ischemic stroke and procedural code for MT were included with and without COVID-19. Odds ratios (OR) were calculated using a logistic regression model with age, sex, stroke location, Elixhauser comorbidity score, and other patient variables deemed clinically relevant as covariates. RESULTS Patients in the COVID-19 group were younger (64.3±14.4 vs 69.4±14.5 years, P<0.001), had a higher rate of inpatient mortality (22.4% vs 10.1%, P<0.001), and a longer length of stay (10 vs 6 days, P<0.001). Patients with COVID-19 had higher odds of death (OR 2.78, 95% CI 2.11 to 3.65) and lower odds of a routine discharge (OR 0.65, 95% CI 0.48 to 0.89). There was no difference in the odds of subsequent stroke and cerebral hemorrhage, but patients with COVID-19 had statistically significantly higher odds of respiratory failure, pulmonary embolism, deep vein thrombosis, myocardial infarction, acute kidney injury, and sepsis. CONCLUSIONS Patients with LVOs undergoing MT within the 2020 NIS database had worse outcomes when co-diagnosed with COVID-19, likely due to non-neurological manifestations of COVID-19.
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Affiliation(s)
- Ian A Ramsay
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Hayes Fountain
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Turki Elarjani
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Vaidya Govindarajan
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael Silva
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ahmed Abdelsalam
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Joshua D Burks
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Robert M Starke
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Evan Luther
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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Li D, Jiang Y, Zhuge C, Wu A. Treatment of aneurysmal artery with PED: A case report. Medicine (Baltimore) 2023; 102:e36377. [PMID: 38050221 PMCID: PMC10695510 DOI: 10.1097/md.0000000000036377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/09/2023] [Indexed: 12/06/2023] Open
Abstract
RATIONALE Pipeline embolization devices are a new treatment for intracranial aneurysms, especially irregular, giant aneurysms. PATIENT CONCERNS A 48-year-old female patient presented with a headache in the frontal part for 3 weeks. DIAGNOSES Cerebral computed tomographic angiography and magnetic resonance angiography showed a saccular aneurysm in the right internal carotid artery that wrapped the parent artery. Digital subtraction angiography provided images with 1 large saccular internal carotid aneurysm. INTERVENTIONS The patient was treated by flow diverter stent and coil embolization and dual antiplatelet therapy with aspirin and ticagrelor in the ICU and was discharged after 10 days without complications. OUTCOMES One year after interventional therapy, repeated digital subtraction angiography showed no recurrence of aneurysm and embolization well, and the patient reported improvement in neurological symptoms. LESSONS Aneurysmal parent artery is a rare phenomenon. The combination of flow diverter stents and coil embolization to treat cases with large saccular aneurysms has important clinical significance and this may provide a reference for clinical treatment of aneurysmal parent artery.
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Affiliation(s)
- Da Li
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Yunxia Jiang
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Chengjun Zhuge
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - An Wu
- Department of Neurosurgery, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Quzhou, People’s Republic of China
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Wang B, Shen C, Su Z, Nie X, Zhao J, Qiu S, Li Y. Correlation between the rate of morphological changes and rupture of intracranial aneurysms during one cardiac cycle analyzed by 4D-CTA. Front Neurol 2023; 14:1235312. [PMID: 37849835 PMCID: PMC10577209 DOI: 10.3389/fneur.2023.1235312] [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: 06/08/2023] [Accepted: 09/11/2023] [Indexed: 10/19/2023] Open
Abstract
Objective This study aimed to analyze the relationship between the rate of morphological changes and intracranial aneurysm rupture during the cardiac cycle. Methods Eighty-four patients with intracranial aneurysms were retrospectively analyzed and divided into the rupture (42 cases) and unruptured (42 cases) groups. Four-dimensional computed tomography angiography (4D-CTA) was performed to collect quantitative parameters of aneurysm morphology and calculate the morphological change rate. The potential factors associated with aneurysm rupture were determined by comparing the general clinical data and rate of change in the location and morphology of the aneurysm between the two groups. Results Each morphological change rate in the rupture group was generally higher than that of the unruptured group. The rate of dome height change and aneurysm volume change were independent factors associated with aneurysm rupture. ROC curve analysis revealed that the diagnostic accuracy of the aneurysm volume change rate was higher. When the volume change rate was 12.33%, the sensitivity and specificity of rupture were 90.5 and 55.8%, respectively. Conclusion The rate of change in dome height and volume of intracranial aneurysms during one cardiac cycle were independent factors associated with aneurysm rupture.
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Affiliation(s)
- Binghao Wang
- Department of Neurosurgery, Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation, Huzhou, China
- Department of Neurosurgery, Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Chengen Shen
- Department of Neurosurgery, Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation, Huzhou, China
| | - Zhongzhou Su
- Department of Neurosurgery, Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation, Huzhou, China
| | - Xiaohu Nie
- Department of Neurosurgery, Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation, Huzhou, China
| | - Jingjing Zhao
- Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation, Huzhou, China
- Department of Hospital Infection Control, Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
| | - Sheng Qiu
- Department of Neurosurgery, Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation, Huzhou, China
| | - Yuntao Li
- Department of Neurosurgery, Huzhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation, Huzhou, China
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Raghuram A, Patel R, Varon A, Sabotin R, Sanchez S, Derdeyn CP, Jabbour P, Hasan DM, Samaniego EA. Volumetric surveillance of brain aneurysms: Pitfalls of MRA. Interv Neuroradiol 2023; 29:532-539. [PMID: 35549745 PMCID: PMC10549707 DOI: 10.1177/15910199221100619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/26/2022] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Untreated brain aneurysms are usually surveilled with serial MR imaging and evaluated with 2D multiplanar measurements. The assessment of aneurysm growth may be more accurate with volumetric analysis. We evaluated the accuracy of a magnetic resonance angiography (MRA) segmentation pipeline for aneurysm volume measurement and surveillance. METHODS A pipeline to determine aneurysm volume was developed and tested on two aneurysm phantoms imaged with time-of flight (TOF) MRA and 3D rotational angiography (3DRA). The accuracy of the pipeline was then evaluated by reconstructing 10 aneurysms imaged with contrast enhanced-MRA (CE-MRA) and 3DRA. This calibrated and refined post-processing pipeline was subsequently used to analyse aneurysms from our prospectively acquired database. Volume changes above the threshold of error were considered true volume changes. The accuracy of these measurements was analysed. RESULTS TOF-MRA reconstructions were not as accurate as CE-MRA reconstructions. When compared to 3DRA, CE-MRA underestimated aneurysm volume by 7.8% and did not accurately register the presence of blebs. Eighteen aneurysms (13 saccular and 5 fusiform) were analysed with the optimized 3D volume reconstruction pipeline, with a mean follow-up time of 11 months. Artifact accounted for 10.2% error in volume measurements using serial CE-MRA. When this margin of error was used to assess aneurysms volume in serial imaging with CE-MRA, only two fusiform aneurysms changed in volume. The variations in volume of these two fusiform aneurysms were caused by intra-mural and intrasaccular thrombosis. CONCLUSIONS CE-MRA and TOF-MRA 3D volume reconstructions may not register minor morphological changes such as the appearance of blebs. CE-MRA underestimates volume by 7.8% compared to 3DRA. Serial CE-MRA volume measurements had a larger margin of error of approximately 10.2%. MRA-based volumetric measurements may not be appropriate for aneurysm surveillance.
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Affiliation(s)
- Ashrita Raghuram
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Rishi Patel
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Alberto Varon
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Ryan Sabotin
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Sebastian Sanchez
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Colin P Derdeyn
- Department of Radiology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - David M. Hasan
- Department of Neurosurgery, Duke University, Durham, NC, USA
| | - Edgar A. Samaniego
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
- Department of Radiology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Feng J, Zeng R, Geng Y, Chen Q, Zheng Q, Yu F, Deng T, Lv L, Li C, Xue B, Li C. Automatic differentiation of ruptured and unruptured intracranial aneurysms on computed tomography angiography based on deep learning and radiomics. Insights Imaging 2023; 14:76. [PMID: 37142819 PMCID: PMC10160318 DOI: 10.1186/s13244-023-01423-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 04/05/2023] [Indexed: 05/06/2023] Open
Abstract
OBJECTIVES Rupture of intracranial aneurysm is very dangerous, often leading to death and disability. In this study, deep learning and radiomics techniques were used to automatically detect and differentiate ruptured and unruptured intracranial aneurysms. MATERIALS AND METHODS 363 ruptured aneurysms and 535 unruptured aneurysms from Hospital 1 were included in the training set. 63 ruptured aneurysms and 190 unruptured aneurysms from Hospital 2 were used for independent external testing. Aneurysm detection, segmentation and morphological features extraction were automatically performed with a 3-dimensional convolutional neural network (CNN). Radiomic features were additionally computed via pyradiomics package. After dimensionality reduction, three classification models including support vector machines (SVM), random forests (RF), and multi-layer perceptron (MLP) were established and evaluated via area under the curve (AUC) of receiver operating characteristics. Delong tests were used for the comparison of different models. RESULTS The 3-dimensional CNN automatically detected, segmented aneurysms and calculated 21 morphological features for each aneurysm. The pyradiomics provided 14 radiomics features. After dimensionality reduction, 13 features were found associated with aneurysm rupture. The AUCs of SVM, RF and MLP on the training dataset and external testing dataset were 0.86, 0.85, 0.90 and 0.85, 0.88, 0.86, respectively, for the discrimination of ruptured and unruptured intracranial aneurysms. Delong tests showed that there was no significant difference among the three models. CONCLUSIONS In this study, three classification models were established to distinguish ruptured and unruptured aneurysms accurately. The aneurysms segmentation and morphological measurements were performed automatically, which greatly improved the clinical efficiency. CLINICAL RELEVANCE STATEMENT Our fully automatic models could rapidly process the CTA data and evaluate the status of aneurysms in one minute.
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Affiliation(s)
- Junbang Feng
- Medical Imaging Department, Chongqing University Central Hospital, No. 1, Jiankang Road, Yuzhong District, Chongqing, 400014, China
- Medical Imaging Department, Chongqing Emergency Medical Center, No. 1, Jiankang Road, Yuzhong District, Chongqing, 400014, China
| | - Rong Zeng
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Yayuan Geng
- Department of Research and Development, Shukun (Beijing) Network Technology Co., Ltd, No. Room 801, Jinhui Building, Qiyang Road, Chaoyang District, Beijing, 200232, China
| | - Qiang Chen
- Department of Research and Development, Shukun (Beijing) Network Technology Co., Ltd, No. Room 801, Jinhui Building, Qiyang Road, Chaoyang District, Beijing, 200232, China
| | - Qingqing Zheng
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Fei Yu
- Medical Imaging Department, Chongqing University Central Hospital, No. 1, Jiankang Road, Yuzhong District, Chongqing, 400014, China
- Medical Imaging Department, Chongqing Emergency Medical Center, No. 1, Jiankang Road, Yuzhong District, Chongqing, 400014, China
| | - Tie Deng
- Medical Imaging Department, Chongqing University Central Hospital, No. 1, Jiankang Road, Yuzhong District, Chongqing, 400014, China
- Medical Imaging Department, Chongqing Emergency Medical Center, No. 1, Jiankang Road, Yuzhong District, Chongqing, 400014, China
| | - Lei Lv
- Medical Imaging Department, Chongqing University Central Hospital, No. 1, Jiankang Road, Yuzhong District, Chongqing, 400014, China
| | - Chang Li
- Medical Imaging Department, Chongqing University Central Hospital, No. 1, Jiankang Road, Yuzhong District, Chongqing, 400014, China
- Medical Imaging Department, Chongqing Emergency Medical Center, No. 1, Jiankang Road, Yuzhong District, Chongqing, 400014, China
| | - Bo Xue
- Medical Imaging Department, Chongqing University Central Hospital, No. 1, Jiankang Road, Yuzhong District, Chongqing, 400014, China.
- Medical Imaging Department, Chongqing Emergency Medical Center, No. 1, Jiankang Road, Yuzhong District, Chongqing, 400014, China.
| | - Chuanming Li
- Medical Imaging Department, Chongqing University Central Hospital, No. 1, Jiankang Road, Yuzhong District, Chongqing, 400014, China.
- Medical Imaging Department, Chongqing Emergency Medical Center, No. 1, Jiankang Road, Yuzhong District, Chongqing, 400014, China.
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Zhai X, Hu P, Wang Y, Zhang H, Cao L, Huang T, Lu J, Luo Y. Association of local solid mechanical, hemodynamic and morphological characteristics with ruptured intracranial aneurysm. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2023; 39:e3674. [PMID: 36541137 DOI: 10.1002/cnm.3674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/31/2022] [Accepted: 12/17/2022] [Indexed: 06/17/2023]
Abstract
The rupture of intracranial aneurysms (IAs) is a complicated phenomenon of which the mechanism is not fully understood. The purpose of this study is to associate local solid mechanical, hemodynamic, and morphological characteristics with rupture regions through statistical means, in an attempt to identify the parameters that are indicative of rupture propensity for IAs. Twenty patient-specific ruptured IA models were reconstructed from digital subtraction angiography (DSA), and applied in the analysis of wall tension, wall shear stress (WSS) and curvature. The precise rupture locations were marked out through intraoperative videos. Pearson correlation analysis was employed to investigate the correlations of these three parameters with patient characteristics and global geometric features. Univariate and multivariate logistic regression analysis were further performed on wall tension, WSS and curvature with regards to rupture and nonrupture regions. Receiver operating characteristic (ROC) analysis defining area under the curve (AUC) was performed on these three parameters. The univariate model of wall tension (AUC, 0.9750), WSS (AUC, 0.9300), curvature (0.8150) and their combined multivariate model (AUC, 0.9875) all present high AUC values. The wall tension, WSS and curvature are acceptable parameters relating to rupture regions. The rupture odd is more sensitive to the wall tension and WSS than curvature. Each logistic model is capable in discriminating ruptures from nonrupture regions, while the multivariate model is the most efficient.
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Affiliation(s)
- Xiaodong Zhai
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Peng Hu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Yadong Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Hongqi Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Lan Cao
- Boea Wisdom (Hangzhou) Network Technology Co., Ltd., Hangzhou, Zhejiang, China
| | - Tianming Huang
- Boea Wisdom (Hangzhou) Network Technology Co., Ltd., Hangzhou, Zhejiang, China
| | - Jia Lu
- Department of Mechanical Engineering, The University of Iowa, Iowa City, Iowa, USA
| | - Yuanming Luo
- Department of Mechanical Engineering, The University of Iowa, Iowa City, Iowa, USA
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Zhu G, Luo X, Yang T, Cai L, Yeo JH, Yan G, Yang J. Deep learning-based recognition and segmentation of intracranial aneurysms under small sample size. Front Physiol 2022; 13:1084202. [PMID: 36601346 PMCID: PMC9806214 DOI: 10.3389/fphys.2022.1084202] [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: 10/30/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
The manual identification and segmentation of intracranial aneurysms (IAs) involved in the 3D reconstruction procedure are labor-intensive and prone to human errors. To meet the demands for routine clinical management and large cohort studies of IAs, fast and accurate patient-specific IA reconstruction becomes a research Frontier. In this study, a deep-learning-based framework for IA identification and segmentation was developed, and the impacts of image pre-processing and convolutional neural network (CNN) architectures on the framework's performance were investigated. Three-dimensional (3D) segmentation-dedicated architectures, including 3D UNet, VNet, and 3D Res-UNet were evaluated. The dataset used in this study included 101 sets of anonymized cranial computed tomography angiography (CTA) images with 140 IA cases. After the labeling and image pre-processing, a training set and test set containing 112 and 28 IA lesions were used to train and evaluate the convolutional neural network mentioned above. The performances of three convolutional neural networks were compared in terms of training performance, segmentation performance, and segmentation efficiency using multiple quantitative metrics. All the convolutional neural networks showed a non-zero voxel-wise recall (V-Recall) at the case level. Among them, 3D UNet exhibited a better overall segmentation performance under the relatively small sample size. The automatic segmentation results based on 3D UNet reached an average V-Recall of 0.797 ± 0.140 (3.5% and 17.3% higher than that of VNet and 3D Res-UNet), as well as an average dice similarity coefficient (DSC) of 0.818 ± 0.100, which was 4.1%, and 11.7% higher than VNet and 3D Res-UNet. Moreover, the average Hausdorff distance (HD) of the 3D UNet was 3.323 ± 3.212 voxels, which was 8.3% and 17.3% lower than that of VNet and 3D Res-UNet. The three-dimensional deviation analysis results also showed that the segmentations of 3D UNet had the smallest deviation with a max distance of +1.4760/-2.3854 mm, an average distance of 0.3480 mm, a standard deviation (STD) of 0.5978 mm, a root mean square (RMS) of 0.7269 mm. In addition, the average segmentation time (AST) of the 3D UNet was 0.053s, equal to that of 3D Res-UNet and 8.62% shorter than VNet. The results from this study suggested that the proposed deep learning framework integrated with 3D UNet can provide fast and accurate IA identification and segmentation.
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Affiliation(s)
- Guangyu Zhu
- School of Energy and Power Engineering, Xi’an Jiaotong University, Xi’an, China,*Correspondence: Guangyu Zhu, ; Jian Yang,
| | - Xueqi Luo
- School of Energy and Power Engineering, Xi’an Jiaotong University, Xi’an, China
| | - Tingting Yang
- School of Energy and Power Engineering, Xi’an Jiaotong University, Xi’an, China
| | - Li Cai
- Xi’an Key Laboratory of Scientific Computation and Applied Statistics, Xi’an, China,School of Mathematics and Statistics, Northwestern Polytechnical University, Xi’an, China
| | - Joon Hock Yeo
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Ge Yan
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Jian Yang
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China,*Correspondence: Guangyu Zhu, ; Jian Yang,
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Silva MA, Chen S, Starke RM. Unruptured cerebral aneurysm risk stratification: Background, current research, and future directions in aneurysm assessment. Surg Neurol Int 2022; 13:182. [PMID: 35509527 PMCID: PMC9062958 DOI: 10.25259/sni_1112_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/07/2022] [Indexed: 12/04/2022] Open
Abstract
Background: The optimal management of unruptured cerebral aneurysms is widely debated in the medical field. Rapid technology advances, evolving understanding of underlying pathophysiology, and shifting practice patterns have made the cerebrovascular field particularly dynamic in recent years. Despite progress, there remains a dearth of large randomized studies to help guide the management of these controversial patients. Methods: We review the existing literature on the natural history of unruptured cerebral aneurysms and highlight ongoing research aimed at improving our ability to stratify risk in these patients. Results: Landmark natural history studies demonstrated the significance of size, location, and other risk factors for aneurysm rupture, but prior studies have significant limitations. We have begun to understand the underlying pathophysiology behind aneurysm formation and rupture and are now applying new tools such as flow dynamics simulations and machine learning to individualize rupture risk stratification. Conclusion: Prior studies have identified several key risk factors for aneurysmal rupture, but have limitations. New technology and research methods have enabled us to better understanding individual rupture risk for patients with unruptured cerebral aneurysms.
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10
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Golub VM, Reddy DS. Post-Traumatic Epilepsy and Comorbidities: Advanced Models, Molecular Mechanisms, Biomarkers, and Novel Therapeutic Interventions. Pharmacol Rev 2022; 74:387-438. [PMID: 35302046 PMCID: PMC8973512 DOI: 10.1124/pharmrev.121.000375] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Post-traumatic epilepsy (PTE) is one of the most devastating long-term, network consequences of traumatic brain injury (TBI). There is currently no approved treatment that can prevent onset of spontaneous seizures associated with brain injury, and many cases of PTE are refractory to antiseizure medications. Post-traumatic epileptogenesis is an enduring process by which a normal brain exhibits hypersynchronous excitability after a head injury incident. Understanding the neural networks and molecular pathologies involved in epileptogenesis are key to preventing its development or modifying disease progression. In this article, we describe a critical appraisal of the current state of PTE research with an emphasis on experimental models, molecular mechanisms of post-traumatic epileptogenesis, potential biomarkers, and the burden of PTE-associated comorbidities. The goal of epilepsy research is to identify new therapeutic strategies that can prevent PTE development or interrupt the epileptogenic process and relieve associated neuropsychiatric comorbidities. Therefore, we also describe current preclinical and clinical data on the treatment of PTE sequelae. Differences in injury patterns, latency period, and biomarkers are outlined in the context of animal model validation, pathophysiology, seizure frequency, and behavior. Improving TBI recovery and preventing seizure onset are complex and challenging tasks; however, much progress has been made within this decade demonstrating disease modifying, anti-inflammatory, and neuroprotective strategies, suggesting this goal is pragmatic. Our understanding of PTE is continuously evolving, and improved preclinical models allow for accelerated testing of critically needed novel therapeutic interventions in military and civilian persons at high risk for PTE and its devastating comorbidities.
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Affiliation(s)
- Victoria M Golub
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, Texas
| | - Doodipala Samba Reddy
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, Texas
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11
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Timmins K, Kuijf H, Vergouwen M, Ruigrok Y, Velthuis B, van der Schaaf I. Relationship between 3D Morphologic Change and 2D and 3D Growth of Unruptured Intracranial Aneurysms. AJNR Am J Neuroradiol 2022; 43:416-421. [PMID: 35144935 PMCID: PMC8910794 DOI: 10.3174/ajnr.a7418] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/02/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Untreated unruptured intracranial aneurysms are usually followed radiologically to detect aneurysm growth, which is associated with increased rupture risk. The ideal aneurysm size cutoff for defining growth remains unclear and also whether change in morphology should be part of the definition. We investigated the relationship between change in aneurysm size and 3D quantified morphologic changes during follow-up. MATERIALS AND METHODS We performed 3D morphology measurements of unruptured intracranial aneurysms on baseline and follow-up TOF-MRAs. Morphology measurements included surface area, compactness, elongation, flatness, sphericity, shape index, and curvedness. We investigated the relation between morphologic change between baseline and follow-up scans and unruptured intracranial aneurysm growth, with 2D and 3D growth defined as a continuous variable (correlation statistics) and a categoric variable (t test statistics). Categoric growth was defined as ≥1-mm increase in 2D length or width. We assessed unruptured intracranial aneurysms that changed in morphology and the proportion of growing and nongrowing unruptured intracranial aneurysms with statistically significant morphologic change. RESULTS We included 113 patients with 127 unruptured intracranial aneurysms. Continuous growth of unruptured intracranial aneurysms was related to an increase in surface area and flatness and a decrease in the shape index and curvedness. In 15 growing unruptured intracranial aneurysms (12%), curvedness changed significantly compared with nongrowing unruptured intracranial aneurysms. Of the 112 nongrowing unruptured intracranial aneurysms, 10 (9%) changed significantly in morphology (flatness, shape index, and curvedness). CONCLUSIONS Growing unruptured intracranial aneurysms show morphologic change. However, nearly 10% of nongrowing unruptured intracranial aneurysms change in morphology, suggesting that they could be unstable. Future studies should investigate the best growth definition including morphologic change and size to predict aneurysm rupture.
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Affiliation(s)
- K.M. Timmins
- From the Image Sciences Institute (K.M.T., H.J.K.)
| | - H.J. Kuijf
- From the Image Sciences Institute (K.M.T., H.J.K.)
| | - M.D.I. Vergouwen
- Department of Neurology and Neurosurgery (M.D.I.V., Y.M.R.), University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Y.M. Ruigrok
- Department of Neurology and Neurosurgery (M.D.I.V., Y.M.R.), University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - B.K. Velthuis
- Department of Radiology (B.K.V., I.C.v.d.S.), University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - I.C. van der Schaaf
- Department of Radiology (B.K.V., I.C.v.d.S.), University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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12
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Acosta JM, Cayron AF, Dupuy N, Pelli G, Foglia B, Haemmerli J, Allémann E, Bijlenga P, Kwak BR, Morel S. Effect of Aneurysm and Patient Characteristics on Intracranial Aneurysm Wall Thickness. Front Cardiovasc Med 2021; 8:775307. [PMID: 34957259 PMCID: PMC8692777 DOI: 10.3389/fcvm.2021.775307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/16/2021] [Indexed: 11/30/2022] Open
Abstract
Background: The circle of Willis is a network of arteries allowing blood supply to the brain. Bulging of these arteries leads to formation of intracranial aneurysm (IA). Subarachnoid hemorrhage (SAH) due to IA rupture is among the leading causes of disability in the western world. The formation and rupture of IAs is a complex pathological process not completely understood. In the present study, we have precisely measured aneurysmal wall thickness and its uniformity on histological sections and investigated for associations between IA wall thickness/uniformity and commonly admitted risk factors for IA rupture. Methods: Fifty-five aneurysm domes were obtained at the Geneva University Hospitals during microsurgery after clipping of the IA neck. Samples were embedded in paraffin, sectioned and stained with hematoxylin-eosin to measure IA wall thickness. The mean, minimum, and maximum wall thickness as well as thickness uniformity was measured for each IA. Clinical data related to IA characteristics (ruptured or unruptured, vascular location, maximum dome diameter, neck size, bottleneck factor, aspect and morphology), and patient characteristics [age, smoking, hypertension, sex, ethnicity, previous SAH, positive family history for IA/SAH, presence of multiple IAs and diagnosis of polycystic kidney disease (PKD)] were collected. Results: We found positive correlations between maximum dome diameter or neck size and IA wall thickness and thickness uniformity. PKD patients had thinner IA walls. No associations were found between smoking, hypertension, sex, IA multiplicity, rupture status or vascular location, and IA wall thickness. No correlation was found between patient age and IA wall thickness. The group of IAs with non-uniform wall thickness contained more ruptured IAs, women and patients harboring multiple IAs. Finally, PHASES and ELAPSS scores were positively correlated with higher IA wall heterogeneity. Conclusion: Among our patient and aneurysm characteristics of interest, maximum dome diameter, neck size and PKD were the three factors having the most significant impact on IA wall thickness and thickness uniformity. Moreover, wall thickness heterogeneity was more observed in ruptured IAs, in women and in patients with multiple IAs. Advanced medical imaging allowing in vivo measurement of IA wall thickness would certainly improve personalized management of the disease and patient care.
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Affiliation(s)
- Jason M. Acosta
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Anne F. Cayron
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Nicolas Dupuy
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Graziano Pelli
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Bernard Foglia
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Julien Haemmerli
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Eric Allémann
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Philippe Bijlenga
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Brenda R. Kwak
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sandrine Morel
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- *Correspondence: Sandrine Morel
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13
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Whiffin CJ, Smith BG, Esene IN, Karekezi C, Bashford T, Mukhtar Khan M, Hutchinson PJ, Kolias AG, Fontoura Solla DJ, Paiva WS, Figaji A. Neurosurgeons' experiences of conducting and disseminating clinical research in low-income and middle-income countries: a reflexive thematic analysis. BMJ Open 2021; 11:e051806. [PMID: 34551952 PMCID: PMC8461280 DOI: 10.1136/bmjopen-2021-051806] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Low-income and-middle-income countries (LMICs) are increasing investment in research and development, yet there remains a paucity of neurotrauma research published by those in LMICs. The aim of this study was to understand neurosurgeons' experiences of, aspirations for, and ability to conduct and disseminate clinical research in LMICs. DESIGN This was a two-stage inductive qualitative study situated within the naturalistic paradigm. This study committed to an interpretivist way of knowing (epistemology), and considered reality subjective and multiple (ontology). Data collection used online methods and included a web-based survey tool for demographic data, an asynchronous online focus group and follow-up semistructured interviews. Data were analysed using Braun and Clarke's Reflexive Thematic Analysis supported by NVivo V.12. SETTING LMICs. PARTICIPANTS In April-July 2020, 26 neurosurgeons from 11 LMICs participated in this study (n=24 in the focus groups, n=20 in follow-up interviews). RESULTS The analysis gave rise to five themes: The local landscape; creating capacity; reach and impact; collaborative inquiry; growth and sustainability. Each theme contained an inhibitor and stimulus to neurosurgeons conducting and disseminating clinical research, interpreted as 'the neurosurgical research potential in LMICs'. Mentorship, education, infrastructure, impact and engagement were identified as specific accelerators. Whereas lack of generalisability, absence of dissemination and dissemination without peer review may desensitise the impact of research conducted by neurosurgeons. CONCLUSION The geographical, political and population complexities make research endeavour challenging for neurosurgeons in LMICs. Yet in spite of, and because of, these complexities LMICs provide rich opportunities to advance global neurosurgery. More studies are required to evaluate the specific effects of accelerators of research conducted by neurosurgeons and to understand the effects of desensitisers on high-quality, high-impact clinical research.
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Affiliation(s)
- Charlotte Jane Whiffin
- University of Cambridge, NIHR Global Health Research Group on Neurotrauma, Cambridge, UK
- College of Health Psychology and Social Care, University of Derby, Derby, UK
| | - Brandon George Smith
- University of Cambridge, NIHR Global Health Research Group on Neurotrauma, Cambridge, UK
- Department of Clinical Neurosciences, Division of Neurosurgery, Addenbrooke's Hospital, Cambridge, UK
| | - Ignatius N Esene
- University of Cambridge, NIHR Global Health Research Group on Neurotrauma, Cambridge, UK
- Neurosurgery Division, Faculty of Health Sciences, University of Bamenda, Bambili, NW Region, Cameroon
| | - Claire Karekezi
- Department of Neurosurgery, Rwanda Military Hospital, Kigali, Kigali City, Rwanda
- Young Neurosurgeons Committee, World Federation of Neurosurgical Societies, Nyon, Switzerland
| | - Tom Bashford
- University of Cambridge, NIHR Global Health Research Group on Neurotrauma, Cambridge, UK
- Department of Clinical Neurosciences, Division of Neurosurgery, Addenbrooke's Hospital, Cambridge, UK
| | - Muhammad Mukhtar Khan
- Young Neurosurgeons Committee, World Federation of Neurosurgical Societies, Nyon, Switzerland
- Neurosurgery, Northwest School of Medicine, Northwest General Hospital & Research Center, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Peter John Hutchinson
- University of Cambridge, NIHR Global Health Research Group on Neurotrauma, Cambridge, UK
- Department of Clinical Neurosciences, Division of Neurosurgery, Addenbrooke's Hospital, Cambridge, UK
| | - Angelos G Kolias
- University of Cambridge, NIHR Global Health Research Group on Neurotrauma, Cambridge, UK
- Department of Clinical Neurosciences, Division of Neurosurgery, Addenbrooke's Hospital, Cambridge, UK
| | | | - Wellingson S Paiva
- University of Cambridge, NIHR Global Health Research Group on Neurotrauma, Cambridge, UK
- Department of Neurology, Division of Neurosurgery, University of Sao Paulo, Sao Paulo, Brazil
| | - Anthony Figaji
- University of Cambridge, NIHR Global Health Research Group on Neurotrauma, Cambridge, UK
- Division of Neurosurgery, Red Cross Children's Hospital & University of Cape Town, Cape Town, South Africa
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14
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Gaidzik F, Pravdivtseva M, Larsen N, Jansen O, Hövener JB, Berg P. Luminal enhancement in intracranial aneurysms: fact or feature?-A quantitative multimodal flow analysis. Int J Comput Assist Radiol Surg 2021; 16:1999-2008. [PMID: 34519953 PMCID: PMC8589743 DOI: 10.1007/s11548-021-02486-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 08/17/2021] [Indexed: 11/04/2022]
Abstract
Purpose Intracranial aneurysm (IA) wall enhancement on post-contrast vessel wall magnetic resonance imaging (VW-MRI) is assumed to be a biomarker for vessel wall inflammation and aneurysm instability. However, the exact factors contributing to enhancement are not yet clarified. This study investigates the relationship between luminal enhancement and intra-aneurysmal flow behaviour to assess the suitability of VW-MRI as a surrogate method for determining quantitative and qualitative flow behaviour in the aneurysm sac. Methods VW-MRI signal is measured in the lumen of three patient-specific IA flow models and compared with the intra-aneurysmal flow fields obtained using phase-contrast magnetic resonance imaging (PC-MRI) and computational fluid dynamics (CFD). The IA flow models were supplied with two different time-varying flow regimes. Results Overall, the velocity fields acquired using PC-MRI or CFD were in good agreement with the VW-MRI enhancement patterns. Generally, the regions with slow-flowing blood show higher VW-MRI signal intensities, whereas high flow leads to a suppression of the signal. For all aneurysm models, a signal value above three was associated with velocity values below three cm/s. Conclusion Regions with lower enhancements have been correlated with the slow and high flow at the same time. Thus, further factors like flow complexity and stability can contribute to flow suppression in addition to the flow magnitude. Nevertheless, VW-MRI can qualitatively assess intra-aneurysmal flow phenomena and estimate the velocity range present in the corresponding region.
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Affiliation(s)
- Franziska Gaidzik
- Laboratory of Fluid Dynamics and Technical Flows, Otto-von-Guericke University, University of Magdeburg, Forschungscampus STIMULATE, Universitätsplatz 3, 39106, Magdeburg, Germany.
| | - Mariya Pravdivtseva
- Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), Kiel University, Kiel, Germany.,Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - Naomi Larsen
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - Jan-Bernd Hövener
- Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), Kiel University, Kiel, Germany.,Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - Philipp Berg
- Laboratory of Fluid Dynamics and Technical Flows, Otto-von-Guericke University, University of Magdeburg, Forschungscampus STIMULATE, Universitätsplatz 3, 39106, Magdeburg, Germany
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15
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Complex and continuous change in hypothetic risk of rupture of intracranial cerebral aneurysms – Bleb mandala –. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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16
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Liu X, Haraldsson H, Wang Y, Kao E, Ballweber M, Martin AJ, McCulloch CE, Faraji F, Saloner D. A Volumetric Metric for Monitoring Intracranial Aneurysms: Repeatability and Growth Criteria in a Longitudinal MR Imaging Study. AJNR Am J Neuroradiol 2021; 42:1591-1597. [PMID: 34167960 DOI: 10.3174/ajnr.a7190] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/01/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The reliability of contrast-enhanced MRA in monitoring serial volumetric changes of unruptured intracranial aneurysms has not been established. We aimed to determine the coefficient of variance of contrast-enhanced MRA in measuring aneurysm volumes, thus establishing criteria for aneurysm growth and permitting identification of variables predictive of growth. MATERIALS AND METHODS Aneurysm volumes were measured from serial contrast-enhanced MRA studies of patients with untreated intracranial aneurysms who underwent >2 sequential MR imaging evaluations. After coregistering all sequential studies in 3D space for each aneurysm and signal intensity normalization, aneurysm volume was determined across all time points. A linear mixed effects model was built to estimate the coefficient of variance of the measurement as well as to determine predictive variables. Growth was defined as relative growth exceeding 2 times the measurement coefficient of variance (sudden growth, as 4 times the coefficient of variance). RESULTS A total of 95 patients with 112 aneurysms were included (5.9 scans during 4.0 years on average, 616 scan measurements in total). The coefficient of variance was 5.5% of the aneurysm volume, and the relative growth rate was dependent on the location: anterior cerebral artery, 4.52% per year; vertebral artery, 2.46% per year; middle cerebral artery, 2.74% per year; basilar artery, 2.36% per year; internal carotid artery, 1.14% per year. Thirty-six of 112 (32%) aneurysms were characterized as growing, and 11/36 of them had an episode of sudden growth. CONCLUSIONS Volume measurement of unruptured intracranial aneurysms by contrast-enhanced MRA seems a reliable metric for tracking the growth trajectory of aneurysms. Furthermore, the aneurysm growth rate differs among different locations.
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Affiliation(s)
- X Liu
- From the Department of Interventional Neuroradiology (X.L.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Departments of Radiology and Biomedical Imaging, and Epidemiology and Biostatistics (X.L., H.H., Y.W., E.K., M.B., A.J.M., C.E.M., F.F., D.S), University of California San Francisco, San Francisco, Californa
| | - H Haraldsson
- Departments of Radiology and Biomedical Imaging, and Epidemiology and Biostatistics (X.L., H.H., Y.W., E.K., M.B., A.J.M., C.E.M., F.F., D.S), University of California San Francisco, San Francisco, Californa
| | - Y Wang
- Departments of Radiology and Biomedical Imaging, and Epidemiology and Biostatistics (X.L., H.H., Y.W., E.K., M.B., A.J.M., C.E.M., F.F., D.S), University of California San Francisco, San Francisco, Californa .,Department of Radiology (Y.W.), Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - E Kao
- Departments of Radiology and Biomedical Imaging, and Epidemiology and Biostatistics (X.L., H.H., Y.W., E.K., M.B., A.J.M., C.E.M., F.F., D.S), University of California San Francisco, San Francisco, Californa
| | - M Ballweber
- Departments of Radiology and Biomedical Imaging, and Epidemiology and Biostatistics (X.L., H.H., Y.W., E.K., M.B., A.J.M., C.E.M., F.F., D.S), University of California San Francisco, San Francisco, Californa
| | - A J Martin
- Departments of Radiology and Biomedical Imaging, and Epidemiology and Biostatistics (X.L., H.H., Y.W., E.K., M.B., A.J.M., C.E.M., F.F., D.S), University of California San Francisco, San Francisco, Californa
| | - C E McCulloch
- Departments of Radiology and Biomedical Imaging, and Epidemiology and Biostatistics (X.L., H.H., Y.W., E.K., M.B., A.J.M., C.E.M., F.F., D.S), University of California San Francisco, San Francisco, Californa
| | - F Faraji
- Departments of Radiology and Biomedical Imaging, and Epidemiology and Biostatistics (X.L., H.H., Y.W., E.K., M.B., A.J.M., C.E.M., F.F., D.S), University of California San Francisco, San Francisco, Californa
| | - D Saloner
- Departments of Radiology and Biomedical Imaging, and Epidemiology and Biostatistics (X.L., H.H., Y.W., E.K., M.B., A.J.M., C.E.M., F.F., D.S), University of California San Francisco, San Francisco, Californa
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17
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Larsen N, Flüh C, Saalfeld S, Voß S, Hille G, Trick D, Wodarg F, Synowitz M, Jansen O, Berg P. Multimodal validation of focal enhancement in intracranial aneurysms as a surrogate marker for aneurysm instability. Neuroradiology 2020; 62:1627-1635. [PMID: 32681192 PMCID: PMC7666674 DOI: 10.1007/s00234-020-02498-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/13/2020] [Indexed: 11/09/2022]
Abstract
Purpose Circumferential enhancement on MR vessel wall imaging has been proposed as a biomarker of a higher risk of rupture in intracranial aneurysms. Focal enhancement is frequently encountered in unruptured aneurysms, but its implication for risk stratification and patient management remains unclear. This study investigates the association of focal wall enhancement with hemodynamic and morphological risk factors and histologic markers of wall inflammation and degeneration. Methods Patients with an unruptured middle cerebral artery aneurysm who underwent 3D rotational angiography and 3T MR vessel wall imaging showing focal wall enhancement were included. Hemodynamic parameters were calculated based on flow simulations and compared between enhanced regions and the entire aneurysm surface. Morphological parameters were semiautomatically extracted and quantitatively associated with wall enhancement. Histological analysis included detection of vasa vasorum, CD34, and myeloperoxidase staining in a subset of patients. Results Twenty-two aneurysms were analyzed. Enhanced regions were significantly associated with lower AWSS, lower maxOSI, and increased LSA. In multivariate analysis, higher ellipticity index was an independent predictor of wall enhancement. Histologic signs of inflammation and degeneration and higher PHASES score were significantly associated with focal enhancement. Conclusion Focal wall enhancement is colocalized with hemodynamic factors that have been related to a higher rupture risk. It is correlated with morphological factors linked to rupture risk, higher PHASES score, and histologic markers of wall destabilization. The results support the hypothesis that focal enhancement could serve as a surrogate marker for aneurysm instability.
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Affiliation(s)
- Naomi Larsen
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein Campus Kiel, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Germany.
| | - Charlotte Flüh
- Department of Neurosurgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Sylvia Saalfeld
- Forschungscampus STIMULATE, University of Magdeburg, Magdeburg, Germany.,Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
| | - Samuel Voß
- Forschungscampus STIMULATE, University of Magdeburg, Magdeburg, Germany.,Institute of Fluid Dynamics and Thermodynamics, University of Magdeburg, Magdeburg, Germany
| | - Georg Hille
- Forschungscampus STIMULATE, University of Magdeburg, Magdeburg, Germany.,Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
| | - David Trick
- Institute of Pathology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Fritz Wodarg
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein Campus Kiel, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Germany
| | - Michael Synowitz
- Department of Neurosurgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein Campus Kiel, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Germany
| | - Philipp Berg
- Forschungscampus STIMULATE, University of Magdeburg, Magdeburg, Germany.,Institute of Fluid Dynamics and Thermodynamics, University of Magdeburg, Magdeburg, Germany
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18
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Liu Q, Jiang P, Jiang Y, Li S, Ge H, Jin H, Li Y. Bifurcation Configuration Is an Independent Risk Factor for Aneurysm Rupture Irrespective of Location. Front Neurol 2019; 10:844. [PMID: 31447764 PMCID: PMC6691088 DOI: 10.3389/fneur.2019.00844] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/22/2019] [Indexed: 11/30/2022] Open
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.
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Affiliation(s)
- Qinglin Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Neurointerventional Engineering Center, Beijing, China
| | - Peng Jiang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuhua Jiang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Neurointerventional Engineering Center, Beijing, China
| | - Shaolin Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Huijian Ge
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Neurointerventional Engineering Center, Beijing, China
| | - Hengwei Jin
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Neurointerventional Engineering Center, Beijing, China
| | - Youxiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Neurointerventional Engineering Center, Beijing, China
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Prestigiacomo CJ. Editorial. Looking at aneurysms by the numbers: morphometrics and the potentials of aneurysm analysis. Neurosurg Focus 2019; 47:E6. [PMID: 31261129 DOI: 10.3171/2019.4.focus19332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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