AView: An Image-based Clinical Computational Tool for Intracranial Aneurysm Flow Visualization and Clinical Management

Abstract

Intracranial aneurysms (IAs) occur in around 3% of the entire population. IA rupture is responsible for the most devastating type of hemorrhagic strokes, with high fatality and disability rates as well as healthcare costs. With increasing detection of unruptured aneurysms, clinicians are routinely faced with the dilemma whether to treat IA patients and how to best treat them. Hemodynamic and morphological characteristics are increasingly considered in aneurysm rupture risk assessment and treatment planning, but currently no computational tools allow routine integration of flow visualization and quantitation of these parameters in clinical workflow. In this paper, we introduce AView, a prototype of a clinician-oriented, integrated computation tool for aneurysm hemodynamics, morphology, and risk and data management to aid in treatment decisions and treatment planning in or near the procedure room. Specifically, we describe how we have designed the AView structure from the end-user's point of view, performed a pilot study and gathered clinical feedback. The positive results demonstrate AView's potential clinical value on enhancing aneurysm treatment decision and treatment planning.

Initial Clinical Experience with AView—A Clinical Computational Platform for Intracranial Aneurysm Morphology, Hemodynamics, and Treatment Management

“…7 In this paper, we report 12 aneurysm cases from the AView pilot study to test the feasibility of this technology. We demonstrate that AView has the potential to help clinicians in both aneurysm treatment decision-making and treatment planning.…”

“…The details of each module were described previously. 7 Briefly, in the clinical data module, clinical demographic data (including age, sex, family or previous history of IAs, smoking habits, hypertension) are collected in an anonymous form. In the segmentation module, three-dimensional (3D) models of the aneurysm and adjacent vascular structures are generated from 3D images, including rotational catheter angiography, computed tomographic angiography (CTA), and magnetic resonance angiography (MRA).…”

“…Synthetic hemodynamics indices for the aneurysm sac are automatically computed and reported to the user. 7 Finally, a report with a summary of clinical data, computed morphologic and hemodynamic quantities, and rupture risk assessment is provided to the user (Figure 1). The statistical models from Xiang et al 9 have been adopted to calculate the rupture resemblance score (RRS).…”

“…We developed a prototype for a clinical software platform, “AView,” for rapid assessment of patient-specific IA hemodynamics and morphometrics in the clinical setting. 7 We then deployed this prototype at 8 clinical centers to test its technical feasibility. All participating clinicians embraced this innovative clinical tool, and all of them underscored the urgent need for such a tool to be integrated into the day-to-day clinical workflow for IA management.…”

Computer-assisted adjuncts for aneurysmal morphologic assessment: toward more precise and accurate approaches

“…We have developed AView as an image-based vascular analysis tool for rapid assessment of aneurysmal morphometrics and hemodynamics [3]. AView was a result of collaboration between biomedical engineers at University at Buffalo's Toshiba Stroke and Vascular Research Center, neurosurgeons at Gates Vascular Institute, and software developers at Orobix Srl (Bergamo, Italy).…”