Quantitative analysis of flow vortices: differentiation of unruptured and ruptured medium-sized middle cerebral artery aneurysms

Background Surgical intervention for unruptured intracranial aneurysms (IAs) carries inherent health risks. The analysis of patient-specific IA geometric and computational fluid dynamics (CFD) simulated wall shear stress (WSS) data has been investigated to differentiate IAs at high and low risk of rupture to help clinical decision making. Yet, outcomes vary among studies, suggesting that novel analysis could improve rupture characterization. The authors describe a CFD analytic method to assess spatiotemporal characteristics of swirling flow vortices within IAs to improve characterization. Methods CFD simulations were performed for 47 subjects harboring one medium-sized (4-10 mm) middle cerebral artery (MCA) aneurysm with available 3D digital subtraction angiography data. Alongside conventional indices, quantified IA flow vortex spatiotemporal characteristics were applied during statistical characterization. Statistical supervised machine learning using a support vector machine (SVM) method was run with cross-validation (100 iterations) to assess flow vortex-based metrics' strength toward rupture characterization. Results Relying solely on vortex indices for statistical characterization underperformed compared with established geometric characteristics (total accuracy of 0.77 vs 0.80) yet showed improvements over wall shear stress models (0.74). However, the application of vortex spatiotemporal characteristics into the combined geometric and wall shear stress parameters augmented model strength for assessing the rupture status of middle cerebral artery aneurysms (0.85). Conclusions This preliminary study suggests that the spatiotemporal characteristics of flow vortices within MCA aneurysms are of value to improve the differentiation of ruptured aneurysms from unruptured ones.

Automated summary

This study utilized a CFD analytic method to evaluate the spatiotemporal characteristics of swirling flow vortices within intracranial aneurysms. The results showed that incorporating vortex spatiotemporal characteristics into a combined model with geometric and wall shear stress parameters improved the assessment of rupture status in middle cerebral artery aneurysms.