Detmer Felicitas J, Chung Bong Jae, Jimenez Carlos, Hamzei-Sichani Farid, Kallmes David, Putman Christopher, Cebral Juan R
Bioengineering Department, Volgenau School of Engineering, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA.
Neurosurgery Department, University of Antioquia, Medellin, Colombia.
Neuroradiology. 2019 Mar;61(3):275-284. doi: 10.1007/s00234-018-2135-9. Epub 2018 Nov 19.
The mechanisms of cerebral aneurysm rupture are not fully understood. We analyzed the associations of hemodynamics, morphology, and patient age and gender with aneurysm rupture stratifying by location.
Using image-based models, 20 hemodynamic and 17 morphological parameters were compared in 1931 ruptured and unruptured aneurysms with univariate logistic regression. Rupture rates were compared between males and females as well as younger and older patients and bifurcation versus sidewall aneurysms for different aneurysm locations. Subsequently, associations between hemodynamics and morphology and patient as well as aneurysm characteristics were analyzed for aneurysms at five locations.
Compared to unruptured aneurysms, ruptured aneurysms were characterized by a more irregular shape and were exposed to a more adverse hemodynamic environment described by faster flow, higher wall shear stress, more oscillatory shear, and more unstable and complex flows. These associations with rupture status were consistent for different aneurysm locations. Rupture rates were significantly higher in males at the internal carotid artery (ICA) bifurcation, ophthalmic ICA, and the middle cerebral artery (MCA) bifurcation. At the anterior communicating artery (ACOM) and MCA bifurcation, they were significantly higher for younger patients. Bifurcation aneurysms had significantly larger rupture rates at the MCA and posterior communicating artery (PCOM). In these groups with higher rupture rates, aneurysms were characterized by adverse hemodynamics and more complex shapes.
Hemodynamic and morphological differences between ruptured and unruptured aneurysms are consistent across locations. Adverse morphology and hemodynamics are related to rupture as well as younger age, male gender, and bifurcation aneurysms.
脑动脉瘤破裂的机制尚未完全明确。我们通过按位置分层分析了血流动力学、形态学以及患者年龄和性别与动脉瘤破裂之间的关联。
使用基于图像的模型，通过单因素逻辑回归比较了1931个破裂和未破裂动脉瘤的20个血流动力学参数和17个形态学参数。比较了男性与女性、年轻患者与老年患者以及不同动脉瘤位置的分叉处动脉瘤与侧壁动脉瘤之间的破裂率。随后，分析了五个位置动脉瘤的血流动力学、形态学与患者及动脉瘤特征之间的关联。
与未破裂动脉瘤相比，破裂动脉瘤的特征是形状更不规则，并且处于更不利的血流动力学环境中，表现为血流更快、壁面剪应力更高、剪切振荡更多以及血流更不稳定和复杂。这些与破裂状态的关联在不同动脉瘤位置均一致。颈内动脉（ICA）分叉处、眼ICA和大脑中动脉（MCA）分叉处的男性破裂率显著更高。在前交通动脉（ACOM）和MCA分叉处，年轻患者的破裂率显著更高。MCA和后交通动脉（PCOM）处的分叉动脉瘤破裂率显著更大。在这些破裂率较高的组中，动脉瘤的特征是血流动力学不利且形状更复杂。
破裂和未破裂动脉瘤之间的血流动力学和形态学差异在各位置均一致。不利的形态学和血流动力学与破裂以及年轻、男性性别和分叉动脉瘤有关。
