Objectives The aim of the present study was to identify image-based morphological parameters and anatomical locations associated with intracranial aneurysm (IA) rupture.

Methods Nine morphological parameters and aneurysm location were evaluated in 150 patients with saccular IAs (82 unruptured, 68 ruptured) using three-dimensional geometry. Aneurysm location and morphological parameters including size, aspect ratio, size ratio, height–width ratio, flow angle, aneurysm inclination angle, parent artery angle, vessel angle, and aneurysm shape were explored to identify a correlation with aneurysm rupture. These factors were analyzed using a two-tailed independent Student t test or the χ test for significance. Significant factors were further examined using logistic regression analysis. Additionally, receiver operating characteristic (ROC) analysis was performed to evaluate each parameter.

Results Statistically significant differences were observed in ruptured and unruptured groups for aspect ratio, size ratio, height–width ratio, flow angle, aneurysm inclination angle, vessel angle, aneurysm shape, and aneurysm location. Logistic regression analysis further revealed that size ratio (OR 1.66; 95% CI 1.05 to 2.64), height–width ratio (OR 14.22; 95% CI 2.67 to 75.88), aneurysm inclination angle (OR 1.04; 95% CI 1.01 to 1.07), aneurysm shape (OR 4.68; 95% CI 2.44 to 8.98), and aneurysm location (OR 1.60; 95% CI 1.15 to 2.23) had the strongest independent correlation with ruptured IA. The ROC analysis showed that the size ratio and flow angle had the highest area under the curve, with values of 0.735 and 0.730, respectively.

Conclusions Size ratio, height–width ratio, aneurysm inclination angle, aneurysm shape, and aneurysm location might be important for discriminating between ruptured and unruptured aneurysms. Further investigation will determine whether these morphological parameters and anatomical locations will be reliable predictors of aneurysm rupture.