Surrounding vascular geometry associated with basilar tip aneurysm formation

Abstract Hemodynamic stress is thought to play an important role in the formation of intracranial aneurysms, which is conditioned by the geometry of the surrounding vasculature. Our goal was to identify image-based morphological parameters that were associated with basilar artery tip aneurysms (BTA) in a location-specific manner. Three-dimensional morphological parameters obtained from CT-angiography (CTA) or digital subtraction angiography (DSA) from 207 patients with BTAs and a control group of 106 patients with aneurysms elsewhere to control for non-morphological factors, who were diagnosed at the Brigham and Women’s Hospital and Massachusetts General Hospital between 1990 and 2016, were evaluated. We examined the presence of hypoplastic, aplastic or fetal PCoAs, vertebral dominance, and diameters and angles of surrounding parent and daughter vessels. Univariable and multivariable statistical analyses were performed to determine statistical significance. Sensitivity analyses with small (≤ 3 mm) aneurysms only and with angles excluded, were also performed. In multivariable analysis, daughter–daughter angle was directly, and parent artery diameter and diameter size ratio were inversely associated with BTAs. These results remained significant in the subgroup analysis of small aneurysms (width ≤ 3 mm) and when angles were excluded. These easily measurable and robust parameters that are unlikely to be affected by aneurysm formation could aid in risk stratification for the formation of BTAs in high-risk patients.

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Geometric variations associated with posterior communicating artery aneurysms

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-017062 ◽

2021 ◽

pp. neurintsurg-2020-017062

Author(s):

Jian Zhang ◽

Anil Can ◽

Pui Man Rosalind Lai ◽

Srinivasan Mukundan, Jr. ◽

Victor M Castro ◽

...

Keyword(s):

Massachusetts General Hospital ◽

Conditional Logistic Regression ◽

Statistical Significance ◽

Three Dimensional ◽

Size Ratio ◽

Posterior Communicating Artery ◽

Sensitivity Analyses ◽

Control Group ◽

Conditional Logistic Regression Model ◽

Small Aneurysms

BackgroundHemodynamic stress, conditioned by the morphology of the surrounding vasculature, plays an important role in aneurysm formation. Our goal was to identify image-based location-specific parameters that are associated with posterior communicating artery (PCoA) aneurysms.MethodsThree-dimensional morphological parameters obtained from CT angiography or digital subtraction angiography from 187 patients with unilateral PCoA aneurysms, diagnosed at the Brigham and Women’s Hospital and Massachusetts General Hospital between 1990 and 2016, were evaluated. In order to control for genetic and clinical risk factors, we chose the contralateral unaffected PCoA as a control group. We examined diameters and angles of the surrounding parent and daughter vessels. Univariable and multivariable statistical analyses were performed to determine statistical significance. Sensitivity analyses with small aneurysms (≤5 mm) only and an unmatched analysis of 432 PCoA aneurysms and 197 control patients without PCoA aneurysms were also performed.ResultsIn a multivariable conditional logistic regression model we showed that smaller diameter size ratio (OR 1.45×10−5, 95% CI 1.12×10−7 to 1.88×10−3) and larger daughter-daughter angle (OR 1.04, 95% CI 1.02 to 1.07) were significantly associated with PCoA aneurysm presence after correcting for other variables. In subgroup analyses of small aneurysms (≤5 mm) and in an unmatched analysis the significance and direction of these results were preserved.ConclusionsLarger daughter-daughter angles and smaller diameter size ratio are significantly associated with the presence of PCoA aneurysms. These simple parameters can be utilized to guide the risk assessment for the formation of PCoA aneurysms in high risk patients.

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Morphological variables associated with ruptured basilar tip aneurysms

Scientific Reports ◽

10.1038/s41598-021-81364-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Jian Zhang ◽

Anil Can ◽

Pui Man Rosalind Lai ◽

Srinivasan Mukundan ◽

Victor M. Castro ◽

...

Keyword(s):

Statistical Significance ◽

Multivariable Analysis ◽

Aneurysm Rupture ◽

Size Ratio ◽

Width Ratio ◽

Maximum Height ◽

Morphological Parameters ◽

Flow Angle ◽

Aneurysm Wall ◽

Fisher Grade

AbstractMorphological factors of intracranial aneurysms and the surrounding vasculature could affect aneurysm rupture risk in a location specific manner. Our goal was to identify image-based morphological parameters that correlated with ruptured basilar tip aneurysms. Three-dimensional morphological parameters obtained from CT-angiography (CTA) or digital subtraction angiography (DSA) from 200 patients with basilar tip aneurysms diagnosed at the Brigham and Women’s Hospital and Massachusetts General Hospital between 1990 and 2016 were evaluated. We examined aneurysm wall irregularity, the presence of daughter domes, hypoplastic, aplastic or fetal PCoAs, vertebral dominance, maximum height, perpendicular height, width, neck diameter, aspect and size ratio, height/width ratio, and diameters and angles of surrounding parent and daughter vessels. Univariable and multivariable statistical analyses were performed to determine statistical significance. In multivariable analysis, presence of a daughter dome, aspect ratio, and larger flow angle were significantly associated with rupture status. We also introduced two new variables, diameter size ratio and parent-daughter angle ratio, which were both significantly inversely associated with ruptured basilar tip aneurysms. Notably, multivariable analyses also showed that larger diameter size ratio was associated with higher Hunt-Hess score while smaller flow angle was associated with higher Fisher grade. These easily measurable parameters, including a new parameter that is unlikely to be affected by the formation of the aneurysm, could aid in screening strategies in high-risk patients with basilar tip aneurysms. One should note, however, that the changes in parameters related to aneurysm morphology may be secondary to aneurysm rupture rather than causal.

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Temporal bone Pneumatization in Otosclerosis

Otolaryngology ◽

10.1016/j.otohns.2008.09.004 ◽

2008 ◽

Vol 139 (6) ◽

pp. 850-853 ◽

Cited By ~ 1

Author(s):

Daniel T. Ganc ◽

Robert W. Jyung

Keyword(s):

Temporal Bone ◽

Statistical Significance ◽

Three Dimensional ◽

Neck Surgery ◽

Adult Patients ◽

Control Group ◽

Test Analysis ◽

Temporal Bone Pneumatization ◽

History Of ◽

Temporal Bones

Objectives To determine whether there is a difference in the pneumatization of temporal bones with otosclerosis versus normal temporal bones. Methods A retrospective study of 46 ears from 24 adult patients with otosclerosis and 64 ears from 47 adult patients in a control group. The study group included temporal bone CT scans available from patients with otosclerosis. The control group consisted of patients who had temporal bone CTs for reasons likely unrelated to a history of middle ear disease. Data were obtained with a virtual reality system that allows three-dimensional manipulation and analysis. Results The temporal bone pneumatization for the otosclerosis group was 4.82 ± 2.27 cm3 vs 6.06 ± 2.71 cm3 for the control group. Two-sample t test analysis revealed no statistical significance ( P = 0.059) between pneumatization in the control vs otosclerosis groups. Conclusion There is no difference in temporal bone pneumatization between patients with otosclerosis and a control population. Therefore, temporal bone pneumatization by itself is not an adequate explanation for the apparent protective effect of otosclerosis against otitis media. © 2008 American Academy of Otolaryngology-Head and Neck Surgery Foundation. All rights reserved.

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Magnitude and Associated Factors of Awareness with Recall under General Anesthesia in Amhara Regional State Referral Hospitals, 2018

Anesthesiology Research and Practice ◽

10.1155/2019/7043279 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Tadese Tamire ◽

Habtamu Demelash ◽

Tikuneh Yetneberk ◽

Simegnew Kibret

Keyword(s):

General Anesthesia ◽

Associated Factors ◽

Statistical Significance ◽

Multivariable Analysis ◽

Complete Information ◽

Cross Sectional ◽

Associated Factor ◽

Regional State ◽

Referral Hospitals ◽

Risk Patients

Introduction. Awareness with recall of intraoperative events is an infrequent but potentially devastating complication of general anesthesia, with a reported incidence of 0.1-0.2% in low-risk patients. Higher incidence is expected in resource-limited operation room setups and in high-risk patients. Awareness can result in significant distress to patients and long-term psychological consequences, including symptoms associated with posttraumatic stress disorder, anxiety, night mares, night terror, dissatisfaction with surgical service, and sometimes even suicide. Objective. To assess the magnitude and associated factors of awareness with recall under general anesthesia in Amhara regional state referral hospitals. Method. An institution-based cross-sectional study was conducted on 1065 patients who underwent surgery under general anesthesia from January 1 to June 30, 2018. The study participants were selected by systematic random sampling from 4 referral hospitals. The modified Brice questionnaire was used to detect awareness under general anesthesia. Interviewer-administered structured questionnaire and chart review were employed. Data with complete information were entered in to SPSS version 20 computer software. Descriptive statics and bivariate and multivariable analysis were computed. A P-value less than 0.2 was used to select candidate variables for multivariable logistic regression. A P-value less than 0.05 was used to declare statistical significance. Result. 1065 patients were included in the study which makes the response rate of 90.7%. The magnitude of awareness with recall under general anesthesia was found to be 8.2% of which 4.9%, 2.6%, and 0.7% of patients reported hearing voice, pain, and sensation of breathing tube, respectively. Lack of premedication was the only significantly associated factor for awareness with recall under general anesthesia (AOR = 3.014, 95% CI (1.201 to 7.565)). Conclusion and Recommendation. Our study showed higher magnitude of awareness with recall under general anesthesia. Lack of premedication was the only associated factor with awareness with recall under general anesthesia. Anesthetists should give emphasis to prevent the possibility of awareness under general anesthesia by providing premedication. Cohort studies should be done including the consequences of awareness with recall under general anesthesia.

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Relationship between middle cerebral parent artery asymmetry and middle cerebral artery aneurysm rupture risk factors

Journal of Neurosurgery ◽

10.3171/2018.12.jns182951 ◽

2020 ◽

Vol 132 (4) ◽

pp. 1174-1181 ◽

Cited By ~ 2

Author(s):

Yifei Duan ◽

Carlito Lagman ◽

Raleigh Ems ◽

Nicholas C. Bambakidis

Keyword(s):

High Risk ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Artery Aneurysm ◽

Vascular Pathology ◽

Control Group ◽

Parent Artery ◽

Primary Control ◽

Aneurysm Formation ◽

Mca Aneurysm

OBJECTIVEThe exact pathophysiological mechanisms underlying cerebral aneurysm formation remain unclear. Asymmetrical local vascular geometry may play a role in aneurysm formation and progression. The object of this study was to investigate the association between the geometric asymmetry of the middle cerebral artery (MCA) and the presence of MCA aneurysms and associated high-risk features.METHODSUsing a retrospective case-control study design, the authors examined MCA anatomy in all patients who had been diagnosed with an MCA aneurysm in the period from 2008 to 2017 at the University Hospitals Cleveland Medical Center. Geometric features of the MCA ipsilateral to MCA aneurysms were compared with those of the unaffected contralateral side (secondary control group). Then, MCA geometry was compared between patients with MCA aneurysms and patients who had undergone CTA for suspected vascular pathology but were ultimately found to have normal intracranial vasculature (primary control group). Parent vessel and aneurysm morphological parameters were measured, calculated, and compared between case and control groups. Associations between geometric parameters and high-risk aneurysm features were identified.RESULTSThe authors included 247 patients (158 cases and 89 controls) in the study. The aneurysm study group consisted of significantly more women and smokers than the primary control group. Patients with MCA bifurcation aneurysms had lower parent artery inflow angles (p = 0.01), lower parent artery tortuosity (p < 0.01), longer parent artery total length (p = 0.03), and a significantly greater length difference between ipsilateral and contralateral prebifurcation MCAs (p < 0.01) than those in primary controls. Type 2 MCA aneurysms (n = 89) were more likely to be associated with dome irregularity or a daughter sac and were more likely to have a higher cumulative total of high-risk features than type 1 MCA aneurysms (n = 69).CONCLUSIONSData in this study demonstrated that a greater degree of parent artery asymmetry for MCA aneurysms is associated with high-risk features. The authors also found that the presence of a long and less tortuous parent artery upstream of an MCA aneurysm is a common phenotype that is associated with a higher risk profile. The aneurysm parameters are easily measurable and are novel radiographic biomarkers for aneurysm risk assessment.

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Three-dimensional printing of anatomically accurate, patient specific intracranial aneurysm models

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2015-011686 ◽

2015 ◽

Vol 8 (5) ◽

pp. 517-520 ◽

Cited By ~ 40

Author(s):

Jeff R Anderson ◽

Walker L Thompson ◽

Abdulaziz K Alkattan ◽

Orlando Diaz ◽

Richard Klucznik ◽

...

Keyword(s):

Fused Deposition Modeling ◽

Statistical Significance ◽

Three Dimensional ◽

Cerebral Aneurysms ◽

Patient Specific ◽

Parent Artery ◽

Significant Group ◽

Fused Deposition ◽

Deposition Modeling ◽

3D Printed

ObjectiveTo develop and validate a method for creating realistic, patient specific replicas of cerebral aneurysms by means of fused deposition modeling.MethodsThe luminal boundaries of 10 cerebral aneurysms, together with adjacent proximal and distal sections of the parent artery, were segmented based on DSA images, and corresponding virtual three-dimensional (3D) surface reconstructions were created. From these, polylactic acid and MakerBot Flexible Filament replicas of each aneurysm were created by means of fused deposition modeling. The accuracy of the replicas was assessed by quantifying statistical significance in the variations of their inner dimensions relative to 3D DSA images. Feasibility for using these replicas as flow phantoms in combination with phase contrast MRI was demonstrated.Results3D printed aneurysm models were created for all 10 subjects. Good agreement was seen between the models and the source anatomy. Aneurysm diameter measurements of the printed models and source images correlated well (r=0.999; p<0.001), with no statistically significant group difference (p=0.4) or observed bias. The SDs of the measurements were 0.5 mm and 0.2 mm for source images and 3D models, respectively. 3D printed models could be imaged with flow via MRI.ConclusionsThe 3D printed aneurysm models presented were accurate and were able to be produced inhouse. These models can be used for previously cited applications, but their anatomical accuracy also enables their use as MRI flow phantoms for comparison with ongoing studies of computational fluid dynamics. Proof of principle imaging experiments confirm MRI flow phantom utility.

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Flu vaccination rate of patients with severe immune-related adverse events.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e18234 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e18234-e18234

Author(s):

Ian Matthew Allen ◽

Yonina Robbie Murciano-Goroff ◽

Leyre Zubiri ◽

Qun Li ◽

Michael Sang Hughes ◽

...

Keyword(s):

Nearest Neighbor ◽

Massachusetts General Hospital ◽

Statistical Significance ◽

Control Group ◽

P Value ◽

Severe Toxicity ◽

Current Recommendation ◽

Oncology Patients ◽

Pathologic Features ◽

Increased Risk

e18234 Background: Infection with influenza in adults with cancer carries an increased risk of morbidity and mortality. Vaccination against seasonal influenza (Flu-V) can decrease the incidence of influenza, shorten its course, and reduce influenza-associated morbidity. Recent data has suggested that the administration of the Flu-V to patients on an ICI leads to an exaggerated inflammatory response and an increased risk of irAE. However, this trend was demonstrated in a small cohort of patients with lung cancer. Current recommendation for annual Flu-V in patients treated with ICI is unclear and literature about safety is limited. We compared rates of Flu-V for patients on ICI admitted with severe toxicity vs those patients on ICI who were admitted for reasons other than toxicity. We also evaluated rate of Flu-V among oncology patients who had received non-immunotherapy modalities. Methods: We retrospectively evaluated patients treated with ICI who were admitted to Massachusetts General Hospital from February 5, 2011- June 12, 2017. Patients received ipilimumab, pembrolizumab, nivolumab, atezolizumab, durvalumab, avelumab, or a combination in treatment of an advanced solid tumor malignancies including melanoma, NSCLC, SCCHN. Admissions due to irAE were confirmed by review of clinical, radiologic, and pathologic features. Flu-V status was determined by rigorous chart review. Nearest neighbor matching was used to create a control group of cancer patients treated with non-ICI modalities. Descriptive statistics compared rates and timing of Flu-V relative to admission. Statistical significance was determined using Fischer’s Exact Test, p < 0.05. Results: Of 540 patients on ICI, 28% were admitted for irAE, 72% had a non-irAE reason for admission. The rate of Flu-V in the flu season prior to admission for irAE group was lower than for non-irAE (18.5% vs 29.6%; p value = 0.01). There were no differences in vaccination rates within ≤30 days (2.7% vs 3.6%, p = 0.80), ≤90 days (4.0% vs 9.3%, p = 0.05), or ≤180 days of admission (11.9% vs 18.5%, p = 0.07). Flu-V rate overall in patients on ICI was 26.5%. In comparison, Flu-V rate in the nearest neighbor non-immunotherapy oncology patients was 67% (n = 101). Conclusions: Flu-V rates were much lower in patients treated with ICI compared to patients treated with non-ICI modalities. We did not see a higher rate of Flu-V in patients admitted with irAE compared to non-irAE which suggests that Flu-V and severe irAE may not be linked in clinical practice. Additional studies are needed, but Flu-V in patients on ICI holds potential to improve care.

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Comparative Study between the Effect of Induction Chemotherapy with 66 Gy Three Dimensional Conformal and 46 Gy Conventional Radiotherapy in Stage Iii Non- Small Cell Lung Cancer

Faridpur Medical College Journal ◽

10.3329/fmcj.v12i1.33486 ◽

2017 ◽

Vol 12 (1) ◽

pp. 18-24

Author(s):

Asma Siddiqua ◽

Md Nizamul Haque ◽

Sheikh Golam Mostofa ◽

Md Moarraf Hossain ◽

Qamruzzaman Chowdhury

Keyword(s):

Induction Chemotherapy ◽

Statistical Significance ◽

Intervention Group ◽

Three Dimensional ◽

Skin Toxicity ◽

Complete Response ◽

Stage Iii ◽

Control Group ◽

Radiological Response ◽

Stage Iii Nsclc

A quasi experimental study was carried out among 60 stage III NSCLC patients attending at Radiation Oncology Department of National Institute of Cancer Research & Hospital, Mohakhali, Dhaka from August 2012 to July 2013. Patients were divided into group A and group B purposively to receive Induction Chemotherapy followed by conventional or 3D CRT respectively. The study was designed to observe the radiological response and acute toxicity of stage III NSCLC with induction CT and 3DCRT. Treatment related morbidity was more observed in the intervention group with 43.3% Grade ?2 Pneumonitis, 43.4% Grade ?2 Oesophagitis, 40% Grade 2 skin toxicity and 6.7% Grade?3 anemia. Regarding metastasis, 33.3% patients in the intervention arm and 30% patients in the control arm had presented with metastasis at different sites within this six months period. No statistically significance was found between these two groups (p = .781). Death during follow up was observed in 6.7% patients in the intervention group and 3.3 % patients in the control arm which was of no statistically significance difference. (p = 1.00). Complete response was found in 23.3 % patients in intervention group while in control group it was only 6.7%. Partial response was 46.7% and 43.3% respectively. No response was seen in 36.6% patients; 13.3% in the intervention group and 23.3% in the control group. More patients in control group (26.7%) were reported with progressive disease. No statistical significance was found regarding the radiological response between these two arms (p=.114). Both complete and overall responses were better in intervention group than control group.Faridpur Med. Coll. J. Jan 2017;12(1): 18-24

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Research and Application of Multi-Dimensional and ThreeDimensional Teaching in Geriatric Nursing Teaching in the Context of Mass Entrepreneurship and Innovation

Journal of Advances in Medicine Science ◽

10.30564/jams.v1i1.22 ◽

2018 ◽

Vol 1 (1) ◽

pp. 12

Author(s):

Xiuxian Mo

Keyword(s):

Nursing Students ◽

Statistical Significance ◽

Three Dimensional ◽

Theory And Practice ◽

Group Differences ◽

Control Group ◽

Geriatric Nursing ◽

Nursing Knowledge ◽

Traditional Classroom Teaching ◽

Experimental Group

Purpose: Study the specific application effect of multi-dimensional and three-dimensional teaching in Geriatric Nursing teaching in the context of mass entrepreneurship and innovation. Methods: Respectively select 80 2015 nursing undergraduates and 80 2014 nursing undergraduates in our school as the research object of the experimental group and the control group. In terms of Geriatric Nursing teaching, nursing students in the control group adopt traditional classroom teaching methods to carry out, while students in the experimental group adopt multi-dimensional and three-dimensional teaching in the context of mass entrepreneurship and innovation. Then observe and compare the geriatric nursing knowledge scoring as well as theory and practice assessment results in the two groups taught with different methods. Results: It's obvious that the scoring of nursing students in the experimental group is higher than those in the control group in respect of geriatric nursing knowledge, and statistical significance exists in the between-group differences (P < 0.05). The nursing students in the experimental group perform obviously better than those in the control group in terms of the results of theory, practice and comprehensive assessment as well as total score, and statistical significance exists in the between-group differences (P < 0.05). Conclusion: Implementing Geriatric Nursing teaching for higher education nursing undergraduates with multi-dimensional and three-dimensional teaching in the context of mass entrepreneurship and innovation can remarkably improve nursing students' cognitive level in geriatric nursing as well as their mastery degree of theoretical, practical and comprehensive knowledge. Thus, the multi-dimensional and three-dimensional teaching mode in the context of mass entrepreneurship and innovation makes 80 2015 nursing undergraduates in our school direct beneficiaries, which could be popularized and applied in medical colleges.

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Morphological Parameters Associated With Middle Cerebral Artery Aneurysms

Neurosurgery ◽

10.1227/neu.0000000000000713 ◽

2015 ◽

Vol 76 (6) ◽

pp. 721-727 ◽

Cited By ~ 10

Author(s):

Anil Can ◽

Allen L. Ho ◽

Ruben Dammers ◽

Clemens M.F. Dirven ◽

Rose Du

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Vascular Malformations ◽

Statistical Significance ◽

Source Image ◽

Parent Artery ◽

Morphological Parameters ◽

Daughter Branch ◽

Group A ◽

Group B

Abstract BACKGROUND: Morphological factors contribute to the hemodynamics of the middle cerebral artery (MCA). OBJECTIVE: To identify image-based morphological parameters that correlated with the presence of MCA aneurysms. METHODS: Image-based anatomic parameters obtained from 110 patients with and without MCA bifurcation aneurysms were evaluated with Slicer, an open-source image analysis software, to generate 3-dimensional models of the aneurysms and surrounding vascular architecture. We examined segment lengths, diameters, and vessel-to-vessel angles of the parent and daughter vessels at the MCA bifurcation. In order to reduce confounding by genetic and clinical risk factors, 2 control groups were selected: group A (the unaffected contralateral side of patients with unilateral MCA bifurcation aneurysms) and group B (patients without intracranial aneurysms or other vascular malformations). Univariate and multivariate analyses were performed to determine statistical significance. RESULTS: One hundred ten patients who were evaluated from 2007 to 2014 were analyzed (73 patients with MCA aneurysms and 37 control patients). Multivariate analysis revealed that a smaller parent artery diameter (group A: odds ratio [OR] 0.20, P < .01, group B: OR 0.23, P < .01) and a larger daughter-to-daughter branch angle (group A: OR 1.01, P = .04, group B: OR 1.02, P = .04) were most strongly associated with MCA aneurysm presence after adjusting for other morphological factors. CONCLUSION: Smaller parent artery diameter and larger daughter-to-daughter branch angles are associated with the presence of MCA bifurcation aneurysms. These easily measurable parameters may provide objective metrics to assess aneurysm formation and growth risk stratification in high-risk patients.

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