Morphological parameters related to ruptured aneurysm in the patient with multiple cerebral aneurysms (clinical investigation)

Objectives: We evaluated the rupture risk of multiple cerebral aneurysms in aspects of various morphological parameters, and determined which parameter can be a reliable predictor as one aneurysm ruptured, and the others did not. Methods: Between 2007 and 2012, three-dimensional (3D) angiographic images of 85 patients harboring multiple aneurysms (85 ruptured and 104 unruptured aneurysms) were used to assess the following morphological parameters: geometry of the aneurysm itself, e. g. maximal size, aspect ratio, bottleneck ratio, height/width ratio, undulation, and daughter sac; architecture of the aneurysm and surrounding vessels, e. g. aneurysmal angle, vessel angle, inflow angle, parent-daughter angle, and size ratio type I & II. Univariate analysis was applied to all parameters, and significant parameters were identified in multivariate analysis, yielding the cut-off point from receiver-operating characteristic (ROC) curve analysis. Results: On multivariate logistic regression, the aspect ratio [odds ratio (OR), 1.21; 95% confidence interval (CI), 1.05-1.41] and daughter sac (OR, 3.12; 95% CI, 1.05-9.27) were significant parameters in geometries of the aneurysm itself. The size ratio type I (OR, 1.14; 95% CI, 1.05-1.22) and parent-daughter angle (OR, 1.02; 95% CI, 1.00-1.04) were independent parameters in architecture of the aneurysm and surrounding vessels. From the ROC curve, the aspect ratio and size ratio type I had cut-off values of 1.3 and 1.8, respectively. Conclusion: Several morphological parameters were investigated to predict a rupture in multiple cerebral aneurysms using 3D angiogram. The aspect ratio, size ratio type I, daughter sac, and parent-daughter angle were revealed as competent parameters.