Morphologic and Hemodynamic Analysis in the Patients with Multiple Intracranial Aneurysms: Ruptured versus Unruptured

PLoS One. 2015 Jul 6;10(7):e0132494. doi: 10.1371/journal.pone.0132494. eCollection 2015.


Background and purpose: The authors evaluated the impact of morphologic and hemodynamic factors on multiple intracranial aneurysms and aimed to identify which parameters can be reliable indexes as one aneurysm ruptured, and the others did not.

Methods: Between June 2011 and May 2014, 69 patients harboring multiple intracranial aneurysms (69 ruptured and 86 unruptured) were analyzed from 3D-digital subtraction angiography (DSA) images and computational fluid dynamics (CFD). Morphologic and hemodynamic parameters were evaluated for significance with respect to rupture. Receiver operating characteristic (ROC) analysis identified area under the curve (AUC) and optimal thresholds separating ruptured from unruptured intracranial aneurysms for each parameter. Significant parameters were examined by binary logistic regression analysis to identify independent discriminators.

Results: Nine morphologic (size, neck width, surface area, volume, diameter of parent arteries, aspect ratio, size ratio, lateral/bifurcation type and regular/irregular type) and 6 hemodynamic (WSSmean, WSSmin, OSI, LSA, flow stability and flow complexity) parameters achieved statistical significance (p<0.05). Six morphologic (size, surface area, volume, aspect ratio, size ratio and regular/irregular type) and five hemodynamic (WSSmean, WSSmin, LSA, flow stability and flow complexity) parameters had high AUC values (AUC>0.7). By binary logistic regression analysis, large aspect ratio and low WSSmean were the independently significant rupture factors (AUC, 0.924; 95% CI, 0.883-0.965).

Conclusions: Large aspect ratio and low WSSmean were independently associated with the rupture status of multiple intracranial aneurysms.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Aneurysm, Ruptured* / pathology
  • Aneurysm, Ruptured* / physiopathology
  • Cerebrovascular Circulation*
  • Female
  • Hemodynamics*
  • Humans
  • Intracranial Aneurysm* / pathology
  • Intracranial Aneurysm* / physiopathology
  • Male
  • Middle Aged
  • Models, Cardiovascular*
  • Retrospective Studies

Grant support

This work was supported by the National Natural Science Foundation of China (grant nos. 81220108007, 81301003 and 81171079) and Special Research Project for Capital Health Development (grant no. 2014-1-1071). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.