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Original research
Critical role of angiographic acquisition modality and reconstruction on morphometric and haemodynamic analysis of intracranial aneurysms
  1. Alexandra Lauric,
  2. James E Hippelheuser,
  3. Adel M Malek
  1. Cerebrovascular and Endovascular Division, Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
  1. Correspondence to Dr Adel M Malek, Department of Neurosurgery, Tufts Medical Center, Boston, MA 02111, USA; amalek{at}


Background Subtracted 3-D rotational angiography (3DRA) and cone-beam computed tomography angiography (CBCT-A) are often used in assessing cerebral aneurysm shape and haemodynamic profile. We sought to evaluate the effect of imaging modality, reconstruction parameters, and kernel selection on patient-derived aneurysm morphology and computational fluid dynamic (CFD) analysis to assess its potential contribution to inter-study variability.

Methods Four patients (five aneurysms) underwent concurrent 3DRA followed by high-resolution CBCT-A. Six models were reconstructed per aneurysm: 3DRA reconstructed with 0.28 and 0.14 mm voxel sizes (large and small volume of interest (VOI) respectively), and two kernel types (normal/smooth). CBCT-A was reconstructed over small VOI using normal/sharp kernel. Maximal dome dimension, neck diameter and dome/neck ratio were evaluated in 3D. Wall shear stress (WSS) magnitude was evaluated on the entire aneurysm dome and in the 5% dome areas covered by lowest (LWSS) and highest (HWSS) WSS. Parameters were evaluated with pairwise t-test analysis.

Results Smaller VOI reconstructions resulted in smaller Dmax (P value=0.03) and Dmax/neck (P value=0.006) and in larger LWSS (P value=0.03). Use of sharp kernel led to narrower neck (P value=0.04) and higher Dmax/neck values (P value=0.02). CBCT-A resulted in statistically different aneurysm shape (up to 24% difference) and haemodynamics (up to 97% difference) compared with 3DRA.

Conclusion The choice of catheter 3D angiographic modality and reconstruction kernel has a critical impact on derived aneurysm morphological and haemodynamic analysis. The resultant variability can confound and obscure underlying differences within patient populations and between studies performed at different centres using divergent techniques, compromising the accuracy of quantitative aneurysm analysis.

  • intracranial aneurysms
  • wall shear stress
  • image modality
  • reconstruction

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  • Contributors The research is original and each author provided significant contribution to the work.

  • Funding This work was supported by a fellowship support from Medtronic Inc. and Microvention Inc.

  • Competing interests The senior author (AMM) has received research funding from Stryker for research that is unrelated to the submitted work.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval This research was approved by Tufts Health Sciences Campus Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.