Predicting aneurysm rupture probabilities through the application of a computed tomography angiography–derived binary logistic regression model

Abstract

Object. The goal of this study was to establish a biomathematical model to accurately predict the probability of aneurysm rupture. Biomathematical models incorporate various physical and dynamic phenomena that provide insight into why certain aneurysms grow or rupture. Prior studies have demonstrated that regression models may determine which parameters of an aneurysm contribute to rupture. In this study, the authors derived a modified binary logistic regression model and then validated it in a distinct cohort of patients to assess the model's stability.Methods. Patients were examined with CT angiography. Three-dimensional reconstructions were generated and aneurysm height, width, and neck size were obtained in 2 orthogonal planes. Forward stepwise binary logistic regression was performed and then applied to a prospective cohort of 49 aneurysms in 37 patients (not included in the original derivation of the equation) to determine the log-odds of rupture for this aneurysm.Results. A total of 279 aneurysms (156 ruptured and 123 unruptured) were observed in 217 patients. Four of 6 linear dimensions and the aspect ratio were significantly larger (each with p < 0.01) in ruptured aneurysms than unruptured aneurysms. Calculated volume and aneurysm location were correlated with rupture risk. Binary logistic regression applied to an independent prospective cohort demonstrated the model's stability, showing 83% sensitivity and 80% accuracy.Conclusions. This binary logistic regression model of aneurysm rupture identified the status of an aneurysm with good accuracy. The use of this technique and its validation suggests that biomorphometric data and their relationships may be valuable in determining the status of an aneurysm. (DOI: 10.3171/2008.5.17558) Key WorDs • binary logistic regression • cerebral aneurysm • subarachnoid hemorrhage 1 Abbreviations used in this paper: ACoA = anterior communicating artery; BA = basilar artery; ICA = internal carotid artery; MCA = middle cerebral artery; PCoA = posterior communicating artery; SAH = subarachnoid hemorrhage.

Risk Factors for Re-bleeding of Aneurysmal Subarachnoid Hemorrhage: Systemic Review and Meta Analysis

“…Most of studies emphasize that aneurysm size is a major risk for initial rupture [31] [32]. Lei-Mei Guo et al found that the probability of re-bleeding in patients with aneurysms larger than 10 mm was 1.624 fold greater than those with aneurysms of 10 mm or less [23], but this result is not consistent with other studies [22] [17].…”

Size Ratio Correlates With Intracranial Aneurysm Rupture Status

“…It is also encouraging that these data reflect blinded technologists' measurements off of 2-dimensional angiographic images obtained at the time of presentation suggesting that there is an ease of real-world applicability with SR, which has been a criticism of other more complicated morphometrics. 15 It should be noted that various patient factors such as age and comorbidities have been shown to confer rupture risk. These factors were not found to be significantly different between the unruptured and ruptured groups in our study.…”

Influence of geometrical characteristics of sidewall-type multiple aneurysms on hemodynamic factors

“…These data are consistent with previous studies on single aneurysms. [14][15][16][17][18]22 The current objective is to evaluate the mutual influence between aneurysm sacs. (More specifically, to evaluate the hemodynamic factor's variation in aneurysm a 2 caused by changing the geometrical characteristics of a 1 .)…”

“…[10][11][12][13] Since hemodynamics, which strongly depend on the vascular geometry, play a key role in aneurysm growth and rupture, the geometrical characteristics seem to be an important factor in predicting rupture risk. The influences of aneurysm geometry characteristics on the rupture of single aneurysms have been discussed in the literature, including aneurysm size, [14][15][16][17][18] shape, [19][20][21] size ratio (SR) (height/ width), 22 section size, 21 and inflow angle. 23 However, few articles have analyzed the reasons for the higher rupture rate of multiple aneurysms.…”