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Multiple intracranial aneurysms: a direct hemodynamic comparison between ruptured and unruptured vessel malformations

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

Despite numerous studies addressing the rupture risk of intracranial aneurysms that have been published, the assessment thereof still remains challenging. Image-based simulations enable a precise prediction of patient-specific blood flow information. However, those approaches normally consider only small segments of the complete cerebral vasculature.

Methods

To test the validity of the consideration of single aneurysms in one computational setup, domains of the complete anterior and posterior circulations with multiple intracranial aneurysms (MIA) were simulated. Six patients with MIA were investigated, while 3D surfaces of eleven unruptured and six ruptured aneurysms were segmented. The segmentations were used for the determination of morphological parameters and also for image-based blood flow simulations used to characterize the hemodynamic properties of each aneurysm.

Results

In the geometric comparison, neck aspect ratios of unruptured and ruptured aneurysms did not differ significantly. In contrast, size ratios, aspect ratios, surface areas, volumes, and non-sphericity indices were significantly higher in the ruptured cases. The analysis of hemodynamic parameters demonstrated that in each patient, the ruptured aneurysm exhibited the lowest averaged wall shear stresses and highest oscillatory shears. Unstable flow was also detected in ruptured aneurysms based on increased oscillatory velocity.

Conclusion

In this small study involving patients with MIA, different morphologies and flow patterns were observed between ruptured and unruptured aneurysms. The analysis of the hemodynamics in such patients revealed a good agreement with studies that only considered single malformations. Additionally, complex flow patterns are detected in ruptured cases, which require deeper investigation.

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Acknowledgements

The work is partly funded by the Federal Ministry of Education and Research in Germany within the Research Campus STIMULATE under Grant No. 13GW0095A.

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Authors and Affiliations

  1. Laboratory of Fluid Dynamics and Technical Flows, University of Magdeburg “Otto von Guericke”, Universitätsplatz 2, 39106, Magdeburg, Germany

    Philipp Berg

  2. Institute of Neuroradiology, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany

    Oliver Beuing

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Correspondence to Philipp Berg.

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The authors P. Berg and O. Beuing declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Informed consent was obtained from all individual participants included in the study.

Electronic supplementary material

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11548_2017_1643_MOESM1_ESM.mp4

Caption: Time-dependent iso-surface velocity for patient 4 using a velocity threshold of 0.1 m/s. Notice the strong temporal fluctuations within the ruptured AComA aneurysm and the stable flow behavior in the remaining domain. (MP4 Video 945KB)

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Berg, P., Beuing, O. Multiple intracranial aneurysms: a direct hemodynamic comparison between ruptured and unruptured vessel malformations. Int J CARS 13, 83–93 (2018). https://doi.org/10.1007/s11548-017-1643-0

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  • DOI: https://doi.org/10.1007/s11548-017-1643-0

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