J Korean Neurosurg Soc.  2017 Sep;60(5):504-510. 10.3340/jkns.2017.0101.009.

Morphological and Hemodynamic Parameters for Middle Cerebral Artery Bifurcation Aneurysm Rupture Risk Assessment

• Qin H
• Yang Q
• Zhuang Q
• Long J
• Yang F
• Zhang H

• KMID: 2457956
• DOI: http://doi.org/10.3340/jkns.2017.0101.009

Abstract

OBJECTIVE
To investigate the morphological and hemodynamic parameters associated with middle cerebral artery (MCA)bifurcation aneurysm rupture.
METHODS
A retrospective study of 67 consecutive patients was carried out based on 3D digital subtraction angiography data. Morphological and hemodynamic parameters including aneurysm size parameters (dome width, height, and perpendicular height), longest dimension from the aneurysm neck to the dome tip, neck width, aneurysm area, aspect ratio, Longest dimension from the aneurysm neck to the dome tip (Dmax) to dome width, and height-width, Bottleneck factor, as well as wall shear stress (WSS), low WSS area (LSA), percentage of LSA (LSA%) and energy loss (EL) were estimated. Parameters between ruptured and un-ruptured groups were analyzed. Receiver operating characteristics were generated to check prediction performance of all significant variables.
RESULTS
Sixty-seven patients with MCA bifurcation aneurysm were included (31 unruptured, 36 ruptured). Dmax (p=0.008) was greater in ruptured group than that in un-ruptured group. D/W (p<0.001) and the percentage of the low WSS area (0.09±0.13 vs. 0.01±0.03, p<0.001) were also greater in the ruptured group. Moreover, the EL in ruptured group was higher than that in un-ruptured group (6.39±5.04 vs. 1.53±0.86, p<0.001). Multivariate regression analysis suggested D/W and EL were significant predictors of rupture of MCA bifurcation aneurysms. Correlation analyses revealed the D/W value was positively associated with the EL (R=0.442, p<0.01).
CONCLUSION
D/W and EL might be the most two favorable factors to predict rupture risk of MCA bifurcation aneurysms.

Keyword

Biomarkers; Middle cerebral artery aneurysm; Risk assessment; Receiver operating characteristics curve; Angiography; Digital subtraction

MeSH Terms

Aneurysm*
Angiography
Angiography, Digital Subtraction
Biomarkers
Hemodynamics*
Humans
Intracranial Aneurysm
Middle Cerebral Artery*
Neck
Retrospective Studies
Risk Assessment*
ROC Curve
Rupture*
Biomarkers

Figure

• 

  Fig. 1 Definition of morphological variables. 1: neck (N), the average diameter of the aneurysm neck, 3.65 mm; 2: Dmax, the longest dimension from the aneurysm neck to the dome tip, 5.14 mm; 3: height (H), maximal height from dome tip perpendicular to aneurysm neck, 1.67 mm; 4: dome width (W), the maximal diameter perpendicular to Dmax, 2.48 mm. Dmax: longest dimension from the aneurysm neck to the dome tip.

• 

  Fig. 2 Morphological and hemodynamic modelling of un-ruptured (A and B) and ruptured (C and D) MCA bifurcation aneurysms. A1 and B1, examples of refined morphological modelling in un-ruptured group; C1 and D1, examples of refined morphological modelling in ruptured group, which are larger in size than that in un-ruptured group; A2 and B2, hemodynamic simulations for un-ruptured aneurysms, presenting high velocity with red, which affect EL according to formula 2; C2 and D2, hemodynamic simulations for ruptured aneurysms, demonstrating more complex blood flow inside the aneurysms and more energy difference between in-let and out-let arteries; A3 and B3, the distribution of WSS in un-ruptured aneurysms; C3 and D3, the distribution of WSS in ruptured aneurysms with significant more low WSS area than that in un-ruptured group; A4 and B4, the percentage of LSA in un-ruptured aneurysm; C4 and D4, illustrate the LSA% are significantly higher in ruptured aneurysms. MCA: middle cerebral artery, EL: energy loss, WSS: wall shear stress, LSA: low WSS area.

• 

  Fig. 3 The ROC curve for all significant variables predicting MCA bifurcation aneurysm rupture. ROC: receiver operating characteristics, MCA: middle cerebral artery, D/W: dome width, EL: energy loss, H/W: height-width, LSA: low wall shear stress area.

Reference

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