Associations of hemodynamics, morphology, and patient characteristics with aneurysm rupture stratified by aneurysm location

Detmer, Felicitas J.; Chung, Bong Jae; Jimenez, Carlos; Hamzei-Sichani, Farid; Kallmes, David F.; Putman, Christopher M.; Cebral, Juan R.

doi:10.1007/s00234-018-2135-9

Cited by 80 publications

(55 citation statements)

References 33 publications

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“…When such data become available for AAA, the link between 'high risk' as defined here by clinicians and rupture prediction should be studied. A very recent study in cerebral aneurysms showed adverse morphology and hemodynamics to be related to aneurysm rupture 22 . The corresponding statistical model of rupture probability was then successfully validated 23 .…”

Section: Limitationmentioning

confidence: 99%

A Cohort Longitudinal Study Identifies Morphology and Hemodynamics Predictors of Abdominal Aortic Aneurysm Growth

et al. 2019

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Abdominal aortic aneurysms (AAA) are localized, commonly occurring aortic dilations. Following rupture only immediate treatment can prevent morbidity and mortality. AAA maximal diameter and growth are the current metrics to evaluate the associated risk and plan intervention. Although these criteria alone lack patient specificity, predicting their evolution would improve clinical decision. If the disease is known 1 to be associated with altered morphology and blood flow, intraluminal thrombus deposit and clinical symptoms, the growth mechanisms are yet to be fully understood. In this retrospective longitudinal study of 138 scans, morphological analysis and blood flow simulations for 32 patients with clinically diagnosed AAAs and several follow-up CT-scans, are performed and compared to 9 control subjects. Several metrics stratify patients between healthy, low and high risk groups. Local correlations between hemodynamic metrics and AAA growth are also explored but due to their high inter-patient variability, do not explain AAA heterogeneous growth. Finally, high-risk predictors trained with successively clinical, morphological, hemodynamic and all data, and their link to the AAA evolution are built from supervise learning. Predictive performance is high for morphological, hemodynamic and all data, in contrast to clinical data. The morphology-based predictor exhibits an interesting effort-predictability tradeoff to be validated for clinical translation.

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Section: Limitationmentioning

confidence: 99%

A Cohort Longitudinal Study Identifies Morphology and Hemodynamics Predictors of Abdominal Aortic Aneurysm Growth

et al. 2019

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“…The first set of exclusion criteria were as follows: (a) CFD-unrelated (n = 5), (b) rupture-point-known (n = 10), (c) discriminator-unrelated (n = 26), (d) small number of aneurysms (less than 30) (n = 28), and (e) WSS or OSI undisclosed (n = 11), yielding a total of 32 studies. The second set of exclusion criteria were as follows: (f) location-specific (n = 14), (g) locationundefined (n = 2), (h) size-restricted (n = 1), and (i) metaanalysis (n = 2), yielding a total of 13 studies [38,39,[45][46][47][48][49][50][51][52][53][54][55]. Setting a specific location and size was avoided since those factors are known to be related to the aneurysm rupture rate and may lead to a possible bias; however, casematching studies based on location and size were permitted.…”

Section: Study Selectionmentioning

confidence: 99%

“…From the 13 included studies [38,39,[45][46][47][48][49][50][51][52][53][54][55], the following data were extracted: (1) year of publication, (2) study design, (3) location of aneurysms, (4) number of aneurysms, (5) number of ruptured aneurysms, (6) aneurysmal size, (7) aneurysmal aspect ratio, (8) aneurysmal WSS, (9) aneurysmal normalized WSS (NWSS), (10) aneurysmal OSI, and (11) aneurysmal LSA%. The mean (or median), p value, and area under the curve (AUC) from a receiver operating characteristic (ROC) analysis of these geometric and hemodynamic indexes were extracted.…”

Section: Data Extraction and Processingmentioning

confidence: 99%

“…Finally, the coefficient of variation (CV = SD/Mean) was calculated, and its average between ruptured and unruptured aneurysms was used to quantify the variability between groups. Table 1 summarizes the univariate analyses of 13 studies (3,692 aneurysms) [38,39,[45][46][47][48][49][50][51][52][53][54][55]. The percentage of ruptured aneurysms ranged from 30% to 50%.…”

Section: Data Extraction and Processingmentioning

confidence: 99%

“…This type of research has advanced, solely on a statistical basis, by comparing ruptured and unruptured aneurysms. At this moment, both high wall shear stress (HWSS) and low wall shear stress (LWSS) are statistically associated with the rupture statuses of aneurysms [38,39]. The pathological significance of hemodynamics currently has no other measures than relying on in vitro cell cultures and in vivo animal experiments [26,32].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Systematic review of hemodynamic discriminators for ruptured intracranial aneurysms

et al. 2019

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Researchers have aimed to identify unruptured intracranial aneurysms at a higher risk of rupture during follow-up for a long time. Computational fluid dynamics has been used widely to identify a hemodynamic discriminator between ruptured and unruptured aneurysms. However, this method has yet to reach a consensus between groups, which may be due, in part, to the significant degrees of freedom in hemodynamic indexes and computational workflows. The present review aims to characterize the degree of association between ruptured aneurysms and hemodynamic indexes, as well as the degree of variability between groups. A PubMed search identified 588 relevant studies. Thirteen met our criteria, yielding a total of 3,692 aneurysms. The definition of hemodynamic indexes were first carefully assessed and then classified accordingly. The variability of hemodynamic indexes between groups displayed a significant indexdependent nature. Normalizing hemodynamic indexes was an effective measure of reducing variability. Hemodynamic indexes were evaluated for associability and quantifiability. Overall, in an attempt to advance the diagnostic performance of hemodynamic indexes, these results shed light on the poor ability to interpret hemodynamic states pathologically. Future studies should incorporate the pathological significance of hemodynamic states into the design of hemodynamic indexes.

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Association of local solid mechanical, hemodynamic and morphological characteristics with ruptured intracranial aneurysm

Zhai

Wang

et al. 2022

Numer Methods Biomed Eng

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The rupture of intracranial aneurysms (IAs) is a complicated phenomenon of which the mechanism is not fully understood. The purpose of this study is to associate local solid mechanical, hemodynamic, and morphological characteristics with rupture regions through statistical means, in an attempt to identify the parameters that are indicative of rupture propensity for IAs. Twenty patient‐specific ruptured IA models were reconstructed from digital subtraction angiography (DSA), and applied in the analysis of wall tension, wall shear stress (WSS) and curvature. The precise rupture locations were marked out through intraoperative videos. Pearson correlation analysis was employed to investigate the correlations of these three parameters with patient characteristics and global geometric features. Univariate and multivariate logistic regression analysis were further performed on wall tension, WSS and curvature with regards to rupture and nonrupture regions. Receiver operating characteristic (ROC) analysis defining area under the curve (AUC) was performed on these three parameters. The univariate model of wall tension (AUC, 0.9750), WSS (AUC, 0.9300), curvature (0.8150) and their combined multivariate model (AUC, 0.9875) all present high AUC values. The wall tension, WSS and curvature are acceptable parameters relating to rupture regions. The rupture odd is more sensitive to the wall tension and WSS than curvature. Each logistic model is capable in discriminating ruptures from nonrupture regions, while the multivariate model is the most efficient.

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Associations of hemodynamics, morphology, and patient characteristics with aneurysm rupture stratified by aneurysm location

Cited by 80 publications

References 33 publications

A Cohort Longitudinal Study Identifies Morphology and Hemodynamics Predictors of Abdominal Aortic Aneurysm Growth

A Cohort Longitudinal Study Identifies Morphology and Hemodynamics Predictors of Abdominal Aortic Aneurysm Growth

Systematic review of hemodynamic discriminators for ruptured intracranial aneurysms

Association of local solid mechanical, hemodynamic and morphological characteristics with ruptured intracranial aneurysm

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