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Original research
Volume variation may be a relevant metric in the study of aneurysm pulsatility: a study using ECG-gated 4D-CTA (PULSAN)
  1. Brieg Dissaux1,2,
  2. Julien Ognard1,3,
  3. Mourad Cheddad El Aouni1,
  4. Michel Nonent1,2,
  5. Karim Haioun4,
  6. Elsa Magro3,5,
  7. Jean Christophe Gentric1,2
  1. 1 Neuroradiology Department, CHRU de la Cavale Blanche, Brest, France
  2. 2 Groupement d'Etude de la Thrombose en Bretagne Occidentale - EA 3878 (GETBO) IFR 148, CHRU de la Cavale Blanche, Brest, France
  3. 3 Laboratoire de traitement de l’information médicale - LaTIM (Inserm UMR 1101), Brest, France
  4. 4 Canon Medical Systems France, CT Division, Puteaux, France
  5. 5 Neurosurgery Department, CHRU de la Cavale Blanche, Brest, France
  1. Correspondence to Dr Brieg Dissaux, Service d'Imagerie Médicale, CHU de la Cavale Blanche, boulevard Tanguy-Prigent, 29609 Brest Cedex, France; brieg.dissaux{at}; Dr Jean Christophe Gentric; jean-christophe.gentric{at}


​Background and purpose Intracranial aneurysms are a frequently occurring disease, with an estimated prevalence of 2–5% in the general population. They usually remain silent until rupture occurs, with a mortality rate of 35–50% and a high rate of morbidity, including long-term disability. However, preventative treatments have their own risk of complications and morbi-mortality rates, including stroke and hemorrhage. ECG-gated four-dimensional CT angiography (4D-CTA) allows the acquisition of time-resolved three-dimensional reconstructions. The aim of our study was to evaluate different intracranial aneurysm metrics over the cardiac cycle using ECG-gated 4D-CTA.

​Materials and methods ECG-gated 4D-CTA datasets were acquired in patients presenting with intracranial aneurysms. Seven aneurysm metrics, including aneurysm height, aneurysm length, ostium width, aspect ratio, ostium area, volume, and volume-to-ostium ratio, were analysed over different cardiac phases. Intra-reader agreement, inter-reader agreement, and inter-cycle agreement were calculated through the intraclass correlation coefficient.

​Results Twenty-one aneurysms from 11 patients were considered for inclusion. Post-processing failed for three aneurysms, and 18 aneurysms were finally analysed. There was good intra-reader agreement for each metric (ICC >0.9). Agreements among three consecutive cardiac cycles were calculated for six aneurysms and were especially good for the volume metric (ICC >0.9). Volume variation appears to be the most relevant metric and seems especially perceptible for aneurysms larger than 5 mm.

​Conclusions Quantification of aneurysm volume changes during the cardiac cycle seems quantitatively possible and reproducible, especially for aneurysms larger than 5 mm. Further studies need to be conducted to validate this parameter for intracranial aneurysm assessment.

  • Aneurysm
  • CT Angiography

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  • Contributors BD, JCG, and JO designed and directed the project. KH provided technical expertise. EM and MN helped with implementation. BD and MCEA carried out the experiments. BD and JO performed the analysis. JO provided statistical expertise and conducted the primary statistical analysis. JO analyzed and controlled the data. BD, JO, and JCG wrote the paper. All authors discussed the results and commented on the manuscript. JCG is the scientific guarantor of this publication.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests HK is an employee of Canon Medical Systems France and provided technical data about the new acquisition. The study data and results were generated and controlled at all times by the research personnel, with no influence from Canon. The other authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

  • Patient consent for publication Not required.

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

  • Data availability statement No data are available.