1
|
Jeken-Rico P, Chau Y, Goetz A, Sedat J, Hachem E. Investigating Delayed Rupture of Flow Diverter-Treated Giant Aneurysm Using Simulated Fluid-Structure Interactions. Bioengineering (Basel) 2025; 12:305. [PMID: 40150769 PMCID: PMC11939510 DOI: 10.3390/bioengineering12030305] [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: 02/25/2025] [Revised: 03/09/2025] [Accepted: 03/13/2025] [Indexed: 03/29/2025] Open
Abstract
Giant intracranial aneurysms are frequently treated shortly after discovery due to their increased risk of rupture and commonly symptomatic nature. Among available treatments, flow diverters are often the sole viable option, though they carry a rare but serious risk of delayed post-operative rupture. The underlying mechanisms of these ruptures remain unknown, due to the biomechanical complexity of giant aneurysms and challenges in replicating in vivo hemodynamic conditions within numerical simulation frameworks. This study presents a novel fluid-structure interaction simulation of a giant intracranial aneurysm treated with a flow diverter, based on high-resolution rotational angiography imaging. The resulting hemodynamics are compared to three established delayed-rupture hypotheses involving pressure rises, chaotic flow and autolysis. When considering wall compliance, the analysis reveals a consistent phase shift, dampening in pressure cycles, and an increased aneurysmal flow. These findings highlight the need for revisiting existing hypotheses and provide a foundation for advancing both computational modelling and clinical management strategies for giant intracranial aneurysms.
Collapse
Affiliation(s)
- Pablo Jeken-Rico
- Mines Paris, Université PSL, Centre de Mise en Forme des Matériaux (CEMEF), UMR7635 CNRS, 06904 Sophia Antipolis, France; (A.G.); (E.H.)
| | - Yves Chau
- Interventional Neuroradiology Department, Nice University Hospital, 06100 Nice, France; (Y.C.); (J.S.)
| | - Aurèle Goetz
- Mines Paris, Université PSL, Centre de Mise en Forme des Matériaux (CEMEF), UMR7635 CNRS, 06904 Sophia Antipolis, France; (A.G.); (E.H.)
| | - Jacques Sedat
- Interventional Neuroradiology Department, Nice University Hospital, 06100 Nice, France; (Y.C.); (J.S.)
| | - Elie Hachem
- Mines Paris, Université PSL, Centre de Mise en Forme des Matériaux (CEMEF), UMR7635 CNRS, 06904 Sophia Antipolis, France; (A.G.); (E.H.)
| |
Collapse
|
2
|
Yan J. Two-Sample Mendelian Randomization Analyses Identified Lipid Species Associated With Intracranial Aneurysm Formation. Brain Behav 2025; 15:e70435. [PMID: 40103236 PMCID: PMC11919785 DOI: 10.1002/brb3.70435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2024] [Revised: 02/24/2025] [Accepted: 03/02/2025] [Indexed: 03/20/2025] Open
Abstract
OBJECTIVES Intracranial aneurysm (IA) poses a significant health risk, and its formation involves various factors, including lipid metabolism, while former research only focused on the standard lipid. The purpose of this study is to explore 179 lipid variants' impact on unruptured intracranial aneurysms (uIA). MATERIALS AND METHODS Utilizing GWAS data for lipids and uIAs, MR analyses were employed with pleiotropy, heterogeneity, and sensitivity tests. Reverse MR analyses were then conducted. RESULTS MR analyses revealed seven lipids associated with uIAs: TAG (51:3). SE (27:1/16:1), PC (18:2_18:2), TAG (48:1), TAG (48:2), and TAG (51:3) were identified as uIA risk factors, while SE (27:1/18:1) and SM (d34:0) exhibited protective effects. Reverse MR analysis showed no bidirectional causal relationships. CONCLUSIONS This study identifies specific lipid variants causally linked to uIAs, shedding light on their roles in IA formation. These findings contribute to future research on IA risk assessment and potential therapeutic interventions.
Collapse
Affiliation(s)
- Junqing Yan
- Nanxiang Branch of Ruijin HospitalShanghaiChina
| |
Collapse
|
3
|
Zhang M, Yang D, Wang J, Wang D, Xu J, Wang Y. Association of serum lipidomic profiles with risk of intracranial aneurysm: A Mendelian randomization study. J Neurochem 2025; 169:e16247. [PMID: 39449543 DOI: 10.1111/jnc.16247] [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: 07/05/2024] [Revised: 09/01/2024] [Accepted: 09/28/2024] [Indexed: 10/26/2024]
Abstract
A two-sample Mendelian randomization (MR) analysis was utilized to assess the causal relationship between lipidomic profiles and the risk of intracranial aneurysms (IAs). Genetic variants related to lipidomic profiles (227 components) and IA [IA, aneurysmal subarachnoid hemorrhage (aSAH) only, unruptured IA (uIA) only] were obtained from published genome-wide association studies (GWASs) or the IEU Open GWAS project and used as instrumental variables for MR analysis. The inverse-variance weighted method was used in the primary analyses to derive causality estimates and was expressed as odds ratio (OR) with 95% confidence interval (CI). Of these 227 lipidomic profiles, only genetically predicted high levels of cholesterol to total lipids ratio in very small very-low-density lipoproteins (VLDL) [OR = 0.629 (95% CI, 0.504-0.786)], cholesteryl esters to total lipids ratio in very small VLDL [OR = 0.637 (95% CI, 0.509-0.797)], ratio of docosahexaenoic acid to total fatty acids [OR = 0.691 (95% CI, 0.582-0.820)], and ratio of polyunsaturated fatty acids to monounsaturated fatty acids [OR = 0.630 (95% CI, 0.522-0.760)] reduced the risk of aSAH, whereas genetically predicted high ratio of monounsaturated fatty acids to total fatty acids [OR = 1.471 (95% CI, 1.215-1.781)] increased the risk of aSAH. Moreover, genetically predicted high levels of cholesterol to total lipids ratio in very small VLDL [OR = 0.657 (95% CI, 0.542-0.798)], cholesteryl esters to total lipids ratio in very small VLDL [OR = 0.663 (95% CI, 0.548-0.803)], free cholesterol to total lipids ratio in small VLDL [OR = 0.682 (95% CI, 0.560-0.832)], phospholipids to total lipids ratio in small VLDL [OR = 0.674 (95% CI, 0.548-0.830)], and ratio of polyunsaturated fatty acids to monounsaturated fatty acids [OR = 0.678 (95% CI, 0.569-0.808)] reduced the risk of IA. The results of multivariable MR demonstrated that these causal associations persisted after adjusting for systolic blood pressure and cigarettes smoked per day. The effect of serum lipids on IA and aSAH may be mainly caused by subclasses of lipids such as VLDL.
Collapse
Affiliation(s)
- Mingqin Zhang
- Department of Encephalopathy, The First Affiliated Hospital of Henan University of CM, Zhengzhou, Henan, People's Republic of China
| | - Dongyi Yang
- Interventional Department, The First Affiliated Hospital of Henan University of CM, Zhengzhou, Henan, People's Republic of China
| | - Jiabin Wang
- Interventional Department, The First Affiliated Hospital of Henan University of CM, Zhengzhou, Henan, People's Republic of China
| | - Dan Wang
- Department of Encephalopathy, The First Affiliated Hospital of Henan University of CM, Zhengzhou, Henan, People's Republic of China
| | - Jin Xu
- Department of Encephalopathy, The First Affiliated Hospital of Henan University of CM, Zhengzhou, Henan, People's Republic of China
| | - Yibo Wang
- Interventional Department, Henan Province Hospital of TCM, Zhengzhou, Henan, People's Republic of China
| |
Collapse
|
4
|
Zhang J, Li X, Zhang J, Sun B, Wang L, Tian J, Mossa-Basha M, Levitt MR, Zhao B, Xu J, Zhou Y, Zhao H, Zhu C. Irregular pulsation on 4D-CTA and quantitative wall enhancement on VW-MRI are associated with symptoms of unruptured intracranial aneurysms. J Neurointerv Surg 2025:jnis-2024-022483. [PMID: 39622639 DOI: 10.1136/jnis-2024-022483] [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: 09/10/2024] [Accepted: 11/11/2024] [Indexed: 12/06/2024]
Abstract
BACKGROUND Unruptured intracranial aneurysms (IAs) that become symptomatic have been associated with instability. OBJECTIVE To investigate the relationship between irregular pulsation on four-dimensional CT angiography (4D-CTA) and aneurysm wall enhancement (AWE) on vessel wall MRI (VW-MRI), and to evaluate their ability to identify symptomatic IAs. METHODS This retrospective study included consecutive patients with IAs who underwent 4D-CTA and VW-MRI between March 2018 and May 2023. IAs were categorized as asymptomatic and symptomatic. The presence of irregular pulsation was identified on 4D-CTA video. Qualitative and quantitative AWE were evaluated. Univariate and multivariate analyses were used to identify the parameters associated with symptoms. RESULTS 192 patients with 216 aneurysms (167 asymptomatic and 49 symptomatic) were included. IAs with irregular pulsation had significantly higher wall enhancement index (WEI) than IAs without irregular pulsation (median (IQR), 0.5 (0.2-1.1) vs 0.2 (0.0-0.6), P<0.001). Symptomatic IAs had significantly higher WEI than asymptomatic IAs (median (IQR), 0.7 (0.3-1.5) vs 0.2 (0.0-0.5), P<0.001), and more irregular pulsations (79.6% vs 25.1%, P<0.001). Both irregular pulsation (OR=6.86; 95% CI 2.62 to 17.96; P<0.001) and WEI (OR=2.56; 95% CI 1.14 to 5.71; P=0.022) were independently associated with symptoms. Combination of irregular pulsation and WEI achieved the highest area under the curve of 0.86 in identifying symptomatic aneurysms compared with irregular pulsation or WEI alone (P<0.001 and P=0.002, respectively). CONCLUSION In a large cohort of patients with unruptured IAs who underwent 4D-CTA and VW-MRI, both irregular pulsation and WEI were independently associated with symptoms. Such measures could identify IAs at higher risk of growth or rupture.
Collapse
Affiliation(s)
- Jianjian Zhang
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao Li
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jin Zhang
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Beibei Sun
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lingling Wang
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiaqi Tian
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Michael R Levitt
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA
| | - Bing Zhao
- Department of Neurosurgery, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianrong Xu
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Zhou
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huilin Zhao
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, Washington, USA
| |
Collapse
|
5
|
Tataranu LG, Munteanu O, Kamel A, Gheorghita KL, Rizea RE. Advancements in Brain Aneurysm Management: Integrating Neuroanatomy, Physiopathology, and Neurosurgical Techniques. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1820. [PMID: 39597005 PMCID: PMC11596862 DOI: 10.3390/medicina60111820] [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: 08/14/2024] [Revised: 10/29/2024] [Accepted: 11/02/2024] [Indexed: 11/29/2024]
Abstract
Brain aneurysms, characterized by abnormal bulging in blood vessels, pose significant risks if ruptured, necessitating precise neuroanatomical knowledge and advanced neurosurgical techniques for effective management. This article delves into the intricate neuroanatomy relevant to brain aneurysms, including the vascular structures and critical regions involved. It provides a comprehensive overview of the pathophysiology of aneurysm formation and progression. The discussion extends to modern neurosurgical approaches for treating brain aneurysms, such as microsurgical clipping, endovascular coiling, and flow diversion techniques. Emphasis is placed on preoperative planning, intraoperative navigation, and postoperative care, highlighting the importance of a multidisciplinary approach. By integrating neuroanatomical insights with cutting-edge surgical practices, this article aims to enhance the understanding and treatment outcomes of brain aneurysms.
Collapse
Affiliation(s)
- Ligia Gabriela Tataranu
- Neurosurgical Department, Carol Davila University of Medicine and Pharmacy, 020022 Bucharest, Romania; (L.G.T.); (R.E.R.)
- Neurosurgical Department, Bagdasar-Arseni Clinical Emergency Hospital, 041915 Bucharest, Romania;
| | - Octavian Munteanu
- Anatomy Department, Carol Davila University of Medicine and Pharmacy, 020022 Bucharest, Romania
- University Emergency Hospital, 050098 Bucharest, Romania
| | - Amira Kamel
- Neurosurgical Department, Bagdasar-Arseni Clinical Emergency Hospital, 041915 Bucharest, Romania;
| | | | - Radu Eugen Rizea
- Neurosurgical Department, Carol Davila University of Medicine and Pharmacy, 020022 Bucharest, Romania; (L.G.T.); (R.E.R.)
- Neurosurgical Department, Bagdasar-Arseni Clinical Emergency Hospital, 041915 Bucharest, Romania;
| |
Collapse
|
6
|
Xie H, Yu H, Wu H, Wang J, Wu S, Zhang J, Zhao H, Yuan M, Benitez Mendieta J, Anbananthan H, Winter C, Zhu C, Li Z. Quantifying irregular pulsation of intracranial aneurysms using 4D-CTA. J Biomech 2024; 174:112269. [PMID: 39128410 DOI: 10.1016/j.jbiomech.2024.112269] [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: 04/22/2024] [Revised: 07/18/2024] [Accepted: 08/06/2024] [Indexed: 08/13/2024]
Abstract
Recent studies have suggested that irregular pulsation of intracranial aneurysm during the cardiac cycle may be potentially associated with aneurysm rupture risk. However, there is a lack of quantification method for irregular pulsations. This study aims to quantify irregular pulsations by the displacement and strain distribution of the intracranial aneurysm surface during the cardiac cycle using four-dimensional CT angiographic image data. Four-dimensional CT angiography was performed in 8 patients. The image data of a cardiac cycle was divided into approximately 20 phases, and irregular pulsations were detected in four intracranial aneurysms by visual observation, and then the displacement and strain of the intracranial aneurysm was quantified using coherent point drift and finite element method. The displacement and strain were compared between aneurysms with irregular and normal pulsations in two different ways (total and stepwise). The stepwise first principal strain was significantly higher in aneurysms with irregular than normal pulsations (0.20±0.01 vs 0.16±0.02, p=0.033). It was found that the irregular pulsations in intracranial aneurysms usually occur during the consecutive ascending or descending phase of volume changes during the cardiac cycle. In addition, no statistically significant difference was found in the aneurysm volume changes over the cardiac cycle between the two groups. Our method can successfully quantify the displacement and strain changes in the intracranial aneurysm during the cardiac cycle, which may be proven to be a useful tool to quantify intracranial aneurysm deformability and aid in aneurysm rupture risk assessment.
Collapse
Affiliation(s)
- Hujin Xie
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD 4000, Australia.
| | - Han Yu
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD 4000, Australia.
| | - Hao Wu
- School of Biological Science & Medical Engineering, Southeast University, Nanjing 210096, Jiangsu, China.
| | - Jiaqiu Wang
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD 4000, Australia; School of Engineering, London South Bank University, London, United Kingdom.
| | - Shanglin Wu
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD 4000, Australia.
| | - Jianjian Zhang
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, China.
| | - Huilin Zhao
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, China.
| | - Mingyang Yuan
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD 4000, Australia.
| | - Jessica Benitez Mendieta
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD 4000, Australia.
| | - Haveena Anbananthan
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD 4000, Australia.
| | - Craig Winter
- The Kenneth G Jamieson Department of Neurosurgery, Royal Brisbane and Women's Hospital, Brisbane, QLD 4006, Australia.
| | - Chengcheng Zhu
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, United States.
| | - Zhiyong Li
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD 4000, Australia; Faculty of Sports Science, Ningbo University, Ningbo 315211, Zhejiang, China.
| |
Collapse
|
7
|
Goetz A, Jeken-Rico P, Pelissier U, Chau Y, Sédat J, Hachem E. AnXplore: a comprehensive fluid-structure interaction study of 101 intracranial aneurysms. Front Bioeng Biotechnol 2024; 12:1433811. [PMID: 39007055 PMCID: PMC11243300 DOI: 10.3389/fbioe.2024.1433811] [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: 05/16/2024] [Accepted: 06/03/2024] [Indexed: 07/16/2024] Open
Abstract
Advances in computational fluid dynamics continuously extend the comprehension of aneurysm growth and rupture, intending to assist physicians in devising effective treatment strategies. While most studies have first modelled intracranial aneurysm walls as fully rigid with a focus on understanding blood flow characteristics, some researchers further introduced Fluid-Structure Interaction (FSI) and reported notable haemodynamic alterations for a few aneurysm cases when considering wall compliance. In this work, we explore further this research direction by studying 101 intracranial sidewall aneurysms, emphasizing the differences between rigid and deformable-wall simulations. The proposed dataset along with simulation parameters are shared for the sake of reproducibility. A wide range of haemodynamic patterns has been statistically analyzed with a particular focus on the impact of the wall modelling choice. Notable deviations in flow characteristics and commonly employed risk indicators are reported, particularly with near-dome blood recirculations being significantly impacted by the pulsating dynamics of the walls. This leads to substantial fluctuations in the sac-averaged oscillatory shear index, ranging from -36% to +674% of the standard rigid-wall value. Going a step further, haemodynamics obtained when simulating a flow-diverter stent modelled in conjunction with FSI are showcased for the first time, revealing a 73% increase in systolic sac-average velocity for the compliant-wall setting compared to its rigid counterpart. This last finding demonstrates the decisive impact that FSI modelling can have in predicting treatment outcomes.
Collapse
Affiliation(s)
- Aurèle Goetz
- Computing and Fluids Research Group, CEMEF, Mines Paris PSL, Sophia Antipolis, France
| | - Pablo Jeken-Rico
- Computing and Fluids Research Group, CEMEF, Mines Paris PSL, Sophia Antipolis, France
| | - Ugo Pelissier
- Computing and Fluids Research Group, CEMEF, Mines Paris PSL, Sophia Antipolis, France
| | - Yves Chau
- Department of Neuro-Interventional and Vascular Interventional, University Hospital of Nice, Nice, France
| | - Jacques Sédat
- Department of Neuro-Interventional and Vascular Interventional, University Hospital of Nice, Nice, France
| | - Elie Hachem
- Computing and Fluids Research Group, CEMEF, Mines Paris PSL, Sophia Antipolis, France
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Goetz A, Jeken-Rico P, Chau Y, Sédat J, Larcher A, Hachem E. Analysis of Intracranial Aneurysm Haemodynamics Altered by Wall Movement. Bioengineering (Basel) 2024; 11:269. [PMID: 38534544 DOI: 10.3390/bioengineering11030269] [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: 01/31/2024] [Revised: 02/27/2024] [Accepted: 03/06/2024] [Indexed: 03/28/2024] Open
Abstract
Computational fluid dynamics is intensively used to deepen our understanding of aneurysm growth and rupture in an attempt to support physicians during therapy planning. Numerous studies assumed fully rigid vessel walls in their simulations, whose sole haemodynamics may fail to provide a satisfactory criterion for rupture risk assessment. Moreover, direct in vivo observations of intracranial aneurysm pulsation were recently reported, encouraging the development of fluid-structure interaction for their modelling and for new assessments. In this work, we describe a new fluid-structure interaction functional setting for the careful evaluation of different aneurysm shapes. The configurations consist of three real aneurysm domes positioned on a toroidal channel. All geometric features, employed meshes, flow quantities, comparisons with the rigid wall model and corresponding plots are provided for the sake of reproducibility. The results emphasise the alteration of flow patterns and haemodynamic descriptors when wall deformations were taken into account compared with a standard rigid wall approach, thereby underlining the impact of fluid-structure interaction modelling.
Collapse
Affiliation(s)
- Aurèle Goetz
- Computing and Fluids Research Group, CEMEF, Mines Paris PSL, 06904 Sophia Antipolis, France
| | - Pablo Jeken-Rico
- Computing and Fluids Research Group, CEMEF, Mines Paris PSL, 06904 Sophia Antipolis, France
| | - Yves Chau
- Department of Neuro-Interventional and Vascular Interventional, University Hospital of Nice, 06000 Nice, France
| | - Jacques Sédat
- Department of Neuro-Interventional and Vascular Interventional, University Hospital of Nice, 06000 Nice, France
| | - Aurélien Larcher
- Computing and Fluids Research Group, CEMEF, Mines Paris PSL, 06904 Sophia Antipolis, France
| | - Elie Hachem
- Computing and Fluids Research Group, CEMEF, Mines Paris PSL, 06904 Sophia Antipolis, France
| |
Collapse
|
10
|
Xie H, Wu H, Wang J, Mendieta JB, Yu H, Xiang Y, Anbananthan H, Zhang J, Zhao H, Zhu Z, Huang Q, Fang R, Zhu C, Li Z. Constrained estimation of intracranial aneurysm surface deformation using 4D-CTA. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 244:107975. [PMID: 38128464 DOI: 10.1016/j.cmpb.2023.107975] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/08/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND AND OBJECTIVE Intracranial aneurysms are relatively common life-threatening diseases, and assessing aneurysm rupture risk and identifying the associated risk factors is essential. Parameters such as the Oscillatory Shear Index, Pressure Loss Coefficient, and Wall Shear Stress are reliable indicators of intracranial aneurysm development and rupture risk, but aneurysm surface irregular pulsation has also received attention in aneurysm rupture risk assessment. METHODS The present paper proposed a new approach to estimate aneurysm surface deformation. This method transforms the estimation of aneurysm surface deformation into a constrained optimization problem, which minimizes the error between the displacement estimated by the model and the sparse data point displacements from the four-dimensional CT angiography (4D-CTA) imaging data. RESULTS The effect of the number of sparse data points on the results has been discussed in both simulation and experimental results, and it shows that the proposed method can accurately estimate the surface deformation of intracranial aneurysms when using sufficient sparse data points. CONCLUSIONS Due to a potential association between aneurysm rupture and surface irregular pulsation, the estimation of aneurysm surface deformation is needed. This paper proposed a method based on 4D-CTA imaging data, offering a novel solution for the estimation of intracranial aneurysm surface deformation.
Collapse
Affiliation(s)
- Hujin Xie
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD 4000, Australia.
| | - Hao Wu
- School of Biological Science & Medical Engineering, Southeast University, Nanjing, Jiangsu 210096, China
| | - Jiaqiu Wang
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD 4000, Australia; School of Engineering, London South Bank University, London, UK
| | - Jessica Benitez Mendieta
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Han Yu
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Yuqiao Xiang
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Haveena Anbananthan
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Jianjian Zhang
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, China
| | - Huilin Zhao
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, China
| | - Zhengduo Zhu
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Qiuxiang Huang
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Runxing Fang
- School of Biological Science & Medical Engineering, Southeast University, Nanjing, Jiangsu 210096, China
| | - Chengcheng Zhu
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, United States
| | - Zhiyong Li
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD 4000, Australia; Faculty of Sports Science, Ningbo University, Ningbo, Zhejiang 315211, China.
| |
Collapse
|
11
|
Pan T, Shi Y, Yu G, Mamtimin A, Zhu W. Intracranial Aneurysms and Lipid Metabolism Disorders: From Molecular Mechanisms to Clinical Implications. Biomolecules 2023; 13:1652. [PMID: 38002334 PMCID: PMC10669412 DOI: 10.3390/biom13111652] [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: 10/08/2023] [Revised: 10/23/2023] [Accepted: 11/01/2023] [Indexed: 11/26/2023] Open
Abstract
Many vascular diseases are linked to lipid metabolism disorders, which cause lipid accumulation and peroxidation in the vascular wall. These processes lead to degenerative changes in the vessel, such as phenotypic transformation of smooth muscle cells and dysfunction and apoptosis of endothelial cells. In intracranial aneurysms, the coexistence of lipid plaques is often observed, indicating localized lipid metabolism disorders. These disorders may impair the function of the vascular wall or result from it. We summarize the literature on the relationship between lipid metabolism disorders and intracranial aneurysms below.
Collapse
Affiliation(s)
- Tonglin Pan
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200090, China; (T.P.); (Y.S.); (G.Y.); (A.M.)
- Neurosurgical Institute, Fudan University, Shanghai 200032, China
| | - Yuan Shi
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200090, China; (T.P.); (Y.S.); (G.Y.); (A.M.)
- Neurosurgical Institute, Fudan University, Shanghai 200032, China
| | - Guo Yu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200090, China; (T.P.); (Y.S.); (G.Y.); (A.M.)
- Neurosurgical Institute, Fudan University, Shanghai 200032, China
| | - Abdureshid Mamtimin
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200090, China; (T.P.); (Y.S.); (G.Y.); (A.M.)
- Neurosurgical Institute, Fudan University, Shanghai 200032, China
| | - Wei Zhu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200090, China; (T.P.); (Y.S.); (G.Y.); (A.M.)
- Neurosurgical Institute, Fudan University, Shanghai 200032, China
| |
Collapse
|
12
|
Zhang J, Li X, Zhao B, Zhang J, Sun B, Wang L, Tian J, Mossa-Basha M, Kim LJ, Yan J, Wan J, Xu J, Zhou Y, Zhao H, Zhu C. Irregular pulsation of aneurysmal wall is associated with symptomatic and ruptured intracranial aneurysms. J Neurointerv Surg 2023; 15:91-96. [PMID: 35169029 DOI: 10.1136/neurintsurg-2021-018381] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/23/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Irregular pulsation of aneurysmal wall detected by four-dimensional CT angiography (4D-CTA) has been described as a novel imaging feature of aneurysm vulnerability. Our study aimed to investigate whether irregular pulsation is associated with symptomatic and ruptured intracranial aneurysms (IAs). METHODS This retrospective study included consecutive patients with IAs who underwent 4D-CTA from January 2018 to July 2021. IAs were categorized as asymptomatic, symptomatic or ruptured. The presence of irregular pulsation (defined as a temporary focal protuberance ≥1 mm on more than three successive frames) was identified on 4D-CTA movies. Univariate and multivariate analyses were used to identify the parameters associated with aneurysm symptomatic or ruptured status. RESULTS Overall, 305 patients with 328 aneurysms (37 ruptured, 60 symptomatic, 231 asymptomatic) were included. Ruptured and symptomatic IAs were significantly larger in size compared with asymptomatic IAs (median (IQR) 6.5 (5.1-8.3) mm, 7.0 (5.5-9.7) mm vs 4.7 (3.8-6.3) mm, p=0.001 and p<0.001, respectively) and had more irregular pulsations (70.3%, 78.3% vs 28.1%, p<0.05). Irregular pulsation (OR 5.03, 95% CI 2.83 to 8.92; p<0.001) was independently associated with aneurysm symptomatic/ruptured status in the whole population. With unruptured IAs, both irregular pulsation (OR 6.31, 95% CI 3.02 to 13.20; p<0.001) and size (OR 1.17, 95% CI 1.03 to 1.32; p=0.015) were independently associated with the symptoms. The combination of irregular pulsation and size increased the accuracy over size alone in identifying symptomatic aneurysms (AUC 0.81 vs 0.77, p=0.007) in unruptured IAs. CONCLUSION In a large cohort of patients with IAs detected by 4D-CTA, the presence of irregular pulsation was independently associated with aneurysm symptomatic and ruptured status.
Collapse
Affiliation(s)
- Jianjian Zhang
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao Li
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bing Zhao
- Department of Neurosurgery, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jin Zhang
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Beibei Sun
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lingling Wang
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiaqi Tian
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Louis J Kim
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Jing Yan
- Research Collaboration, Canon Medical Systems (China) Co., LTD, Shanghai, China
| | - Jieqing Wan
- Department of Neurosurgery, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianrong Xu
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Zhou
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huilin Zhao
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, Washington, USA
| |
Collapse
|
13
|
High-fidelity fluid structure interaction simulations of turbulent-like aneurysm flows reveals high-frequency narrowband wall vibrations: A stimulus of mechanobiological relevance? J Biomech 2022; 145:111369. [PMID: 36375263 DOI: 10.1016/j.jbiomech.2022.111369] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 10/19/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022]
Abstract
Recent high-fidelity/resolution computational fluid dynamics simulations of intracranial aneurysm hemodynamics have revealed turbulent-like flows. We hypothesized that the associated high-frequency pressure fluctuations could promote aneurysm wall vibrations. We performed fully coupled high-fidelity transient fluid structure interaction simulations between the blood flow and compliant aneurysm sac wall taking 5,000 time steps per second using a 3D patient-specific model previously shown to harbour turbulent-like flow. Our results show that the flow velocity contained fluctuations with a smooth and continuously decaying energy up to ∼160Hz, and fluctuating pressures with characteristic frequency peaks at approximately 30, 130 and 210Hz. There was a strong two-way coupling between the pressure and the wall deformation, for which the frequency spectrum showed similar characteristics, but with a narrow band peak at ∼120Hz with large regional differences in amplitude up to 80μm. The physics of the flow is broadly consistent with clinical reports of turbulent-like flows, while the physics of the wall is consistent with reports of spectral peaks in aneurysm patients. As many aneurysms are known to harbour turbulent-like flows, wall vibrations could be a widespread phenomenon. Finally, since aneurysms are vascular pathologies by definition and many/most aneurysms do not have endothelial cells but still display a focal remodeling, we hypothesize that vibrations and stresses within the wall itself might play a role in the mechanobiological processes of vessel wall pathology.
Collapse
|
14
|
Tanaka R, Liew BS, Yamada Y, Sasaki K, Miyatani K, Komatsu F, Kawase T, Kato Y, Hirose Y. Depiction of Cerebral Aneurysm Wall by Computational Fluid Dynamics (CFD) and Preoperative Illustration. Asian J Neurosurg 2022; 17:43-49. [PMID: 35873850 PMCID: PMC9298587 DOI: 10.1055/s-0042-1749148] [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] [Indexed: 11/05/2022] Open
Abstract
Introduction
Preoperative illustration is a part of an important exercise to study the configuration, direction, and presence of any perforations, and is the weakest point in the wall of the cerebral aneurysm. The same illustration is used to study the surrounding brain structures to decide the best and safe surgical approach prior to any surgical procedure. With the evolution of the aneurysm wall study and study of flow dynamic within the involved artery and its aneurysm wall using computational fluid dynamics (CFD), a better surgical plan can be formulated to improve the flow dynamics. As one of the clinical applications of CFD, we propose a study using a composite image that combines preoperative illustration and CFD, which is traditionally widely used in neurosurgery.
Methods and Materials
We study the use of illustrations of the unruptured cerebral aneurysm of internal carotid-posterior communicating (ICPC) artery and anterior communicating artery (AcomA) treated at our hospital. The combinations of both preoperative illustrations and CFD images by using “ipad Pro” were used.
Result and Conclusion
Medical illustration in the preoperative study of unruptured cerebral aneurysm with combinations of CFD and surrounding brain structures is helpful to decide the surgical approaches and successful surgical treatments.
Collapse
Affiliation(s)
- Riki Tanaka
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Boon Seng Liew
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Yasuhiro Yamada
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Kento Sasaki
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Kyosuke Miyatani
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Fuminari Komatsu
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Tsukasa Kawase
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Yoko Kato
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Yuichi Hirose
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| |
Collapse
|
15
|
Zhou J, Guo Q, Chen Y, Lin B, Ding S, Zhao H, Pan Y, Wan J, Zhao B. Irregular Pulsation of Intracranial Aneurysm Detected by Four-Dimensional CT Angiography and Associated With Small Aneurysm Rupture: A Single-Center Prospective Analysis. Front Neurol 2022; 13:809286. [PMID: 35280280 PMCID: PMC8907400 DOI: 10.3389/fneur.2022.809286] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Predicting the risk of rupture of small intracranial aneurysms remains challenging. The irregular pulsation of aneurysms detected by four-dimensional CT angiography (4D-CTA) could be an imaging marker of aneurysm vulnerability. We aimed to investigate the association of irregular pulsation with small aneurysm rupture. Materials and Methods This was a prospective study on intracranial aneurysms detected by 4D-CTA from October 2017 to January 2020. A total of 242 consecutive patients with 316 aneurysms were enrolled. Irregular pulsation was defined as a temporary focal protuberance on more than 3 consecutive frames of the 20 phases in the RR interval. Small aneurysms were defined as those <7 mm. Univariate and multivariate analyses were performed to determine the independent predictors of small aneurysm rupture. Results A total of 169 patients with 217 small intracranial aneurysms were included. Fourteen (6.5%) of the aneurysms had ruptured, and 77 (35.5%) had irregular pulsation. There were no significant differences in age, sex, hypertension, smoking, diabetes, drinking, or hyperlipidemia between the ruptured and unruptured aneurysm groups. The univariate analysis showed that smaller vessel size (p = 0.008), larger size ratio (p = 0.003), larger aspect ratio (p = 0.006), larger flow angle (p = 0.001), large vessel angle (p = 0.004), middle cerebral artery aneurysms (p = 0.046), anterior cerebral artery/posterior communicating artery/posterior circulation aneurysm (p = 0.006), irregular aneurysm (p = 0.001), and t presence of irregular pulsation (p = 0.001) were associated with small aneurysm rupture. The multivariate analysis showed that the presence of irregular pulsation (p = 0.003), anterior cerebral artery/posterior communicating artery/posterior circulation aneurysms (p = 0.014), and larger flow angle (p = 0.006) was independently associated with aneurysm rupture. Multivariate analysis of predictors of the irregular pulsation of small aneurysms showed that the aneurysm rupture (p = 0.022), irregular aneurysm (p < 0.001), and large size ratio (p = 0.005) were independently associated with the presence of irregular pulsation. Conclusions The ruptured small aneurysms more often had irregular pulsation. The irregular pulsation was independently associated with aneurysm rupture and may help evaluate the risk of rupture of small intracranial aneurysms.
Collapse
Affiliation(s)
- Jiafeng Zhou
- Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qinhua Guo
- Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yongchun Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Boli Lin
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shenghao Ding
- Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Huilin Zhao
- Department of Radiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yaohua Pan
- Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jieqing Wan
- Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- *Correspondence: Jieqing Wan
| | - Bing Zhao
- Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Bing Zhao
| |
Collapse
|
16
|
Maupu C, Lebas H, Boulaftali Y. Imaging Modalities for Intracranial Aneurysm: More Than Meets the Eye. Front Cardiovasc Med 2022; 9:793072. [PMID: 35242823 PMCID: PMC8885801 DOI: 10.3389/fcvm.2022.793072] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/17/2022] [Indexed: 11/21/2022] Open
Abstract
Intracranial aneurysms (IA) are often asymptomatic and have a prevalence of 3 to 5% in the adult population. The risk of IA rupture is low, however when it occurs half of the patients dies from subarachnoid hemorrhage (SAH). To avoid this fatal evolution, the main treatment is an invasive surgical procedure, which is considered to be at high risk of rupture. This risk score of IA rupture is evaluated mainly according to its size and location. Therefore, angiography and anatomic imaging of the intracranial aneurysm are crucial for its diagnosis. Moreover, it has become obvious in recent years that several other factors are implied in this complication, such as the blood flow complexity or inflammation. These recent findings lead to the development of new IA imaging tools such as vessel wall imaging, 4D-MRI, or molecular MRI to visualize inflammation at the site of IA in human and animal models. In this review, we will summarize IA imaging techniques used for the patients and those currently in development.
Collapse
|
17
|
Vanrossomme AE, Chodzyński KJ, Eker OF, Boudjeltia KZ. Development of experimental ground truth and quantification of intracranial aneurysm pulsation in a patient. Sci Rep 2021; 11:9441. [PMID: 33941796 PMCID: PMC8093229 DOI: 10.1038/s41598-021-88420-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/12/2021] [Indexed: 11/16/2022] Open
Abstract
Aneurysm wall motion has been reported to be associated with rupture. However, its quantification with medical imaging is challenging and should be based on experimental ground-truth to avoid misinterpretation of results. In this work a time-resolved CT angiography (4D-CTA) acquisition protocol is proposed to detect the pulsation of intracranial aneurysms with a low radiation dose. To acquire ground-truth data, the accuracy of volume pulsation detection and quantification in a silicone phantom was assessed by applying pressure sinusoidal waves of increasing amplitudes. These experiments were carried out using a test bench that could reproduce pulsatile waveforms similar to those inside the internal carotid arteries of human subjects. 4D-CTA acquisition parameters (mAs, kVp) were then selected to achieve reliable pulsation detection and quantification with the lowest radiation dose achievable. The resulting acquisition protocol was then used to image an anterior communicating artery aneurysm in a human subject. Data reveals that in a simplified in vitro setting 4D-CTA allows for an effective and reproducible method to detect and quantify aneurysm volume pulsation with an inferior limit as low as 3 mm3 and a background noise of 0.5–1 mm3. Aneurysm pulsation can be detected in vivo with a radiation dose approximating 1 mSv.
Collapse
Affiliation(s)
- Axel E Vanrossomme
- Laboratory of Experimental Medecine (ULB 222 Unit), Medicine Faculty, Université Libre de Bruxelles, CHU de Charleroi, 6110, Montigny-le-Tilleul, Belgium. .,Medical Imaging Unit, Centre Hospitalier Universitaire de Charleroi, 6042, Charleroi, Belgium.
| | - Kamil J Chodzyński
- Laboratory of Experimental Medecine (ULB 222 Unit), Medicine Faculty, Université Libre de Bruxelles, CHU de Charleroi, 6110, Montigny-le-Tilleul, Belgium
| | - Omer F Eker
- Hospices Civils de Lyon, Neurointerventional Radiology, 69003, Lyon, France
| | - Karim Zouaoui Boudjeltia
- Laboratory of Experimental Medecine (ULB 222 Unit), Medicine Faculty, Université Libre de Bruxelles, CHU de Charleroi, 6110, Montigny-le-Tilleul, Belgium
| |
Collapse
|
18
|
Stam LB, Aquarius R, de Jong GA, Slump CH, Meijer FJA, Boogaarts HD. A review on imaging techniques and quantitative measurements for dynamic imaging of cerebral aneurysm pulsations. Sci Rep 2021; 11:2175. [PMID: 33500470 PMCID: PMC7838168 DOI: 10.1038/s41598-021-81753-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/07/2021] [Indexed: 11/09/2022] Open
Abstract
Measurement of intracranial aneurysm wall motion may refine the current rupture risk estimation. A golden standard for measuring aneurysm pulsation is lacking. The aim is to evaluate magnitudes of aneurysm pulsation as published in current literature. Embase and PubMed were searched for publications containing quantitative measures of cardiac-cycle related cerebral aneurysm pulsation (no date or language restrictions). Eleven studies were included, covering 197 unruptured and untreated cerebral aneurysms. Quantitative pulsation measurements were extracted from the studies. Characteristics of the study population and aneurysms were taken into account, as well as the imaging modality, scanning technique and data processing methods used. A meta-analysis was performed of studies with similar methodologies and individual IA measures and locations. The magnitude of the absolute volume pulsations varied between 14 ± 9 mm3 and 106 ± 123 mm3 and the mean relative volume change varied between 5 and 36%. The meta-analysis revealed a positive correlation between size and absolute volume change. The relative volume change in Basilar artery aneurysms seems smaller. No authors were contacted for original study data and articles only describing visual pulsations were excluded. The variation in methodologies impedes an accurate estimation of the magnitude of IA pulsations. Validation of aneurysm pulsation measurement is crucial prior to clinical studies evaluating IA pulsatility in relation to IA rupture risk. Prerequisite is a reliable and robust imaging method with high spatial and temporal resolution and standardization of the image analysis methods.
Collapse
Affiliation(s)
- L B Stam
- Technical Medicine, University of Twente, Enschede, The Netherlands. .,Department of Neurosurgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein-zuid 30, Internal Post Number 633, Nijmegen, The Netherlands.
| | - R Aquarius
- Department of Neurosurgery, Radboud UMC, Nijmegen, The Netherlands
| | - G A de Jong
- Department of Neurosurgery, Radboud UMC, Nijmegen, The Netherlands
| | - C H Slump
- Technical Medical Center, University of Twente, Enschede, The Netherlands
| | - F J A Meijer
- Department of Radiology and Nuclear Medicine, Radboud UMC, Nijmegen, The Netherlands
| | - H D Boogaarts
- Department of Neurosurgery, Radboud UMC, Nijmegen, The Netherlands
| |
Collapse
|
19
|
Borota L, Nyberg C, Lenell S, Semnic R, Mahmoud E. Endovascular treatment of type 1 and type 4 non-saccular aneurysms of cerebral arteries - a single-Centre experience. Interv Neuroradiol 2021; 27:372-387. [PMID: 33467952 DOI: 10.1177/1591019920988204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
AIM OF THE STUDY The aim of this study was to evaluate our results regarding treatment options, complications, and outcomes in patients with non-saccular aneurysms of cerebral arteries belonging to type 1 and type 4 according to Mizutani's classification. METHODS A total of 26 aneurysms in 26 patients were treated between 2014 and 2019. There were 13 males (mean age 42.77 ± 11.73 years) and 13 females (mean age 50.84 ± 9.37 years). In 23 cases the onset was haemorrhagic and in three cases non-haemorrhagic. A combination of conventional stents and coils was used in 10 cases, conventional stents and flow diverters in three cases, flow diverters and coils in five cases, and flow diverters only were used in eight cases. Radiological results of treatment were assessed after eight months and clinical after one year. RESULTS In 24 patients, aneurysms were occluded at the end of the follow-up period. An iatrogenic dissection and two haemorrhagic complications were registered. In three cases, parent arteries were occluded due to re-growth of the aneurysm, which caused middle cerebral artery infarction in one case. A favourable clinical outcome was registered in 19, patients, and non-favourable in five. Two patients died in the early postoperative period due to extensive damage to the brain parenchyma caused by initial bleeding. CONCLUSION Our results indicate that treatment of type 1 and type 4 non-saccular aneurysms with various combination of stents and flow diverters, with or without coils, is promising, although very challenging and technically demanding.
Collapse
Affiliation(s)
- Ljubisa Borota
- Department of Surgical Sciences, University Hospital, Uppsala, Sweden
| | | | - Samuel Lenell
- Department of Surgical Sciences, University Hospital, Uppsala, Sweden
| | - Robert Semnic
- Department of Surgical Sciences, University Hospital, Uppsala, Sweden
| | - Ehab Mahmoud
- Department of Surgical Sciences, University Hospital, Uppsala, Sweden
| |
Collapse
|
20
|
Zhang J, Li X, Zhao B, Zhang J, Sun B, Wang L, Ding S, Liu X, Yan J, Mossa-Basha M, Liu X, Wan J, Zhao H, Xu J, Zhu C. Irregular pulsation of intracranial unruptured aneurysm detected by four-dimensional CT angiography is associated with increased estimated rupture risk and conventional risk factors. J Neurointerv Surg 2021; 13:854-859. [PMID: 33472873 DOI: 10.1136/neurintsurg-2020-016811] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Intracranial aneurysms (IAs) are common in the population and current imaging-based rupture risk assessment needs to be refined. We aimed to use four-dimensional CT angiography (4D-CTA) to investigate the associations of irregular pulsation of IAs with conventional risk factors and the estimated rupture risk. METHODS One hundred and five patients with 117 asymptomatic IAs underwent 4D-CTA. Geometric and morphologic parameters were measured and the presence of irregular pulsation (defined as a temporary focal protuberance ≥1 mm on more than three successive frames) was identified on 4D-CTA movies. One- and 5 year aneurysm rupture risk were estimated using UCAS and PHASES calculators. Univariate and multivariate analyses were performed to investigate the conventional risk factors associated with irregular pulsation. RESULTS Irregular pulsation was observed in 41.0% (48/117) of IAs. Aneurysm size (OR=1.380, 95% CI 1.165 to 1.634), irregular shape (OR=3.737, 95% CI 1.108 to 12.608), and internal carotid artery location (OR=0.151, 95% CI 0.056 to 0.403) were independently associated with irregular pulsation (P<0.05). Aneurysms with irregular pulsation had more than a 6-fold higher estimated rupture risk (1- and 5-year risk [95% CI], 1.56% [0.42%-3.91%], and 2.40% [1.30%-4.30%], respectively) than aneurysms without irregular pulsation (0.23% [0.14%-0.78%] and 0.40% [0.40%-1.30%], respectively) (P<0.001). CONCLUSIONS IAs with irregular pulsation are associated with larger size, irregular-shape, and non-ICA origin, and have more than a 6-fold higher estimated 1- and 5-year rupture risk than aneurysms without irregular pulsation. Irregular pulsation should be validated in future longitudinal studies to determine its predictive value for aneurysm growth and rupture.
Collapse
Affiliation(s)
- Jianjian Zhang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xiao Li
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Bing Zhao
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jin Zhang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Beibei Sun
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Lingling Wang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Shenghao Ding
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xiangyu Liu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jing Yan
- Research Collaboration, Canon Medical Systems (China) Co., LTD, Shanghai, China
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Xiaosheng Liu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jieqing Wan
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Huilin Zhao
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jianrong Xu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, Washington, USA
| |
Collapse
|
21
|
Abderezaei J, Martinez J, Terem I, Fabris G, Pionteck A, Yang Y, Holdsworth SJ, Nael K, Kurt M. Amplified Flow Imaging (aFlow): A Novel MRI-Based Tool to Unravel the Coupled Dynamics Between the Human Brain and Cerebrovasculature. IEEE TRANSACTIONS ON MEDICAL IMAGING 2020; 39:4113-4123. [PMID: 32746150 DOI: 10.1109/tmi.2020.3012932] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
With each heartbeat, periodic variations in arterial blood pressure are transmitted along the vasculature, resulting in localized deformations of the arterial wall and its surrounding tissue. Quantification of such motions may help understand various cerebrovascular conditions, yet it has proven technically challenging thus far. We introduce a new image processing algorithm called amplified Flow (aFlow) which allows to study the coupled brain-blood flow motion by combining the amplification of cine and 4D flow MRI. By incorporating a modal analysis technique known as dynamic mode decomposition into the algorithm, aFlow is able to capture the characteristics of transient events present in the brain and arterial wall deformation. Validating aFlow, we tested it on phantom simulations mimicking arterial walls motion and observed that aFlow displays almost twice higher SNR than its predecessor amplified MRI (aMRI). We then applied aFlow to 4D flow and cine MRI datasets of 5 healthy subjects, finding high correlations between blood flow velocity and tissue deformation in selected brain regions, with correlation values r = 0.61 , 0.59, 0.52 for the pons, frontal and occipital lobe ( ). Finally, we explored the potential diagnostic applicability of aFlow by studying intracranial aneurysm dynamics, which seems to be indicative of rupture risk. In two patients, aFlow successfully visualized the imperceptible aneurysm wall motion, additionally quantifying the increase in the high frequency wall displacement after a one-year follow-up period (20%, 76%). These preliminary data suggest that aFlow may provide a novel imaging biomarker for the assessment of aneurysms evolution, with important potential diagnostic implications.
Collapse
|
22
|
Dissaux B, Ognard J, Cheddad El Aouni M, Nonent M, Haioun K, Magro E, Gentric JC. Volume variation may be a relevant metric in the study of aneurysm pulsatility: a study using ECG-gated 4D-CTA (PULSAN). J Neurointerv Surg 2019; 12:632-636. [DOI: 10.1136/neurintsurg-2019-015336] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/16/2019] [Accepted: 10/28/2019] [Indexed: 11/04/2022]
Abstract
Background and purposeIntracranial aneurysms are a frequently occurring disease, with an estimated prevalence of 2–5% in the general population. They usually remain silent until rupture occurs, with a mortality rate of 35–50% and a high rate of morbidity, including long-term disability. However, preventative treatments have their own risk of complications and morbi-mortality rates, including stroke and hemorrhage. ECG-gated four-dimensional CT angiography (4D-CTA) allows the acquisition of time-resolved three-dimensional reconstructions. The aim of our study was to evaluate different intracranial aneurysm metrics over the cardiac cycle using ECG-gated 4D-CTA.Materials and methodsECG-gated 4D-CTA datasets were acquired in patients presenting with intracranial aneurysms. Seven aneurysm metrics, including aneurysm height, aneurysm length, ostium width, aspect ratio, ostium area, volume, and volume-to-ostium ratio, were analysed over different cardiac phases. Intra-reader agreement, inter-reader agreement, and inter-cycle agreement were calculated through the intraclass correlation coefficient.ResultsTwenty-one aneurysms from 11 patients were considered for inclusion. Post-processing failed for three aneurysms, and 18 aneurysms were finally analysed. There was good intra-reader agreement for each metric (ICC >0.9). Agreements among three consecutive cardiac cycles were calculated for six aneurysms and were especially good for the volume metric (ICC >0.9). Volume variation appears to be the most relevant metric and seems especially perceptible for aneurysms larger than 5 mm.ConclusionsQuantification of aneurysm volume changes during the cardiac cycle seems quantitatively possible and reproducible, especially for aneurysms larger than 5 mm. Further studies need to be conducted to validate this parameter for intracranial aneurysm assessment.
Collapse
|
23
|
Voß S, Beuing O, Janiga G, Berg P. Multiple Aneurysms AnaTomy CHallenge 2018 (MATCH)-Phase Ib: Effect of morphology on hemodynamics. PLoS One 2019; 14:e0216813. [PMID: 31100101 PMCID: PMC6524809 DOI: 10.1371/journal.pone.0216813] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 04/29/2019] [Indexed: 12/16/2022] Open
Abstract
Background Image-based blood flow simulations have been increasingly applied to investigate intracranial aneurysm (IA) hemodynamics. However, the acceptance among physicians remains limited due to the high variability in the underlying assumptions and quality of results. Methods To evaluate the vessel segmentation as one of the most important sources of error, the international Multiple Aneurysms AnaTomy CHallenge 2018 (MATCH) was announced. 26 research groups from 13 different countries segmented three datasets, which contained five IAs in total. Based on these segmentations, 73 time-dependent blood flow simulations under consistent conditions were carried out. Afterwards, relevant flow and shear parameters (e.g., neck inflow rate, parent vessel flow rate, spatial mean velocity, and wall shear stress) were analyzed both qualitatively and quantitatively. Results Regarding the entire vasculature, the variability of the segmented vessel radius is 0.13 mm, consistent and independent of the local vessel radius. However, the centerline velocity shows increased variability in more distal vessels. Focusing on the aneurysms, clear differences in morphological and hemodynamic parameters were observed. The quantification of the segmentation-induced variability showed approximately a 14% difference among the groups for the parent vessel flow rate. Regarding the mean aneurysmal velocity and the neck inflow rate, a variation of 30% and 46% was observed, respectively. Finally, time-averaged wall shear stresses varied between 28% and 51%, depending on the aneurysm in question. Conclusions MATCH reveals the effect of state-of-the-art segmentation algorithms on subsequent hemodynamic simulations for IA research. The observed variations may lead to an inappropriate interpretation of the simulation results and thus, can lead to inappropriate conclusions by physicians. Therefore, accurate segmentation of the region of interest is necessary to obtain reliable and clinically helpful flow information.
Collapse
Affiliation(s)
- Samuel Voß
- Department of Fluid Dynamics and Technical Flows, University of Magdeburg, Magdeburg, Germany
- Forschungscampus STIMULATE, Magdeburg, Germany
- * E-mail:
| | - Oliver Beuing
- Forschungscampus STIMULATE, Magdeburg, Germany
- Institute of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany
| | - Gábor Janiga
- Department of Fluid Dynamics and Technical Flows, University of Magdeburg, Magdeburg, Germany
- Forschungscampus STIMULATE, Magdeburg, Germany
| | - Philipp Berg
- Department of Fluid Dynamics and Technical Flows, University of Magdeburg, Magdeburg, Germany
- Forschungscampus STIMULATE, Magdeburg, Germany
| |
Collapse
|
24
|
Schetelig D, Frölich A, Knopp T, Werner R. A new cerebral vessel benchmark dataset (CAPUT) for validation of image-based aneurysm deformation estimation algorithms. Sci Rep 2018; 8:15999. [PMID: 30375473 PMCID: PMC6207668 DOI: 10.1038/s41598-018-34489-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/16/2018] [Indexed: 11/10/2022] Open
Abstract
Hemodynamic properties and deformation of vessel structures are assumed to be correlated to the initiation, development, and rupture of cerebral aneurysms. Therefore, precise quantification of wall motion is essential. However, using standard-of-care imaging data, approaches for patient-specific estimation of pulsatile deformation are prone to uncertainties due to, e.g., contrast agent inflow-related intensity changes and small deformation compared to the image resolution. A ground truth dataset that allows evaluating and finetuning algorithms for deformation estimation is lacking. We designed a flow phantom with deformable structures that resemble cerebral vessels and exhibit physiologically plausible deformation. The deformation was simultaneously recorded using a flat panel CT and a video camera, yielding video data with higher resolution and SNR, which was used to compute 'ground truth' structure deformation measures. The dataset was further applied to evaluate registration-based deformation estimation. The results illustrate that registration approaches can be used to estimate deformation with adequate precision. Yet, the accuracy depended on the registration parameters, illustrating the need to evaluate and finetune deformation estimation approaches by ground truth data. To fill the existing gap, the acquired benchmark dataset is provided freely available as the CAPUT (Cerebral Aneurysm PUlsation Testing) dataset, accessible at https://www.github.com/IPMI-ICNS-UKE/CAPUT .
Collapse
Affiliation(s)
- Daniel Schetelig
- University Medical Center Hamburg-Eppendorf, Department of Computational Neuroscience, Hamburg, 20246, Germany.
| | - Andreas Frölich
- University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Neuroradiology, Hamburg, 20246, Germany
| | - Tobias Knopp
- University Medical Center Hamburg-Eppendorf, Section for Biomedical Imaging, Hamburg, 20246, Germany.,Hamburg University of Technology, Institute for Biomedical Imaging, Hamburg, 20246, Germany
| | - René Werner
- University Medical Center Hamburg-Eppendorf, Department of Computational Neuroscience, Hamburg, 20246, Germany
| |
Collapse
|
25
|
Schetelig D, Sedlacik J, Fiehler J, Frölich A, Knopp T, Sothmann T, Waschkewitz J, Werner R. Analysis of the influence of imaging-related uncertainties on cerebral aneurysm deformation quantification using a no-deformation physical flow phantom. Sci Rep 2018; 8:11004. [PMID: 30030483 PMCID: PMC6054631 DOI: 10.1038/s41598-018-29282-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 07/04/2018] [Indexed: 11/18/2022] Open
Abstract
Cardiac-cycle related pulsatile aneurysm motion and deformation is assumed to provide valuable information for assessing cerebral aneurysm rupture risk. Accordingly, numerous studies addressed quantification of cerebral aneurysm wall motion and deformation. Most of them utilized in vivo imaging data, but image-based aneurysm deformation quantification is subject to pronounced uncertainties: unknown ground-truth deformation; image resolution in the order of the expected deformation; direct interplay between contrast agent inflow and image intensity. To analyze the impact of the uncertainties on deformation quantification, a multi-imaging modality ground-truth phantom study is performed. A physical flow phantom was designed that allowed simulating pulsatile flow through a variety of modeled cerebral vascular structures. The phantom was imaged using different modalities [MRI, CT, 3D-RA] and mimicking physiologically realistic flow conditions. Resulting image data was analyzed by an established registration-based approach for automated wall motion quantification. The data reveals severe dependency between contrast media inflow-related image intensity changes and the extent of estimated wall deformation. The study illustrates that imaging-related uncertainties affect the accuracy of cerebral aneurysm deformation quantification, suggesting that in vivo imaging studies have to be accompanied by ground-truth phantom experiments to foster data interpretation and to prove plausibility of the applied image analysis algorithms.
Collapse
Affiliation(s)
- Daniel Schetelig
- University Medical Center Hamburg-Eppendorf, Department of Computational Neuroscience, Hamburg, 20246, Germany.
| | - Jan Sedlacik
- University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Neuroradiology, Hamburg, 20246, Germany
| | - Jens Fiehler
- University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Neuroradiology, Hamburg, 20246, Germany
| | - Andreas Frölich
- University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Neuroradiology, Hamburg, 20246, Germany
| | - Tobias Knopp
- University Medical Center Hamburg-Eppendorf, Section for Biomedical Imaging, Hamburg, 20246, Germany.,Hamburg University of Technology, Institute for Biomedical Imaging, Hamburg, 20246, Germany
| | - Thilo Sothmann
- University Medical Center Hamburg-Eppendorf, Department of Computational Neuroscience, Hamburg, 20246, Germany.,University Medical Center Hamburg-Eppendorf, Department of Radiotherapy and Radiation Oncology, Hamburg, 20246, Germany
| | - Jonathan Waschkewitz
- University Medical Center Hamburg-Eppendorf, Department of Radiotherapy and Radiation Oncology, Hamburg, 20246, Germany
| | - René Werner
- University Medical Center Hamburg-Eppendorf, Department of Computational Neuroscience, Hamburg, 20246, Germany
| |
Collapse
|
26
|
Groen D, Richardson RA, Coy R, Schiller UD, Chandrashekar H, Robertson F, Coveney PV. Validation of Patient-Specific Cerebral Blood Flow Simulation Using Transcranial Doppler Measurements. Front Physiol 2018; 9:721. [PMID: 29971012 PMCID: PMC6018476 DOI: 10.3389/fphys.2018.00721] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 05/24/2018] [Indexed: 11/13/2022] Open
Abstract
We present a validation study comparing results from a patient-specific lattice-Boltzmann simulation to transcranial Doppler (TCD) velocity measurements in four different planes of the middle cerebral artery (MCA). As part of the study, we compared simulations using a Newtonian and a Carreau-Yasuda rheology model. We also investigated the viability of using downscaled velocities to reduce the required resolution. Simulations with unscaled velocities predict the maximum flow velocity with an error of less than 9%, independent of the rheology model chosen. The accuracy of the simulation predictions worsens considerably when simulations are run at reduced velocity, as is for example the case when inflow velocities from healthy individuals are used on a vascular model of a stroke patient. Our results demonstrate the importance of using directly measured and patient-specific inflow velocities when simulating blood flow in MCAs. We conclude that localized TCD measurements together with predictive simulations can be used to obtain flow estimates with high fidelity over a larger region, and reduce the need for more invasive flow measurement procedures.
Collapse
Affiliation(s)
- Derek Groen
- Department of Computer Science, Brunel University London, London, United Kingdom
| | - Robin A Richardson
- Centre for Computational Science, University College London, London, United Kingdom
| | - Rachel Coy
- Centre for Mathematics and Physics in the Life Sciences and Experimental Biology, University College London, London, United Kingdom
| | - Ulf D Schiller
- Department of Materials Science and Engineering, Clemson University, Clemson, SC, United States.,School of Health Research, Clemson University, Clemson, SC, United States
| | - Hoskote Chandrashekar
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London, London, United Kingdom
| | - Fergus Robertson
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London, London, United Kingdom
| | - Peter V Coveney
- Centre for Computational Science, University College London, London, United Kingdom.,Centre for Mathematics and Physics in the Life Sciences and Experimental Biology, University College London, London, United Kingdom
| |
Collapse
|
27
|
Kleinloog R, Zwanenburg JJM, Schermers B, Krikken E, Ruigrok YM, Luijten PR, Visser F, Regli L, Rinkel GJE, Verweij BH. Quantification of Intracranial Aneurysm Volume Pulsation with 7T MRI. AJNR Am J Neuroradiol 2018; 39:713-719. [PMID: 29472302 DOI: 10.3174/ajnr.a5546] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 11/30/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Aneurysm volume pulsation is a potential predictor of intracranial aneurysm rupture. We evaluated whether 7T MR imaging can quantify aneurysm volume pulsation. MATERIALS AND METHODS In Stage I of the study, 10 unruptured aneurysms in 9 patients were studied using a high-resolution (0.6-mm, isotropic) 3D gradient-echo sequence with cardiac gating. Semiautomatic segmentation was used to measure aneurysm volume (in cubic millimeters) per cardiac phase. Aneurysm pulsation was defined as the relative increase in volume between the phase with the smallest volume and the phase with the largest volume. The accuracy and precision of the measured volume pulsations were addressed by digital phantom simulations and a repeat image analysis. In Stage II, the imaging protocol was optimized and 9 patients with 9 aneurysms were studied with and without administration of a contrast agent. RESULTS The mean aneurysm pulsation in Stage I was 8% ± 7% (range, 2%-27%), with a mean volume change of 15 ± 14 mm3 (range, 3-51 mm3). The mean difference in volume change for the repeat image analysis was 2 ± 6 mm3. The artifactual volume pulsations measured with the digital phantom simulations were of the same magnitude as the volume pulsations observed in the patient data, even after protocol optimization in Stage II. CONCLUSIONS Volume pulsation quantification with the current imaging protocol on 7T MR imaging is not accurate due to multiple imaging artifacts. Future studies should always include aneurysm-specific accuracy analysis.
Collapse
Affiliation(s)
- R Kleinloog
- From the Department of Neurology and Neurosurgery (R.K., B.S., E.K., Y.M.R., L.R., G.J.E.R., B.H.V.), Brain Center Rudolf Magnus
| | - J J M Zwanenburg
- Department of Radiology (J.J.M.Z., P.R.L., F.V.), Utrecht University, University Medical Center Utrecht, Utrecht, the Netherlands
| | - B Schermers
- From the Department of Neurology and Neurosurgery (R.K., B.S., E.K., Y.M.R., L.R., G.J.E.R., B.H.V.), Brain Center Rudolf Magnus.,Department of Technical Medicine (B.S., E.K.), Faculty of Science and Technology, University of Twente, Enschede, the Netherlands
| | - E Krikken
- From the Department of Neurology and Neurosurgery (R.K., B.S., E.K., Y.M.R., L.R., G.J.E.R., B.H.V.), Brain Center Rudolf Magnus.,Department of Technical Medicine (B.S., E.K.), Faculty of Science and Technology, University of Twente, Enschede, the Netherlands
| | - Y M Ruigrok
- From the Department of Neurology and Neurosurgery (R.K., B.S., E.K., Y.M.R., L.R., G.J.E.R., B.H.V.), Brain Center Rudolf Magnus
| | - P R Luijten
- Department of Radiology (J.J.M.Z., P.R.L., F.V.), Utrecht University, University Medical Center Utrecht, Utrecht, the Netherlands
| | - F Visser
- Department of Radiology (J.J.M.Z., P.R.L., F.V.), Utrecht University, University Medical Center Utrecht, Utrecht, the Netherlands.,Philips Healthcare (F.V.), Best, the Netherlands
| | - L Regli
- From the Department of Neurology and Neurosurgery (R.K., B.S., E.K., Y.M.R., L.R., G.J.E.R., B.H.V.), Brain Center Rudolf Magnus.,Department of Neurosurgery (L.R.), University Hospital Zurich, Zurich, Switzerland
| | - G J E Rinkel
- From the Department of Neurology and Neurosurgery (R.K., B.S., E.K., Y.M.R., L.R., G.J.E.R., B.H.V.), Brain Center Rudolf Magnus
| | - B H Verweij
- From the Department of Neurology and Neurosurgery (R.K., B.S., E.K., Y.M.R., L.R., G.J.E.R., B.H.V.), Brain Center Rudolf Magnus
| |
Collapse
|
28
|
Hemodynamics in a giant intracranial aneurysm characterized by in vitro 4D flow MRI. PLoS One 2018; 13:e0188323. [PMID: 29300738 PMCID: PMC5754057 DOI: 10.1371/journal.pone.0188323] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 11/03/2017] [Indexed: 11/19/2022] Open
Abstract
Experimental and computational data suggest that hemodynamics play a critical role in the development, growth, and rupture of cerebral aneurysms. The flow structure, especially in aneurysms with a large sac, is highly complex and three-dimensional. Therefore, volumetric and time-resolved measurements of the flow properties are crucial to fully characterize the hemodynamics. In this study, phase-contrast Magnetic Resonance Imaging is used to assess the fluid dynamics inside a 3D-printed replica of a giant intracranial aneurysm, whose hemodynamics was previously simulated by multiple research groups. The physiological inflow waveform is imposed in a flow circuit with realistic cardiovascular impedance. Measurements are acquired with sub-millimeter spatial resolution for 16 time steps over a cardiac cycle, allowing for the detailed reconstruction of the flow evolution. Moreover, the three-dimensional and time-resolved pressure distribution is calculated from the velocity field by integrating the fluid dynamics equations, and is validated against differential pressure measurements using precision transducers. The flow structure is characterized by vortical motions that persist within the aneurysm sac for most of the cardiac cycle. All the main flow statistics including velocity, vorticity, pressure, and wall shear stress suggest that the flow pattern is dictated by the aneurysm morphology and is largely independent of the pulsatility of the inflow, at least for the flow regimes investigated here. Comparisons are carried out with previous computational simulations that used the same geometry and inflow conditions, both in terms of cycle-averaged and systolic quantities.
Collapse
|
29
|
Dynamic Four-Dimensional Computed Tomography Angiography for Neurovascular Pathologies. World Neurosurg 2017; 105:1034.e11-1034.e18. [DOI: 10.1016/j.wneu.2017.06.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 06/01/2017] [Accepted: 06/02/2017] [Indexed: 11/22/2022]
|
30
|
Dahbour L, Mansour TR, Alnemari A, Buehler M, Gaudin D. Diagnostic Work-Up of a Giant Calcified Intracranial Aneurysm: Comparing 4D-CTA and Cerebral Angiogram Findings. Cureus 2017; 9:e1367. [PMID: 28744414 PMCID: PMC5519308 DOI: 10.7759/cureus.1367] [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] [Indexed: 11/08/2022] Open
Abstract
The risks associated with unruptured intracranial aneurysms can be neurologically debilitating and even fatal. Evaluation of these aneurysms is critical for determining what type of intervention is warranted, if at all. Cerebral angiography has long been the gold standard in the evaluation of intracranial aneurysms. However, this diagnostic modality is accompanied by several risks that are made clear to the patient before they consent to the procedure. These risks include the possibility of stroke, groin hematomas, contrast-induced anaphylaxis, contrast nephropathy, and catheter-associated infections. Dynamic CT angiography (4D-CTA) has been studied as an assessment tool for cerebral vasculopathies such as stroke, arteriovenous malformations, and aneurysms. It has been shown that 4D-CTA has the advantage of being less invasive and has a shorter examination time than cerebral angiography. In this article, we present a rare case of a giant calcified aneurysm and compare the findings of a cerebral angiogram and a 4D-CTA study.
Collapse
Affiliation(s)
- Layth Dahbour
- Department of Surgery, Division of Neurosurgery, The University of Toledo Medical Center
| | - Tarek R Mansour
- Department of Surgery, Division of Neurosurgery, The University of Toledo Medical Center
| | - Ahmed Alnemari
- Department of Surgery, Division of Neurosurgery, The University of Toledo Medical Center
| | - Mark Buehler
- Department of Radiology, The University of Toledo Medical Center
| | - Daniel Gaudin
- Department of Surgery, Division of Neurosurgery, The University of Toledo Medical Center
| |
Collapse
|
31
|
Wang Y, Navarro L, Zhang Y, Kao E, Zhu Y, Courbebaisse G. Intracranial Aneurysm Phantom Segmentation Using a 4D Lattice Boltzmann Method. Comput Sci Eng 2017. [DOI: 10.1109/mcse.2017.3151252] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
32
|
Yoon NK, McNally S, Taussky P, Park MS. Imaging of cerebral aneurysms: a clinical perspective. ACTA ACUST UNITED AC 2016. [DOI: 10.1186/s40809-016-0016-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|