Prediction of Thin-Walled Areas of Unruptured Cerebral Aneurysms through Comparison of Normalized Hemodynamic Parameters and Intraoperative Images

Abstract

Object. Rupture of a cerebral aneurysm occurs mainly in a thin-walled area (TWA). Prediction of TWAs would help to assess the risk of rupture and select appropriate treatment strategy. There are several limitations of current prediction techniques for TWAs. To predict TWAs more accurately, HP should be normalized to minimize the influence of analysis conditions, and the effectiveness of normalized, combined hemodynamic parameters (CHPs) should be investigated with help of the quantitative color analysis of intraoperative images. Methods. A total of 21 unruptured cerebral aneurysms in 19 patients were analyzed. A normalized CHP was newly suggested as a weighted average of normalized wall shear stress (WSS) and normalized oscillatory shear index (OSI). Delta E from International Commission on Illumination was used to more objectively quantify color differences in intraoperative images. Results. CFD analysis results indicated that WSS and OSI were more predictive of TWAs than pressure (P<.001, P=.187, P=.970, respectively); these two parameters were selected to define the normalized CHP. The normalized CHP became more statistically significant (P<.001) as the weighting factor of normalized WSS increased and that of normalized OSI decreased. Locations with high CHP values corresponded well to those with high Delta E values (P<.001). Predicted TWAs based on the normalized CHP showed a relatively good agreement with intraoperative images (17 in 21 cases, 81.0%). Conclusion. 100% weighting on the normalized WSS produced the most statistically significant result. The normalization scheme for WSS and OSI suggested in this work was validated using quantitative color analyses, rather than subjective judgments, of intraoperative images, and it might be clinically useful for predicting TWAs of unruptured cerebral aneurysms. The normalization scheme would also be integrated into further fluid-structure interaction analysis for more reliable estimation of the risk of aneurysm rupture.