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International Journal of Computer Assisted Radiology and Surgery

Published in:

01-11-2018 | Original Article

Development and internal validation of an aneurysm rupture probability model based on patient characteristics and aneurysm location, morphology, and hemodynamics

Authors: Felicitas J. Detmer, Bong Jae Chung, Fernando Mut, Martin Slawski, Farid Hamzei-Sichani, Christopher Putman, Carlos Jiménez, Juan R. Cebral

Published in: International Journal of Computer Assisted Radiology and Surgery | Issue 11/2018

Abstract

Purpose

Unruptured cerebral aneurysms pose a dilemma for physicians who need to weigh the risk of a devastating subarachnoid hemorrhage against the risk of surgery or endovascular treatment and their complications when deciding on a treatment strategy. A prediction model could potentially support such treatment decisions. The aim of this study was to develop and internally validate a model for aneurysm rupture based on hemodynamic and geometric parameters, aneurysm location, and patient gender and age.

Methods

Cross-sectional data from 1061 patients were used for image-based computational fluid dynamics and shape characterization of 1631 aneurysms for training an aneurysm rupture probability model using logistic group Lasso regression. The model’s discrimination and calibration were internally validated based on the area under the curve (AUC) of the receiver operating characteristic and calibration plots.

Results

The final model retained 11 hemodynamic and 12 morphological variables, aneurysm location, as well as patient age and gender. An adverse hemodynamic environment characterized by a higher maximum oscillatory shear index, higher kinetic energy and smaller low shear area as well as a more complex aneurysm shape, male gender and younger age were associated with an increased rupture risk. The corresponding AUC of the model was 0.86 (95% CI [0.85, 0.86], after correction for optimism 0.84).

Conclusion

The model combining variables from various domains was able to discriminate between ruptured and unruptured aneurysms with an AUC of 86%. Internal validation indicated potential for the application of this model in clinical practice after evaluation with longitudinal data.

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Title: Development and internal validation of an aneurysm rupture probability model based on patient characteristics and aneurysm location, morphology, and hemodynamics
Authors: Felicitas J. Detmer
Bong Jae Chung
Fernando Mut
Martin Slawski
Farid Hamzei-Sichani
Christopher Putman
Carlos Jiménez
Juan R. Cebral
Publication date: 01-11-2018
Publisher: Springer International Publishing
Published in: International Journal of Computer Assisted Radiology and Surgery / Issue 11/2018
Print ISSN: 1861-6410
Electronic ISSN: 1861-6429
DOI: https://doi.org/10.1007/s11548-018-1837-0

At a glance: The STEP trials

Springer Medicine

Development and internal validation of an aneurysm rupture probability model based on patient characteristics and aneurysm location, morphology, and hemodynamics

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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