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Shape irregularity of the intracranial aneurysm lumen exhibits diagnostic value

  • Original Article - Vascular Neurosurgery - Aneurysm
  • Published:
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Abstract

Background

Morphological irregularity is linked to intracranial aneurysm wall instability and manifests in the lumen shape. Yet there is currently no consent on how to assess shape irregularity. The aims of this work are to quantify irregularity as perceived by clinicians, to break down irregularity into morphological attributes, and to relate these to clinically relevant factors such as rupture status, aneurysm location, and patient age or sex.

Methods

Thirteen clinicians and 26 laypersons assessed 134 aneurysm lumen segmentations in terms of overall perceived irregularity and five different morphological attributes (presence/absence of a rough surface, blebs, lobules, asymmetry, complex geometry of the parent vasculature). We examined rater agreement and compared the ratings with clinical factors by means of regression analysis or binary classification.

Results

Using rank-based aggregation, the irregularity ratings of clinicians and laypersons did not differ statistically. Perceived irregularity showed good agreement with curvature (coefficient of determination R2 = 0.68 ± 0.08) and was modeled very accurately using the five morphological rating attributes plus shape elongation (R2 = 0.95 ± 0.02). In agreement with previous studies, irregularity was associated with aneurysm rupture status (AUC = 0.81 ± 0.08); adding aneurysm location as an explanatory variable increased the AUC to 0.87 ± 0.09. Besides irregularity, perceived asymmetry, presence of blebs or lobules, aneurysm size, non-sphericity, and curvature were linked to rupture. No association was found between morphology and any of patient sex, age, and history of smoking or hypertension. Aneurysm size was linked to morphology.

Conclusions

Irregular lumen shape carries significant information on the aneurysm’s disease status. Irregularity constitutes a continuous parameter that shows a strong association with the rupture status. To improve the objectivity of morphological assessment, we suggest examining shape through six different morphological attributes, which can characterize irregularity accurately.

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Acknowledgments

We would like to thank John Bennett for proofreading the manuscript as well as all study participants (in alphabetical order): Jonas Abeken, Sepideh Amin-Hanjani, Hitomi Anzai, Andrea Boraschi, Stefano Buoso, Marco Corniola, Claudia Danzer, Diane de Zélicourt, Felicitas J. Detmer, Michael J. Durka, Guilherme Fideles, Christian F. Freyschlag, Victor Garcia, Manuel Gehlen, Stefan Glüge, David M. Hasan, Nora Huuska, Kartik Jain, Keisuke Kadooka, Eva L. Leemans, Max Lehtinen, Filippo Molica, Manuel Nüesch, Eliisa Netti, Rahul Raj, Sandro Roth, Isabelle Rudolf, Karl Schaller, Andreas Spiegelberg, Vincent Tutino, Isabel Wanke, Kazuhiro Watanabe, Paul Watton, Stephan Wetzel, Karsten H. Wrede, and Erich Zbinden.

Funding

This work was supported by SystemsX.ch, the Swiss initiative in systems biology, under Grant MRD 2014/261 (AneuX project); and by the Swiss National Science Foundation under Grant 147,193 (NCCR Kidney.CH).

Author information

Authors and Affiliations

  1. Institute of Applied Simulation, Zurich University of Applied Sciences, Wädenswil, Switzerland

    Norman Juchler, Sabine Schilling & Sven Hirsch

  2. The Interface Group, Institute of Physiology, University of Zurich, Zurich, Switzerland

    Norman Juchler & Vartan Kurtcuoglu

  3. Institute of Tourism ITW, Lucerne University of Applied Sciences and Arts, Lucerne, Switzerland

    Sabine Schilling

  4. Neurosurgery Division, Department of Clinical Neurosciences, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland

    Philippe Bijlenga & Sandrine Morel

  5. Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland

    Sandrine Morel

  6. Neuroradiology, SNRI, Klinik Hirslanden, Zurich, Switzerland

    Daniel Rüfenacht

  7. Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland

    Vartan Kurtcuoglu

  8. National Center of Competence in Research, Kidney.CH, Zurich, Switzerland

    Vartan Kurtcuoglu

  9. Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland

    Vartan Kurtcuoglu

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  1. Norman Juchler
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Correspondence to Norman Juchler or Sven Hirsch.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving patients 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. Raw 3D-DRA of the AneuX test data set were provided by the University Hospital of Geneva and collected with formal patient consent according to the @neurIST protocol and ethics authorization PB_2018-00073 (previously CER 07-05) released June 1st 2007 and renewed April 13th 2010, August 19th 2014, and February 28th 2018 initially by the Geneva Cantonal Ethics Commission for Research involving Humans and renewed by Swissethics in 2018.

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Juchler, N., Schilling, S., Bijlenga, P. et al. Shape irregularity of the intracranial aneurysm lumen exhibits diagnostic value. Acta Neurochir 162, 2261–2270 (2020). https://doi.org/10.1007/s00701-020-04428-0

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  • DOI: https://doi.org/10.1007/s00701-020-04428-0

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