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Research ArticleInterventional

Comparing Morphology and Hemodynamics of Stable-versus-Growing and Grown Intracranial Aneurysms

E.L. Leemans, B.M.W. Cornelissen, C.H. Slump, C.B.L.M. Majoie, J.R. Cebral and H.A. Marquering
American Journal of Neuroradiology December 2019, 40 (12) 2102-2110; DOI: https://doi.org/10.3174/ajnr.A6307
E.L. Leemans
aFrom the Departments of Biomedical Engineering and Physics (E.L.L., B.M.W.C., H.A.M.)
bRadiology and Nuclear Medicine (E.L.L., B.M.W.C., C.B.L.M.M., H.A.M.), Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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B.M.W. Cornelissen
aFrom the Departments of Biomedical Engineering and Physics (E.L.L., B.M.W.C., H.A.M.)
bRadiology and Nuclear Medicine (E.L.L., B.M.W.C., C.B.L.M.M., H.A.M.), Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
cMIRA Institute for Biomedical Engineering and Technical Medicine (B.M.W.C., C.H.S.), University of Twente, Enschede, the Netherlands
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C.H. Slump
cMIRA Institute for Biomedical Engineering and Technical Medicine (B.M.W.C., C.H.S.), University of Twente, Enschede, the Netherlands
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C.B.L.M. Majoie
bRadiology and Nuclear Medicine (E.L.L., B.M.W.C., C.B.L.M.M., H.A.M.), Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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J.R. Cebral
dBioengineering and Mechanical Engineering Department, (J.R.C.), Volgenau School of Engineering, George Mason University, Fairfax, Virginia.
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H.A. Marquering
bRadiology and Nuclear Medicine (E.L.L., B.M.W.C., C.B.L.M.M., H.A.M.), Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Figures

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  • Fig 1.
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    Fig 1.

    Boxplot showing the growth rate per aneurysm location. ACA indicates anterior cerebral artery; PcomA, posterior communicating artery; AcomA, anterior communicating artery; BA, basilar artery; SCA, superior cerebellar artery; VA, vertebral artery.

  • Fig 2.
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    Fig 2.

    Dumbbell plot depicting the ratio between the median value of growing and stable aneurysms at baseline (blue) and last imaging (red). Characteristics are sorted according to baseline size. ICI indicates inflow concentration index; SR, mean aneurysm shear rate; VE, mean aneurysm velocity; SCI, shear concentration index; AR, aspect ratio; BF, bottleneck factor; BL, bulge location; IPR, isoperimetric ratio; UI, undulation index; NSI, nonsphericity index; Avol, aneurysm Volume; Nsize, Neck Size; HWR, height-to-width ratio; Asize, Aneurysm Size; podent, proper orthogonal decomposition entropy; max, maximum; Vdiam, Vessel diameter; corlean, core line length.

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    Fig 3.

    Boxplot comparing core-line length (left) and low shear area (right) in the different location categories according to the ELAPSS (upper row) and PHASES (lower row) scores. ACA indicates anterior cerebral artery; PcomA, posterior communicating artery; AcomA, anterior communicating artery.

Tables

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    Table 1:

    Description of morphologic and hemodynamic characteristics

    NameDescriptionUnit
    Morphologic characteristics
     Aneurysm volumeVolume of the aneurysmcm3
     Aneurysm sizeMaximum Euclidean distance of the aneurysm surfacecm
     Neck sizeMaximum Euclidean distance of the neck surfacecm
     Parent vessel diameterDiameter of the vessel nearest to the aneurysm neckcm
     ARAspect ratio; aneurysm height/neck sizeRatio
     HWRHeight-to-width ratio; aneurysm height/aneurysm widthRatio
     BFBottleneck factor; aneurysm width/neck sizeRatio
     BLBulge location; distance of plane with largest diameter from neck/aneurysm heightRatio
     SizeRSize ratioRatio
     VORVolume to ostium ratio; aneurysm volume/neck areaRatio
     IPRIsoperimetric ratio; aneurysm area/aneurysm volume2/3Ratio
     UIUndulation indexIndex
     EIEllipticity indexIndex
     NSINonsphericity indexIndex
     GAAArea weighted average of the Gaussian curvaturecm–2
    Hemodynamic characteristics
     ICIInflow concentration indexIndex
     SRShear rate1/s
     VEMean velocitycm/s
     VOMean vorticity1/s
     WSSWall shear stress (time averaged mean and maximum)dyne/cm2
     LSALow shear stress area%
     SCIShear concentration indexIndex
     OSIOscilatory shear index (time averaged mean and maximum)Index
     CLLTime-averaged vortex core-line lengthcm
     PODEProper orthogonal decomposition entropy
    • View popup
    Table 2:

    Baseline and hemodynamic characteristics for each group

    Stable AneurysmsGrowing Aneurysms: BaselineGrown Aneurysms: Follow-Up Imaging
    No.815656
    Sexb
     Male11 (14%)7 (12%)
     Female53 (65%)48 (86%)
     Unknown17 (21%)1 (2%)
    Artery (%)
     ACA5 (6%)1 (2%)
     AcomA8 (10%)8 (14%)
     ICA37 (46%)18 (32%)
     MCA16 (20%)19 (34%)
     PcomA12 (15%)3 (5%)
     Posterior circulation3 (3%)7 (13%)
    Previous SAH = yes (%)2 (2%)14 (25%)a
    Configuration = lateral (%)33 (41%)18 (32%)
    Age (mean) (SD) (yr)59 (18)55 (14)59 (13)
    PHASES (mean) (SD)3 (2)4 (3)c5 (3)a
     Without hypertension and population3 (3)4 (3)5 (3)c
    ELAPSS (mean) (SD)14 (6)15 (7)17 (6)b
     Without population14 (6)15 (7)17 (6)b
    Hemodynamic characteristics
     ICI (median) (IQR)0.4 (0.2–1.0)0.5 (0.3–1.2)0.6 (0.3–1.2)
     SR (median) (IQR) (1/s)207.3 (124.0–317.5)190.1 (67.8–273.7)126.3 (65.1–177.0)a
     VE (median) (IQR) (cm/s)9.4 (5.9–13.6)8.0 (4.6–11.4)6.6 (3.8–10.2)b
     VO (median) (IQR) (1/s)270.5 (165.5–416.2)256.9 (93.9–384.5)177.5 (88.3–255.0)a
     Max WSS (median) (IQR) (dyne/cm2)175.2 (126.8–239.2)149.5 (107.6–194.5)c146.8 (94.7–186.1)b
     Mean WSS (median) (IQR) (dyne/cm2)17.5 (11.2–29.9)16.5 (6.5–24.2)11.5 (5.4–18.8)a
     LSA (median) (IQR) (%)54 (29–74)53 (31–77)68 (50–89)c
     SCI (median) (IQR)3.2 (1.9–4.6)2.7 (1.0–4.2)3.2 (0.2–5.7)
     Max OSI (median) (IQR)0.3 (0.1–0.4)0.2 (0.2–0.4)0.3 (0.2–0.4)
     Mean OSI (median) (IQR)0.01 (0.01–0.01)0.01 (0.0–0.01)0.01 (0.01–0.02)
     CLL (median) (IQR)0.7 (0.2–1.4)0.6 (0.4–1.5)1.1 (0.5–2.0)c
     PODE (median) (IQR)0.1 (0.1–0.2)0.1 (0.1–0.2)0.2 (0.1–0.3)
    • Note:–ACA indicates anterior cerebral artery; AcomA, anterior communicating artery; PcomA, posterior communicating artery; Q, flow rate; ICI, inflow concentration index; SR, mean aneurysm shear rate; SCI, shear concentration index; max, maximum. P-value compared to stable aneurysms.

    • ↵a P < .001.

    • ↵b P < .02.

    • ↵c P < .05.

    • View popup
    Table 3:

    Morphologic characteristics for each group

    Stable AneurysmsGrowing Aneurysms: BaselineGrown Aneurysms: Follow-Up Imaging
    No.815656
    Aneurysm volume (median) (IQR) (cm)0.02 (0.01–0.11)0.03 (0.01–0.12)0.05 (0.02–0.19)b
    Aneurysm size (median) (IQR) (cm)0.53 (0.36–0.76)0.53 (0.41–0.81)0.64 (0.46–0.97)b
    Neck size (median) (IQR) (cm)0.42 (0.30–0.55)0.43 (0.33–0.62)0.48 (0.38–0.69)b
    Parent vessel diameter (median) (IQR) (cm)0.37 (0.29–0.45)0.33 (0.28–0.38)b0.33 (0.28–0.38)b
    AR (median) (IQR)0.73 (0.53–1.10)0.76 (0.56–0.95)0.88 (0.71–1.08)c
    HWR (median) (IQR)0.82 (0.64–0.97)0.84 (0.70–0.95)0.90 (0.80–1.08)b
    BF (median) (IQR)1.00 (0.87–1.25)1.03 (0.89–1.25)1.15 (0.97–1.32)c
    BL (median) (IQR)0.30 (0.13–0.44)0.32 (0.16–0.45)0.39 (0.26–0.48)b
    SizeR (median) (IQR)0.37 (0.29–0.45)1.82 (1.12–2.49)2.14 (1.44–3.01)a
    VOR (median) (IQR)1.38 (1.07–2.04)0.25 (0.14–0.59)0.35 (0.20–0.89)b
    IPR (median) (IQR)0.22 (0.10–0.67)4.71 (4.60–4.85)4.71 (4.61–4.93)
    UI (median) (IQR)4.74 (4.61–4.90)0.23 (0.14–0.36)0.19 (0.13–0.27)
    EI (median) (IQR)0.21 (0.14–0.35)0.26 (0.25–0.28)0.26 (0.24–0.27)
    NSI (median) (IQR)0.26 (0.25–0.29)0.19 (0.17–0.21)0.19 (0.17–0.22)
    GAA (median) (IQR) (cm–2)10.4 (5.0–21.2)8.7 (4.4–15.9)6.0 (3.2–10.7)b
    • Note:–P-value compared with stable aneurysms.

    • ↵a P < .001.

    • ↵b P < .02.

    • ↵c P < .05.

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E.L. Leemans, B.M.W. Cornelissen, C.H. Slump, C.B.L.M. Majoie, J.R. Cebral, H.A. Marquering
Comparing Morphology and Hemodynamics of Stable-versus-Growing and Grown Intracranial Aneurysms
American Journal of Neuroradiology Dec 2019, 40 (12) 2102-2110; DOI: 10.3174/ajnr.A6307

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Comparing Morphology and Hemodynamics of Stable-versus-Growing and Grown Intracranial Aneurysms
E.L. Leemans, B.M.W. Cornelissen, C.H. Slump, C.B.L.M. Majoie, J.R. Cebral, H.A. Marquering
American Journal of Neuroradiology Dec 2019, 40 (12) 2102-2110; DOI: 10.3174/ajnr.A6307
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