A Simple Flow Classification Parameter Can Discriminate Rupture Status in Intracranial Aneurysms.
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BACKGROUND: A simple dimensionless aneurysm number ($An$), which depends on geometry and flow pulsatility, was previously shown to distinguish the flow mode in intracranial aneurysms (IA): vortex mode with a dynamic vortex formation/evolution if $An > 1$, and cavity mode with a steady shear layer if $An < 1$. OBJECTIVE: To hypothesize that $An > 1$ can distinguish rupture status because vortex mode is associated with high oscillatory shear index, which, in turn, is statistically associated with rupture. METHODS: The above hypothesis is tested on a retrospective, consecutively collected database of 204 patient-specific IAs. The first 119 cases are assigned to training and the remainder to testing dataset. $An$ is calculated based on the pulsatility index (PI) approximated either from the literature or solving an optimization problem (denoted as$ widehat {PI}$). Student's t-test and logistic regression (LR) are used for hypothesis testing and data fitting, respectively. RESULTS: $An$ can significantly discriminate ruptured and unruptured status with 95% confidence level (P <.0001). $An$ (using PI) and $widehat {An}$ (using $widehat {PI}$) significantly predict the ruptured IAs (for training dataset $An!: $AUC=0.85, $widehat {An}!: $AUC=0.90, and for testing dataset $An!: $sensitivity=94%, specificity=33%, $widehat {An}!: $sensitivity=93.1%, specificity=52.85%). CONCLUSION: $An > 1$ predicts ruptured status. Unlike traditional hemodynamic parameters such as wall shear stress and oscillatory shear index, $An$ has a physical threshold of one (does not depend on statistical analysis) and does not require time-consuming flow simulations. Therefore, $An$ is a simple, practical discriminator of IA rupture status.
