Background Intracranial aneurysms (IAs) are common in the population and current imaging-based rupture risk assessment needs to be refined. We aimed to use four-dimensional CT angiography (4D-CTA) to investigate the associations of irregular pulsation of IAs with conventional risk factors and the estimated rupture risk.
Methods One hundred and five patients with 117 asymptomatic IAs underwent 4D-CTA. Geometric and morphologic parameters were measured and the presence of irregular pulsation (defined as a temporary focal protuberance ≥1 mm on more than three successive frames) was identified on 4D-CTA movies. One- and 5 year aneurysm rupture risk were estimated using UCAS and PHASES calculators. Univariate and multivariate analyses were performed to investigate the conventional risk factors associated with irregular pulsation.
Results Irregular pulsation was observed in 41.0% (48/117) of IAs. Aneurysm size (OR=1.380, 95% CI 1.165 to 1.634), irregular shape (OR=3.737, 95% CI 1.108 to 12.608), and internal carotid artery location (OR=0.151, 95% CI 0.056 to 0.403) were independently associated with irregular pulsation (P<0.05). Aneurysms with irregular pulsation had more than a 6-fold higher estimated rupture risk (1- and 5-year risk [95% CI], 1.56% [0.42%–3.91%], and 2.40% [1.30%–4.30%], respectively) than aneurysms without irregular pulsation (0.23% [0.14%–0.78%] and 0.40% [0.40%–1.30%], respectively) (P<0.001).
Conclusions IAs with irregular pulsation are associated with larger size, irregular-shape, and non-ICA origin, and have more than a 6-fold higher estimated 1- and 5-year rupture risk than aneurysms without irregular pulsation. Irregular pulsation should be validated in future longitudinal studies to determine its predictive value for aneurysm growth and rupture.
- CT angiography
- vessel wall
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JZ and XL are joint first authors.
JZ and XL contributed equally.
Contributors JZ and XL conceived and designed the research. JZ, XL, JZ, BS, LW, XL, JY, and HZ collected and reviewed the data. JZ and XL analyzed the data and performed the statistical analysis. XL, BZ, BS, HZ, and JX handled funding and supervision. JZ and XL drafted the manuscript. JZ, HZ, SD, MMB, XL, JW, and CZ made revision of the manuscript for important intellectual content.
Funding This study has received funding from the grants by National Natural Science Foundation of China (81801650, 81571630), Shanghai Municipal Health Commission (201940060, 201740080), Renji Hospital Project (RJZZ18-002, 2019NYBSZX01), and SJTU Medical Engineering Cross-cutting Research Foundation (YG2017MS45).
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval This study was approved by our institutional ethics committee (Renji hospital  no.093).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request. Because of the sensitive nature of the data, it is available upon request to the corresponding author.
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