scholarly journals Deep Shape Features for Predicting Future Intracranial Aneurysm Growth

2021 ◽  
Vol 12 ◽  
Author(s):  
Žiga Bizjak ◽  
Franjo Pernuš ◽  
Žiga Špiclin
Keyword(s):  
Prediction Models ◽  
Feature Learning ◽  
Treatment Decision ◽  
Vascular Pathology ◽  
Shape Features ◽  
Rupture Risk ◽  
Risk Of Rupture ◽  
Treatment Paradigm ◽  
Aneurysm Growth

Introduction: Intracranial aneurysms (IAs) are a common vascular pathology and are associated with a risk of rupture, which is often fatal. Aneurysm growth is considered a surrogate of rupture risk; therefore, the study aimed to develop and evaluate prediction models of future artificial intelligence (AI) growth based on baseline aneurysm morphology as a computer-aided treatment decision support.Materials and methods: Follow-up CT angiography (CTA) and magnetic resonance angiography (MRA) angiograms of 39 patients with 44 IAs were classified by an expert as growing and stable (25/19). From the angiograms vascular surface meshes were extracted and the aneurysm shape was characterized by established morphologic features and novel deep shape features. The features corresponding to the baseline aneurysms were used to predict future aneurysm growth using univariate thresholding, multivariate random forest and multi-layer perceptron (MLP) learning, and deep shape learning based on the PointNet++ model.Results: The proposed deep shape feature learning method achieved an accuracy of 0.82 (sensitivity = 0.96, specificity = 0.63), while the multivariate learning and univariate thresholding methods were inferior with an accuracy of up to 0.68 and 0.63, respectively.Conclusion: High-performing classification of future growing IAs renders the proposed deep shape features learning approach as the key enabling tool to manage rupture risk in the “no treatment” paradigm of patient follow-up imaging.

scholarly journals PHASES Score for Prediction of Intracranial Aneurysm Growth

Stroke ◽  
2015 ◽  
Vol 46 (5) ◽  
pp. 1221-1226 ◽  
Author(s):  
Daan Backes ◽  
Mervyn D.I. Vergouwen ◽  
Andreas T. Tiel Groenestege ◽  
A. Stijntje E. Bor ◽  
Birgitta K. Velthuis ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Cox Regression ◽  
Continuous Variable ◽  
Aneurysm Rupture ◽  
Hazard Ratios ◽  
Unruptured Intracranial Aneurysms ◽  
Increased Risk ◽  
Risk Of Rupture ◽  
Aneurysm Growth

Background and Purpose— Growth of an intracranial aneurysm occurs in around 10% of patients at 2-year follow-up imaging and may be associated with aneurysm rupture. We investigated whether PHASES, a score providing absolute risks of aneurysm rupture based on 6 easily retrievable risk factors, also predicts aneurysm growth. Methods— In a multicenter cohort of patients with unruptured intracranial aneurysms and follow-up imaging with computed tomography angiography or magnetic resonance angiography, we performed univariable and multivariable Cox regression analyses for the predictors of the PHASES score at baseline, with aneurysm growth as outcome. We calculated hazard ratios and corresponding 95% confidence intervals (CI), with the PHASES score as continuous variable and after division into quartiles. Results— We included 557 patients with 734 unruptured aneurysms. Eighty-nine (12%) aneurysms in 87 patients showed growth during a median follow-up of 2.7 patient-years (range 0.5–10.8). Per point increase in PHASES score, hazard ratio for aneurysm growth was 1.32 (95% CI, 1.22–1.43). With the lowest quartile of the PHASES score (0–1) as reference, hazard ratios were for the second (PHASES 2–3) 1.07 (95% CI, 0.49–2.32), the third (PHASES 4) 2.29 (95% CI, 1.05–4.95), and the fourth quartile (PHASES 5–14) 2.85 (95% CI, 1.43–5.67). Conclusions— Higher PHASES scores were associated with an increased risk of aneurysm growth. Because higher PHASES scores also predict aneurysm rupture, our findings suggest that aneurysm growth can be used as surrogate outcome measure of aneurysm rupture in follow-up studies on risk prediction or interventions aimed to reduce the risk of rupture.

Abstract WMP30: Risk Analysis Of Growth And Rupture In Unruptured Intreacranial Aneurysms : Single Institutional Cohort Study

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Yuichi Murayama ◽  
Toshihiro Ishibashi ◽  
Hiroyuki Takao ◽  
Ichiro Yuki ◽  
Hideki Arakawa ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Three Dimensional ◽  
Aneurysm Rupture ◽  
Posterior Circulation ◽  
Single Center ◽  
Risk Of Rupture ◽  
Aneurysm Growth ◽  
The Mean ◽  
Small Aneurysms

Introduction: Risk of growth and rupture in unruptured intracranial saccular aneurysm (UIA) are still unclear. Hypothesis: Gowth and risk of UIA may be correlated and they were evaluated our single center large cohort. Methods: Between January 2003 and March 2011, a total of 2122 patients with 2756 UIA were referred to our institution. 1403 patients with 2037 UIAs were assigned for conservative management. The mean follow up duration was 6201 aneurysm-years. Bi-annual three-dimensional computed tomography angiography (3D CTA) was performed and aneurysm growth was evaluated using 3D workstation. The aneurysm growth was defined as size increase more than 1mm. Results: During observation, 14.6% aneurysms increased their size. Female and male growth rate were 16% and 11% respectively. 130 patients stopped observation and therapeutic intervention was performed due to increase their size or anxiety. During observation 50 UIAs ruptured resulting in a 0.8% rupture rate per year. Aneurysm growth, IC-pcom aneurysms, posterior circulation, female, and SAH associated multiple aneurysms were risk factor for aneurysm rupture. Growing aneurysm was 10 times higher relative risk of rupture compare to stable aneurysm. No aneurysm demonstrated reduction of their size after rupture. Conclusions: Risk of Aneurysm growth and rupture may be correlated. Risk of rupture of UIAs was similar that was reported before but even small aneurysms can be rupture during observation. Growing UIAs should be considered to treat as soon as possible even in small size.

Abstract 190: Prediction of Intracranial Aneurysm Growth Based on Morphology

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Aichi Chien ◽  
Emiko Morimoto ◽  
Hajime Yokota ◽  
Pablo Villablanca ◽  
Noriko Salamon
Keyword(s):  
Intracranial Aneurysm ◽  
Surface Area ◽  
Morphological Characteristics ◽  
T Test ◽  
Maximum Diameter ◽  
Increased Risk ◽  
Risk Of Rupture ◽  
Significant Difference ◽  
Aneurysm Growth

Introduction: Recent studies have strongly associated intracranial aneurysm growth with increased risk of rupture. To plan more effective monitoring and intervention strategies, it would be beneficial to identify aneurysms which are likely to grow. Hypothesis: Morphological characteristics at initial diagnosis differ between unruptured intracranial aneurysms that will grow and those that are stable. Methods: A total of 58 cases of aneurysms in our medical center with follow-up imaging dates in 2015 were selected. All CTA images for the aneurysms were collected, for a total of 250 image sets. Aneurysm 3D geometry was reconstructed and morphological characteristics, including volume, surface area, and non-sphericity index (NSI) were calculated. NSI was calculated as 1 - (18π) 1/3 V 2/3 /S, where V and S represent aneurysm volume and surface area, respectively. Statistical comparisons were made using a two-tailed t-test with an assumption of unequal variance (Welch’s t-test). Results: Aneurysms were followed for an average of 50.5±50.9 months, with an average of 3.29±2.66 follow-up imaging dates. 9 aneurysms exhibited a size increase (>0.6mm) and the remaining 49 aneurysms did not. Based on their maximum diameter, no significant difference was found between initial aneurysm size between the growth (3.80±1.72 mm) and non-growth (4.26±2.00 mm) groups (p=0.13). Likewise, no significant differences in volume or surface area were found (p=0.33, p=0.36, respectively). However, initial NSI was found to be significantly higher in the growth (0.32±0.11) vs. the non-growth (0.23±0.08) group (p=0.049). Conclusions: Among aneurysms with similar size, NSI may be useful for identifying aneurysms which are more likely to grow and planning monitoring strategies accordingly. Higher initial NSI in the aneurysms which eventually grew is consistent with previous findings that higher NSI correlates with increased risk of rupture.

Annual rupture risk of growing unruptured cerebral aneurysms detected by magnetic resonance angiography

2012 ◽  
Vol 117 (1) ◽  
pp. 20-25 ◽  
Author(s):  
Takashi Inoue ◽  
Hiroaki Shimizu ◽  
Miki Fujimura ◽  
Atsushi Saito ◽  
Teiji Tominaga
Keyword(s):  
Magnetic Resonance Angiography ◽  
Mr Angiography ◽  
Cerebral Aneurysms ◽  
Rupture Risk ◽  
Aneurysm Wall ◽  
Short Period ◽  
Aneurysm Growth ◽  
Unruptured Cerebral Aneurysms ◽  
Aneurysm Diameter

Object In this paper, the authors' goals were to clarify the characteristics of growing unruptured cerebral aneurysms detected by serial MR angiography and to establish the recommended follow-up interval. Methods A total of 1002 patients with 1325 unruptured cerebral aneurysms were retrospectively identified. These patients had undergone follow-up evaluation at least twice. Aneurysm growth was defined as an increase in maximum aneurysm diameter by 1.5 times or the appearance of a bleb. Results Aneurysm growth was observed in 18 patients during the period of this study (1.8%/person-year). The annual rupture risk after growth was 18.5%/person-year. The proportion of females among patients with growing aneurysms was significantly larger than those without growing aneurysms (p = 0.0281). The aneurysm wall was reddish, thin, and fragile on intraoperative findings. Frequent follow-up examination is recommended to detect aneurysm growth before rupture. Conclusions Despite the relatively short period, the annual rupture risk of growing unruptured cerebral aneurysms detected by MR angiography was not as low as previously reported. Surgical or endovascular treatment can be considered if aneurysm growth is detected during the follow-up period.

scholarly journals Clinical relevance of short-term follow-up of unruptured intracranial aneurysms

2019 ◽  
Vol 47 (1) ◽  
pp. E7 ◽  
Author(s):  
Rob Molenberg ◽  
Marlien W. Aalbers ◽  
Jan D. M. Metzemaekers ◽  
Aryan Mazuri ◽  
Gert-Jan Luijckx ◽  
...  
Keyword(s):  
Clinical Relevance ◽  
Intracranial Aneurysms ◽  
Significant Risk ◽  
Patient Specific ◽  
Rupture Risk ◽  
Short Term ◽  
Unruptured Intracranial Aneurysms ◽  
Increased Risk ◽  
Risk Of Rupture

OBJECTIVEUnruptured intracranial aneurysms are common incidental findings on brain imaging. Short-term follow-up for conservatively treated aneurysms is routinely performed in most cerebrovascular centers, although its clinical relevance remains unclear. In this study, the authors assessed the extent of growth as well as the rupture risk during short-term follow-up of conservatively treated unruptured intracranial aneurysms. In addition, the influence of patient-specific and aneurysm-specific factors on growth and rupture risk was investigated.METHODSThe authors queried their prospective institutional neurovascular registry to identify patients with unruptured intracranial aneurysms and short-term follow-up imaging, defined as follow-up MRA and/or CTA within 3 months to 2 years after initial diagnosis. Medical records and questionnaires were used to acquire baseline information. The authors measured aneurysm size at baseline and at follow-up to detect growth. Rupture was defined as a CT scan–proven and/or CSF-proven subarachnoid hemorrhage (SAH).RESULTSA total of 206 consecutive patients with 267 conservatively managed unruptured aneurysms underwent short-term follow-up at the authors’ center. Seven aneurysms (2.6%) enlarged during a median follow-up duration of 1 year (range 0.3–2.0 years). One aneurysm (0.4%) ruptured 10 months after initial discovery. Statistically significant risk factors for growth or rupture were autosomal-dominant polycystic kidney disease (RR 8.3, 95% CI 2.0–34.7), aspect ratio > 1.6 or size ratio > 3 (RR 10.8, 95% CI 2.2–52.2), and initial size ≥ 7 mm (RR 10.7, 95% CI 2.7–42.8).CONCLUSIONSSignificant growth of unruptured intracranial aneurysms may occur in a small proportion of patients during short-term follow-up. As aneurysm growth is associated with an increased risk of rupture, the authors advocate that short-term follow-up is clinically relevant and has an important role in reducing the risk of a potential SAH.

Abstract WP86: Early Detection of Aneurysm Growth by Volume and Surface Area Analysis Using 3D Modeling From CT Angiography

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Hajime Yokota ◽  
Aichi Chien ◽  
Emiko Morimoto ◽  
Pablo Villablanca ◽  
Noriko Salamon
Keyword(s):  
Surface Area ◽  
Maximum Diameter ◽  
Parent Artery ◽  
Slice Thickness ◽  
Roc Curve Analysis ◽  
Unruptured Aneurysms ◽  
Increased Risk ◽  
Risk Of Rupture ◽  
Aneurysm Growth

Introduction: Enlargement of unruptured aneurysms indicates an increased risk of rupture. Assessment of aneurysm growth is typically based on aneurysm max diameter. However, this method is often unreliable due to factors such as the degree of contrast enhancement, tilting among studies and artifacts. Hypothesis: Three-dimensional modeling can help to judge aneurysm growth. Methods: All aneurysm patients who underwent CTA (1.0-mm slice thickness) with at least one follow-up in 2015, were reviewed. Intracranial saccular aneurysms were selected and fusiform, dissecting and mycotic aneurysms were excluded. Growth was defined as more than a 0.5 mm increase in size compared with the first study. 3D models were created from the source data using 3D-slicer (http://www.slicer.org). Aneurysm extraction from the parent artery was performed semi-automatically and volume and surface area were calculated using vascular toolkit (http://www.vmtk.org). The Mann-Whitney test and ROC curve analysis were applied to compare cases which increased in size with no-change cases. Results: This research included 59 aneurysms in 51 patients that underwent 250 CTA, with follow-up duration of 50.0 ± 50.5 months. Nine aneurysms increased in size. In 5 of 9 cases, follow-up studies prior to growth detection were available. In these cases, maximum diameter change from the first study was not significant (P = 0.169). By contrast, volume and area were significantly different (P = 0.046 and 0.046, respectively). On ROC analysis, AUCs of maximum diameter, volume, and area changes were 0.7, 0.772 and 0.772. Conclusions: Calculating volume and area changes was useful to judge aneurysm growth earlier than size measurement.

Cavernous sinus aneurysms: risk of growth over time and risk factors

2020 ◽  
Vol 132 (1) ◽  
pp. 22-26 ◽  
Author(s):  
Giovanni Vercelli ◽  
Thomas J. Sorenson ◽  
Ahmad Z. Aljobeh ◽  
Roanna Vine ◽  
Giuseppe Lanzino
Keyword(s):  
Risk Factors ◽  
Internal Carotid ◽  
Limited Information ◽  
Benign Lesions ◽  
Risk Of Rupture ◽  
History Of ◽  
Aneurysm Growth ◽  
Over Time ◽  
New Onset

OBJECTIVECavernous internal carotid artery (ICA) aneurysms are frequently diagnosed incidentally and the benign natural history of these lesions is well known, but there is limited information assessing the risk of growth in untreated patients. The authors sought to assess and analyze risk factors in patients with cavernous ICA aneurysms and compare them to those of patients with intracranial berry aneurysms in other locations.METHODSData from consecutive patients who were diagnosed with a cavernous ICA aneurysm were retrospectively reviewed. The authors evaluated patients for the incidence of cavernous ICA aneurysm growth and rupture. In addition, the authors analyzed risk factors for cavernous ICA aneurysm growth and compared them to risk factors in a population of patients diagnosed with intracranial berry aneurysms in locations other than the cavernous ICA during the same period.RESULTSIn 194 patients with 208 cavernous ICA aneurysms, the authors found a high risk of aneurysm growth (19.2% per patient-year) in patients with large/giant aneurysms. Size was significantly associated with higher risk of growth. Compared to patients with intracranial berry aneurysms in other locations, patients with cavernous ICA aneurysms were significantly more likely to be female and have a lower incidence of hypertension.CONCLUSIONSAneurysms of the cavernous ICA are benign lesions with a negligible risk of rupture but a definite risk of growth. Aneurysm size was found to be associated with aneurysm growth, which can be associated with new onset of symptoms. Serial follow-up imaging of a cavernous ICA aneurysm might be indicated to monitor for asymptomatic growth, especially in patients with larger lesions.

scholarly journals Rapid Documented Growth of Aneurysm Bleb Led to Rupture of an Incidental Intracranial Anterior Communicating Artery Aneurysm

2017 ◽  
Vol 78 (05) ◽  
pp. 521-524 ◽  
Author(s):  
Jorn Fierstra ◽  
Giuseppe Esposito ◽  
Gerasimos Baltsavias ◽  
Oliver Bozinov ◽  
Luca Regli ◽  
...  
Keyword(s):  
High Risk ◽  
Artery Aneurysm ◽  
Aneurysm Rupture ◽  
Anterior Communicating Artery ◽  
Rupture Risk ◽  
Short Term ◽  
Anterior Communicating Artery Aneurysm ◽  
Unruptured Intracranial Aneurysms ◽  
Risk Of Rupture

Background A major challenge in the management of patients with unruptured intracranial aneurysms (UIAs) is to identify criteria indicating a higher risk of future UIA rupture. We report a rare patient with documented short-term bleb growth of an UIA followed by a fatal aneurysm rupture supporting the high risk of rupture of short-term shape changes in UIAs. Case Description A 72-year-old man with an incidental unruptured anterior communicating artery aneurysm of 9 mm showed a bleb growth on the aneurysm sac at 6-week follow-up computed tomography angiography (CTA). Aneurysm treatment was recommended by the interdisciplinary board (PHASES score: 9 points; rupture risk 4.3% in 5 years). The patient wanted to discuss the treatment plan with his family before making a final decision. Two days after the CTA showing bleb growth, he was admitted emergently with a severe subarachnoid hemorrhage (SAH) (World Federation of Neurologic Surgeons grade 5; Fisher 3). The aneurysm was occluded with coils. However, the patient died on day 14 after SAH due to delayed ischemic neurologic deficits and multiple organ failure. Conclusions This case illustrates the high rupture risk of an UIA presenting a documented growth of an aneurysm bleb over a short follow-up time. In retrospect, this patient might have benefited from emergent aneurysm occlusion. The interest of this report comes from the proof that aneurysmal bleb growth constitutes a high risk for short-term aneurysm rupture.

Abstract TP82: The Growth of Small, Asymptomatic, Unruptured Intracranial Aneurysms with no History of SAH -Different Risk Factors Associated with Single and Multiple Aneurysms

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Aichi Chien ◽  
Feng Liang ◽  
James Sayre ◽  
Noriko Salamon ◽  
Pablo Villablanca ◽  
...  
Keyword(s):  
Growth Rates ◽  
Intracranial Aneurysms ◽  
Posterior Circulation ◽  
Rupture Risk ◽  
Multiple Aneurysms ◽  
Factors Associated ◽  
Unruptured Intracranial Aneurysms ◽  
History Of ◽  
Aneurysm Growth

Introduction: The International Study on Unruptured Intracranial Aneurysms suggests that small (<7mm), asymptomatic, unruptured intracranial aneurysms (UIA) in patients with no history of subarachnoid hemorrhage (SAH) should be managed conservatively. Recent research has independently shown considerable variation in the rupture risk of small UIA. As enlargement may indicate increased risk of rupture, the factors related to UIA growth may also influence rupture risk. Information about small UIA growth is limited and heterogeneous due to limited follow-up data. Hypothesis: Growth factors for small UIA vary between subset groups. Methods: A retrospective study was performed based on a total of 508 patients diagnosed with UIA from 2005-2010 in our center. 235 patients with asymptomatic, small UIA and no history of SAH were monitored with high resolution 3D CTA. Patient medical history and aneurysm characteristics (size, growth, location and multiplicity) were analyzed. Multiple logistic regression analysis and the Hosmer-Lemeshow statistic were used to identify the factors associated with growth. The Student’s t-test was applied to compare the aneurysm growth rate between subset groups. Results: A total of 319 UIA were included with follow-up durations of 29.2 20.0 months. 42 UIA increased in size during the follow-up. 5 UIA grew to become ≥ 7 mm (within 38.2±18.3 months). A trend of higher growth rates was found in single aneurysms than in multiple aneurysms (P=0.07). History of stroke was the only factor associated with single aneurysm growth (P=0.03). The number of aneurysms (P=0.014), aneurysms located within the posterior circulation (P=0.023), and patient history of transient ischemic attack (P=0.032) were related to multiple aneurysm growth. Conclusion: We found that multiple small aneurysms were more likely to grow, especially those at posterior circulation. Although single aneurysms have a lower risk of growth, a trend of higher growth rates was found.

Abstract WP89: Hemodynamic Differences Found Between Growing and Stable Aneurysms of Comparable Dome and Neck Sizes

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Vicki Lau ◽  
Qianyi Yu ◽  
Feng Liang ◽  
Tiewei Qi ◽  
Pablo Villablanca ◽  
...  
Keyword(s):  
Blood Flow ◽  
Flow Characteristics ◽  
Stable Matching ◽  
Patient Specific ◽  
Aneurysm Neck ◽  
Aneurysm Size ◽  
Risk Of Rupture ◽  
Flow Pulsatility ◽  
Aneurysm Growth

Introduction: Reports have suggested that high blood flow pulsatility in aneurysms may predict a higher risk of rupture, however, it is unclear whether similar flow dynamics also predict aneurysm growth. The objective of this study is to investigate differences in shape and blood flow characteristics between unruptured growing and stable aneurysms of comparable sizes. Hypothesis: Growing and stable aneurysms of comparable sizes exhibit different flow characteristics across different aneurysm regions. Method: We studied 4 growing aneurysms located at the posterior communicating artery (size ranged from 1.8mm to 11.4mm). Patient-specific aneurysm flow analysis and 3D aneurysm shape analysis were performed to investigate the flow changes during follow-up imaging. Specifically, we compared the shape parameters including aneurysm size, volume, and surface changes. We also compared the aneurysm flow properties including flow velocity, wall shear stress, pulsatility, and flow oscillatory characteristics. The growing aneurysms were analyzed against stable-matching aneurysms which were selected based on similar dome and neck size to find the predictive factors for aneurysm growth. These stable-matching aneurysms exhibiting no size changes for 2 years during follow-up were analyzed as a baseline. Results: We found that blood flow pulsatility through the parent artery was similar across all growing and stable aneurysms, averaging 0.58±0.003. Regardless of aneurysm size, blood flow pulsatility through the aneurysm neck was at the level of 0.66 (0.66±0.06) for growing aneurysms. We also found a clear trend of that blood flow pulsatility increased from the neck to dome in growing aneurysms. Blood flow pulsatility, however, decreased from the aneurysm neck to dome in the stable aneurysms (P<0.05). The rate of increase of blood flow pulsatility through the dome also appears to have an exponential correspondence with the aneurysm volume increase, with a R^2 value of 0.94. Conclusion: We found that increasing blood flow pulsatility from the aneurysm neck to dome may be indicative of aneurysm growth, which may be useful in identifying aneurysms that will potentially grow into high-risk aneurysms.

Sign in / Sign up

Export Citation Format

Share Document