Quantified aneurysm shape and rupture risk

Object. The authors investigated whether quantified shape or size indices could better discriminate between ruptured and unruptured aneurysms. Methods. Several custom algorithms were created to quantifiy the size and shape indices of intracranial aneurysms by using three-dimensional computerized tomography angiography models of the brain vasculature. Data from 27 patients with ruptured or unruptured aneurysms were evaluated in a blinded fashion to determine whether aneurysm size or shape better discriminated between the ruptured and unruptured groups. Five size and eight shape indices were calculated for each aneurysm. Two-tailed independent Student t-tests (significance p < 0.05) were used to determine statistically significant differences between ruptured and unruptured aneurysm groups for all 13 indices. Receiver-operating characteristic-area under curve analyses were performed for all indices to quantify the predictability of each index and to identify optimal threshold values. None of the five size indices were significantly different between the ruptured and unruptured aneurysms. Five of the eight shape indices were significantly different between the two lesion groups, and two other shape indices showed a trend toward discriminating between ruptured and unruptured aneurysms, although these differences did not reach statistical significance. Conclusions. Quantified shape is more effective than size in discriminating between ruptured and unruptured aneurysms. Further investigation will determine whether quantified aneurysm shape will prove to be a reliable predictor of aneurysm rupture.