1
|
Zhu C, Wang Y, Mossa-Basha M. Comprehensive evaluation of cerebral aneurysm instability biomarkers in a large-scale longitudinal Chinese cohort. Sci Bull (Beijing) 2023; 68:2142-2144. [PMID: 37620231 DOI: 10.1016/j.scib.2023.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Affiliation(s)
- Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle WA 98195, USA.
| | - Yuting Wang
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610072, China.
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington, Seattle WA 98195, USA
| |
Collapse
|
2
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
3
|
Sanchez S, Essibayi MA, Hickerson M, Ojeda DJ, Kasab SA, Yoshimura S, Jabbour PM, Mascitelli J, Levitt MR, Cuellar-Saenz HH, Brinjikji W, Spiotta AM, Shaban A, Samaniego EA. Morphological characteristics of brain aneurysms among age groups. Interv Neuroradiol 2023:15910199231201520. [PMID: 37715650 DOI: 10.1177/15910199231201520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND Patient's age is an important factor in determining the risk of aneurysm rupture. However, there is limited data on how aneurysm morphology differs among age groups. We studied morphological characteristics of brain aneurysms among age groups in a large cohort. METHODS Aneurysms from the Stroke Thrombectomy and Aneurysm Registry (STAR) were analyzed. The following parameters were included: location, size, neck, width, height, aspect ratio, and regular versus irregular morphology. The risk of rupture presentation was estimated using logistic regression. RESULTS A total of 1407 unruptured and 607 ruptured saccular aneurysms were included. The most common locations of ruptured aneurysms in patients younger than 70 years-old were the middle cerebral artery (MCA) and the anterior communicating artery (ACOM). The most common location of ruptured aneurysms in patients older than 70 years-old were the posterior communicating artery (PCOM) and ACOM. The size of unruptured aneurysms increased with age (p < .001). Conversely, the size of ruptured aneurysms was similar among age groups (p = .142). Unruptured and ruptured aneurysms became more irregular at presentation with older age (p < .001 and p .025, respectively). Irregular morphology and location were associated with rupture status across all age groups in multivariate regression. CONCLUSIONS Younger patients have small unruptured and ruptured aneurysms, and ruptured aneurysms are mostly located in the MCA and ACOM. Older patients have larger and more irregular unruptured aneurysms, and ruptured aneurysms are mostly located in the PCOM and ACOM. An irregular morphology increases the risk of rupture in all age groups.
Collapse
Affiliation(s)
| | | | | | | | - Sami Al Kasab
- Department of Neurosurgery, Medical University of South Carolina, USA
| | | | | | - Justin Mascitelli
- Department of Neurosurgery, University of Texas Health Science Center at San Antonio, USA
| | | | | | | | | | - Amir Shaban
- Department of Neurology, University of Iowa, USA
| | - Edgar A Samaniego
- Department of Neurology, University of Iowa, USA
- Department of Neurosurgery, University of Iowa, USA
- Department of Radiology, University of Iowa, USA
| |
Collapse
|
4
|
Zhai X, Wang Y, Fang G, Hu P, Zhang H, Zhu C. Case Report: Dynamic Changes in Hemodynamics During the Formation and Progression of Intracranial Aneurysms. Front Cardiovasc Med 2022; 8:775536. [PMID: 35127854 PMCID: PMC8814101 DOI: 10.3389/fcvm.2021.775536] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/28/2021] [Indexed: 11/29/2022] Open
Abstract
Despite the devastating consequences of aneurysmal subarachnoid hemorrhage (SAH), the mechanisms underlying the formation, progression, and rupture of intracranial aneurysms (IAs) are complex and not yet fully clear. In a real-world situation, continuously observing the process of aneurysm development in humans appears unrealistic, which also present challenges for the understanding of the underlying mechanism. We reported the relatively complete course of IA development in two real patients. On this basis, computational fluid dynamics simulation (CFD) was performed to evaluate the changes in hemodynamics and analyze the mechanism underlying the formation, progression, and rupture of IAs. Our results suggested that the formation and progression of IAs can be a dynamic process, with constantly changing hemodynamic characteristics. CFD analysis based on medical imaging provides the opportunity to study the hemodynamic conditions over time. From these two rare cases, we found that concentrated high-velocity inflow jets, flows with vortex structures, extremely high WSS, and a very steep WSSG were correlated with the formation of IAs. Complex multi-vortex flows are possibly related to IAs prior to growth, and the rupture of IAs is possibly related to low WSS, extreme instability and complexity of flow patterns. Our findings provide unique insight into the theoretical hemodynamic mechanism underlying the formation and progression of IAs. Given the small sample size the findings of this study have to be considered preliminary and exploratory.
Collapse
|
5
|
Zhai X, Geng J, Zhu C, Yu J, Li C, Jiang N, Xiang S, Fang G, Hu P, Zhang H. Risk Factors for Pericallosal Artery Aneurysm Rupture Based on Morphological Computer-Assisted Semiautomated Measurement and Hemodynamic Analysis. Front Neurosci 2021; 15:759806. [PMID: 34867168 PMCID: PMC8636593 DOI: 10.3389/fnins.2021.759806] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Although pericallosal artery aneurysms (PAAs) are relatively uncommon, accounting for only 1-9% of all intracranial aneurysms (IAs), they exhibit a considerably high propensity to rupture. Nevertheless, our current knowledge of the risk factors for PAA rupture is still very limited. To fill this gap, we investigated rupture risk factors for PAAs based on morphological computer-assisted semiautomated measurement (CASAM) and hemodynamic analysis. Methods: Patients with PAAs were selected from the IA database in our institute and their baseline data were collected. Morphological parameters were measured in all enrolled patients by applying CASAM. Computational fluid dynamics simulation (CFD) was performed to evaluate the hemodynamic difference between ruptured and unruptured PAAs. Results: From June 2017 to June 2020, among 2141 patients with IAs in our institute, 47 had PAAs (2.2%). Thirty-one patients (mean age 57.65 ± 9.97 years) with 32 PAAs (20 unruptured and 12 ruptured) were included in the final analysis. Comparing with unruptured PAAs, ruptured PAAs had significantly higher aspect ratio (AR), mean normalized wall shear stress (NWSS), and mean oscillatory shear index (OSI) values than the unruptured PAAs (all P < 0.05) in univariate analyses. Multivariable analysis showed that a high mean OSI was an independent risk factor for PAA rupture (OR = 6.45, 95% CI 1.37-30.32, P = 0.018). Conclusion: This preliminary study indicates that there are morphological and hemodynamic differences between ruptured and unruptured PAAs. In particular, a high mean OSI is an independent risk factor for PAA rupture. Further research with a larger sample size is warranted in the future.
Collapse
Affiliation(s)
- Xiaodong Zhai
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,China International Neuroscience Institute, Beijing, China
| | - Jiewen Geng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,China International Neuroscience Institute, Beijing, China
| | - Chengcheng Zhu
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, United States
| | - Jiaxing Yu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,China International Neuroscience Institute, Beijing, China
| | - Chuanjie Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,China International Neuroscience Institute, Beijing, China.,Department of Neurosurgery, Shunyi District Hospital, Beijing, China
| | - Nan Jiang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,China International Neuroscience Institute, Beijing, China
| | - Sishi Xiang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,China International Neuroscience Institute, Beijing, China
| | - Gang Fang
- Department of R&D, UnionStrong (Beijing) Technology Co., Ltd., Beijing, China
| | - Peng Hu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,China International Neuroscience Institute, Beijing, China
| | - Hongqi Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,China International Neuroscience Institute, Beijing, China
| |
Collapse
|
6
|
Valença MM, Silva AHTTD, Mendes RFDA, Andrade PHPD, Silva UAVD, Carvalho DED, Batista LL. Incidental intracranial saccular aneurysm in a patient with post-Covid-19 headache: What to do with the incidentaloma? HM 2021. [DOI: 10.48208/headachemed.2021.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Case report
Collapse
|
7
|
Molenberg R, Aalbers MW, Appelman APA, Uyttenboogaart M, van Dijk JMC. Intracranial aneurysm wall enhancement as an indicator of instability: a systematic review and meta-analysis. Eur J Neurol 2021; 28:3837-3848. [PMID: 34424585 PMCID: PMC9292155 DOI: 10.1111/ene.15046] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Aneurysm wall enhancement (AWE) of intracranial aneurysms on magnetic resonance imaging has been described in previous studies as a surrogate marker of instability. With this study, an updated literature overview and summary risk estimates of the association between AWE and different specific outcomes (i.e., rupture, growth or symptomatic presentation) for both cross-sectional and longitudinal studies are provided. METHODS The PRISMA guideline was followed and a search was performed of PubMed and Embase to 1 January 2021 for studies that reported on AWE and aneurysm instability. In cross-sectional studies, AWE was compared between patients with stable and unstable aneurysms. In longitudinal studies, AWE of stable aneurysms was assessed at baseline after which patients were followed longitudinally. Risk ratios were calculated for longitudinal studies, prevalence ratios for cross-sectional studies and then the ratios were pooled in a random-effects meta-analysis. Also, the performance of AWE to differentiate between stable and unstable aneurysms was evaluated. RESULTS Twelve studies were included with a total of 1761 aneurysms. In cross-sectional studies, AWE was positively associated with rupture (prevalence ratio 11.47, 95% confidence interval [CI] 4.05-32.46) and growth or symptomatic presentation (prevalence ratio 4.62, 95% CI 2.85-7.49). Longitudinal studies demonstrated a positive association between AWE and growth or rupture (risk ratio 8.00, 95% CI 2.14-29.88). Assessment of the performance of AWE showed high sensitivities, mixed specificities, low positive predictive values and high negative predictive values. CONCLUSIONS Although AWE is positively associated with aneurysm instability, current evidence mostly supports the use of its absence as a surrogate marker of aneurysm stability.
Collapse
Affiliation(s)
- Rob Molenberg
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marlien W Aalbers
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Auke P A Appelman
- Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Maarten Uyttenboogaart
- Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J Marc C van Dijk
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|