J Neurol Surg A Cent Eur Neurosurg 2016; 77(01): 025-030
DOI: 10.1055/s-0035-1558409
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Morphological Parameters of Digital Subtraction Angiography 2D Image in Rupture Risk Profile of Small Intracranial Aneurysms: A Pilot Study

Ming Hao
1   Department of Neurosurgery,The Second Hospital of Yulin, Yulin, China
2   Department of Neurosurgery, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
,
Jun Ma
2   Department of Neurosurgery, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
,
Qingjiu Huang
2   Department of Neurosurgery, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
,
Shengxue He
2   Department of Neurosurgery, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
,
Zheng Liang
2   Department of Neurosurgery, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
,
Chengbin Wang
2   Department of Neurosurgery, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
› Author Affiliations
Further Information

Publication History

22 October 2014

31 March 2015

Publication Date:
27 July 2015 (online)

Abstract

Objective To analyze the morphological parameters of small intracranial aneurysms using two-dimensional digital subtraction angiography (DSA) and to identify their relationship with rupture risk.

Methods Clinical and radiologic data from patients with DSA-confirmed small intracranial aneurysms and who received intravascular treatment were retrospectively analyzed. Morphological parameters such as maximum height, transverse diameter, aneurysm neck width, and aspect ratio (AR) were compared between patients with ruptured and unruptured aneurysms. Logistic regression analysis was performed to identify the predictors of rupture risk.

Results There were no significant differences between the unruptured (n = 40) and ruptured groups (n = 34) with respect to maximum height (p = 0.087) and transverse diameter (p = 0.736). However, aneurysm neck width (p = 0.006) and AR (p < 0.001) were found to be significantly different between the groups. AR value was analyzed through the receiver operating characteristic curve, and the best AR threshold was determined to be 1.49. A stepwise multivariate analysis showed that AR was the only independent factor for rupture risk.

Conclusion Two-dimensional DSA could be used to determine AR, which was an independent predictor of rupture risk of small aneurysms. Further studies with large sample sizes are needed to validate these results.

 
  • References

  • 1 Zacharia BE, Hickman ZL, Grobelny BT , et al. Epidemiology of aneurysmal subarachnoid hemorrhage. Neurosurg Clin N Am 2010; 21 (2) 221-233
  • 2 le Roux AA, Wallace MC. Outcome and cost of aneurysmal subarachnoid hemorrhage. Neurosurg Clin N Am 2010; 21 (2) 235-246
  • 3 Meyers PM, Schumacher HC, Higashida RT , et al. Reporting standards for endovascular repair of saccular intracranial cerebral aneurysms. Stroke 2009; 40 (5) e366-e379
  • 4 Lall RR, Eddleman CS, Bendok BR, Batjer HH. Unruptured intracranial aneurysms and the assessment of rupture risk based on anatomical and morphological factors: sifting through the sands of data. Neurosurg Focus 2009; 26 (5) E2
  • 5 Vernooij MW, Ikram MA, Tanghe HL , et al. Incidental findings on brain MRI in the general population. N Engl J Med 2007; 357 (18) 1821-1828
  • 6 Morita A, Kirino T, Hashi K , et al; UCAS Japan Investigators The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med 2012; 366 (26) 2474-2482
  • 7 Wiebers DO, Whisnant JP, Huston III J , et al; International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 2003; 362 (9378) 103-110
  • 8 Sonobe M, Yamazaki T, Yonekura M, Kikuchi H. Small unruptured intracranial aneurysm verification study: SUAVe study, Japan. Stroke 2010; 41 (9) 1969-1977
  • 9 Beck J, Rohde S, Berkefeld J, Seifert V, Raabe A. Size and location of ruptured and unruptured intracranial aneurysms measured by 3-dimensional rotational angiography. Surg Neurol 2006; 65 (1) 18-25 ; discussion 25–27
  • 10 Weir B, Disney L, Karrison T. Sizes of ruptured and unruptured aneurysms in relation to their sites and the ages of patients. J Neurosurg 2002; 96 (1) 64-70
  • 11 Juvela S, Porras M, Poussa K. Natural history of unruptured intracranial aneurysms: probability of and risk factors for aneurysm rupture. J Neurosurg 2008; 108 (5) 1052-1060
  • 12 Kailasnath P, Dickey P. ISUIA-II: the need to share more data. Surg Neurol 2004; 62 (2) 95
  • 13 Clarke G, Mendelow AD, Mitchell P. Predicting the risk of rupture of intracranial aneurysms based on anatomical location. Acta Neurochir (Wien) 2005; 147 (3) 259-263 ; discussion 263
  • 14 Mira JM, Costa FA, Horta BL, Fabião OM. Risk of rupture in unruptured anterior communicating artery aneurysms: meta-analysis of natural history studies. Surg Neurol 2006; 66 (3) (Suppl. 03) S12-S19 ; discussion S19
  • 15 Lawson MF, Neal DW, Mocco J, Hoh BL. Rationale for treating unruptured intracranial aneurysms: actuarial analysis of natural history risk versus treatment risk for coiling or clipping based on 14,050 patients in the Nationwide Inpatient Sample database. World Neurosurg 2013; 79 (3-4) 472-478
  • 16 Connolly Jr ES, Rabinstein AA, Carhuapoma JR , et al; American Heart Association Stroke Council; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; Council on Cardiovascular Surgery and Anesthesia; Council on Clinical Cardiology. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2012; 43 (6) 1711-1737
  • 17 Bederson JB, Connolly Jr ES, Batjer HH , et al; American Heart Association. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 2009; 40 (3) 994-1025
  • 18 Lauric A, Baharoglu MI, Malek AM. Ruptured status discrimination performance of aspect ratio, height/width, and bottleneck factor is highly dependent on aneurysm sizing methodology. Neurosurgery 2012; 71 (1) 38-45
  • 19 Chmayssani M, Rebeiz JG, Rebeiz TJ, Batjer HH, Bendok BR. Relationship of growth to aneurysm rupture in asymptomatic aneurysms ≤ 7 mm: a systematic analysis of the literature. Neurosurgery 2011; 68 (5) 1164-1171 ; discussion 1171
  • 20 You SH, Kong DS, Kim JS , et al. Characteristic features of unruptured intracranial aneurysms: predictive risk factors for aneurysm rupture. J Neurol Neurosurg Psychiatry 2010; 81 (5) 479-484
  • 21 Ujiie H, Tamano Y, Sasaki K, Hori T. Is the aspect ratio a reliable index for predicting the rupture of a saccular aneurysm?. Neurosurgery 2001; 48 (3) 495-502 ; discussion 502–503
  • 22 Rahman M, Smietana J, Hauck E , et al. Size ratio correlates with intracranial aneurysm rupture status: a prospective study. Stroke 2010; 41 (5) 916-920
  • 23 Yasuda R, Strother CM, Taki W , et al. Aneurysm volume-to-ostium area ratio: a parameter useful for discriminating the rupture status of intracranial aneurysms. Neurosurgery 2011; 68 (2) 310-317 ; discussion 317–318
  • 24 Nader-Sepahi A, Casimiro M, Sen J, Kitchen ND. Is aspect ratio a reliable predictor of intracranial aneurysm rupture?. Neurosurgery 2004; 54 (6) 1343-1347 ; discussion 1347–1348
  • 25 Weir B, Amidei C, Kongable G , et al. The aspect ratio (dome/neck) of ruptured and unruptured aneurysms. J Neurosurg 2003; 99 (3) 447-451
  • 26 Backes D, Vergouwen MD, Velthuis BK , et al. Difference in aneurysm characteristics between ruptured and unruptured aneurysms in patients with multiple intracranial aneurysms. Stroke 2014; 45 (5) 1299-1303
  • 27 Elsharkawy A, Lehečka M, Niemelä M , et al. Anatomic risk factors for middle cerebral artery aneurysm rupture: computed tomography angiography study of 1009 consecutive patients. Neurosurgery 2013; 73 (5) 825-837 ; discussion 836–837