Introduction and Purpose Incidentally discovered cerebral aneurysms are increasingly common as patients are more frequently imaged. To aid in their management, we developed an aneurysm alert system. Here we describe the effectiveness and outcomes of our Incidental Aneurysm Alert System (IAAS) and the racial and ethnic disparities on discovery.
Materials and Methods IAAS received MRA and CTA reports from our Radiology department. Reports were parsed using natural language processing to identify ‘aneurysm,’ automatically generating alerts for the interventional neuroradiologists. Background demographics, referral patterns, risk factors, and management were then assessed. Between-group comparison for continuous variables was performed using ANOVA, and categorical variables using the chi-squared test. Multivariable logistic regression was also performed in SPSS. Significance was defined as p ≤ 0.05.
Results From March 2020 to March 2021, 237 consecutive reports were reviewed. After excluding duplicates and non-vascular lesions, there were 183 unique cases resulting in an 83% aneurysm detection accuracy rate. Median age was 65 and 65% were female. Most frequent races were 48% non-Hispanic White, 27% Hispanic, 10% Asian, 7% Black, and 10% unknown and other.
Fifty-five percent were detected in an emergency setting, while 41% were outpatients. The most common referring outpatient specialty was neurology (37%), followed by primary care (32%) and other subspecialties (27%). Of the outpatient referrals, only 16% originated from community practice. The most frequent indication for imaging was acute stroke or focal deficits (54%). Nearly 50% of detected aneurysms resulted in a consultation with a neuro-interventionalist. Of those referred, 58% underwent diagnostic or therapeutic angiography. Sixty-four percent (n=37) of those who underwent cerebral angiography were intervened upon immediately or within two years of discovery. Five percent were ruptured on discovery. Aneurysms were most frequently treated with primary coiling (35%), flow diversion (30%), and clipping (16%).
Asians and Hispanics were significantly younger (mean age 60 and 61 years, respectively) than Non-Hispanic Whites (mean age 69 years, p=0.01). Non-Hispanic Whites were significantly more likely to present in the outpatient setting with more focal complaints, such as acute stroke or headache, than Hispanic patients with non-focal complaints (p=0.03). Asian and Hispanic patients also presented with larger aneurysms and significantly higher PHASES scores on presentation of 6.6 (1.7-2.4% 5-year rupture risk) and 5.2 (1.3-1.7% 5-year rupture risk), respectively (p=0.05). There were no significant differences in aneurysm location or risk factors. Logistic regression analysis showed that higher PHASES scores significantly predicted aneurysm treatment (OR 1.61, 1.14-2.27 95% CI, p=0.007).
Conclusions IAAS is an effective alerting system and can improve the management of incidentally discovered cerebral aneurysms. The natural history of cerebral aneurysms may differ for Hispanic and
Asian Americans, suggesting a potentially higher risk at presentation. Future research is needed to better understand these disparities’ causes and reduce their risks.
Disclosures K. Fukuda: None. Y. Ghochani: None. D. Enzmann: None. C. Arnold: None. X. Chen: None. J. Morales: None. D. Kimball: None. C. Beaman: None. G. Duckwiler: None. R. Jahan: None. S. Tateshima: None. V. Szeder: None. N. Kaneko: None. M. Nour: None.
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