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Shape irregularity of the intracranial aneurysm lumen exhibits diagnostic value


Juchler, Norman; Schilling, Sabine; Bijlenga, Philippe; Morel, Sandrine; Rüfenacht, Daniel; Kurtcuoglu, Vartan; Hirsch, Sven (2020). Shape irregularity of the intracranial aneurysm lumen exhibits diagnostic value. Acta Neurochirurgica, 162(9):2261-2270.

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 R$^{2}$ = 0.68 ± 0.08) and was modeled very accurately using the five morphological rating attributes plus shape elongation (R$^{2}$ = 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.

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 R$^{2}$ = 0.68 ± 0.08) and was modeled very accurately using the five morphological rating attributes plus shape elongation (R$^{2}$ = 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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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Institute of Physiology
07 Faculty of Science > Institute of Physiology

04 Faculty of Medicine > Neuroscience Center Zurich
04 Faculty of Medicine > Center for Integrative Human Physiology
Dewey Decimal Classification:570 Life sciences; biology
610 Medicine & health
Scopus Subject Areas:Health Sciences > Surgery
Health Sciences > Neurology (clinical)
Language:English
Date:September 2020
Deposited On:14 Aug 2020 14:20
Last Modified:15 Aug 2020 20:00
Publisher:Springer
ISSN:0001-6268
OA Status:Closed
Publisher DOI:https://doi.org/10.1007/s00701-020-04428-0
PubMed ID:32500254

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