Abstract
Geometric indices defined on intracranial aneurysms have been widely used in rupture risk assessment and surgical planning. However, most indices employed in clinical settings are currently evaluated based on two-dimensional images that inevitably fail to capture the three-dimensional nature of complex aneurysmal shapes. In addition, since measurements are performed manually, they can suffer from poor inter and intra operator repeatability. The purpose of the current work is to introduce objective and robust techniques for the 3D characterization of intracranial aneurysms, while preserving a close connection to the way aneurysms are currently characterized in clinical settings. Techniques for automatically identifying the neck plane, key aneurysm dimensions, shape factors, and orientations relative to the parent vessel are demonstrated in a population of 15 sidewall and 15 terminal aneurysms whose surface has been obtained by two trained operators using both level-set segmentation and thresholding, the latter reflecting typical clinical practice. Automatically-identified neck planes are shown to be in concordance with those manually positioned by an expert neurosurgeon, and automatically-derived geometric indices are shown to be largely insensitive to segmentation method or operator. By capturing the 3D nature of aneurysmal sacs and by minimizing observer variability, our approach allows large retrospective and prospective studies on aneurysm geometric risk factors to be performed using routinely acquired clinical images.
Similar content being viewed by others
References
Antiga, L., and D. A. Steinman. Robust and objective decomposition and mapping of bifurcating vessels. IEEE Trans. Med. Imaging 23:704–713, 2004.
Antiga, L. and D. A. Steinman. Vascular Modeling Toolkit, 2008. Available at http://www.vmtk.org. Accessed 20 Apr 2012.
Anxionnat, R., S. Bracard, X. Ducrocq, Y. Trousset, L. Launay, E. Kerrien, M. Braun, R. Vaillant, F. Scomazzoni, A. Lebedinsky, and L. Picard. Intracranial aneurysms: clinical value of 3D digital subtraction angiography in the therapeutic decision and endovascular treatment. Radiology 218:799–808, 2001.
Baharoglu, M. I., C. M. Schirmer, D. A. Hoit, B. L. Gao, and A. M. Malek. Aneurysm inflow-angle as a discriminant for rupture in sidewall cerebral aneurysms. Stroke 41:1423–1430, 2010.
Cardenes, R., J. Pozo, H. Bogunovic, I. Larrabide, and A. Frangi. Automatic aneurysm neck detection using surface Voronoi Diagrams. IEEE Trans. Med. Imaging 30(10):1863–1876, 2011.
Cebral, J. R., F. Mut, J. Weir, and C. Putman. Quantitative characterization of the hemodynamic environment in ruptured and unruptured brain aneurysms. AJNR Am. J. Neuroradiol. 32:145–151, 2011.
Cebral, J. R., F. Mut, J. Weir, and C. M. Putman. Association of hemodynamic characteristics and cerebral aneurysm rupture. AJNR Am. J. Neuroradiol. 32:264–270, 2011.
Cebral, J. R., M. Sheridan, and C. M. Putman. Hemodynamics and bleb formation in intracranial aneurysms. AJNR Am. J. Neuroradiol. 31:304–310, 2010.
Chien, A., J. Sayre, and F. Vinuela. Comparative morphological analysis of the geometry of ruptured and unruptured aneurysms. Neurosurgery 69:349–356, 2011.
Dhar, B. E., M. Tremmel, J. Mocco, M. Kim, J. Yamamoto, A. H. Siddiqui, L. N. Hopkins, and H. Meng. Morphology parameters for intracranial aneurysm rupture risk assessment. Neurosurgery 63:185–196, 2008.
Ebel, R. L. Estimation of the reliability of ratings. Psychometrika 16:407–424, 1951.
Ford, M. D., Y. Hoi, M. Piccinelli, L. Antiga, and D. A. Steinman. An objective approach to digital removal of saccular aneurysms: techniques and applications. Br. J. Radiol. 82:S55–S61, 2009.
Ford, M. D., S. W. Lee, S. P. Lownie, D. W. Holdsworth, and D. A. Steinman. On the effect of parent-aneurysm angle on flow patterns in basilar tip aneurysms: towards a surrogate geometric marker of intra-aneurysmal hemodynamics. J. Biomech. 41:241–248, 2008.
Hoh, B. L., C. L. Sistrom, C. S. Firment, G. L. Fautheree, G. J. Velat, J. H. Whiting, J. F. Reavey-Cantwell, and S. B. Lewis. Bottleneck factor and height-width ratio: association with ruptured aneurysms in patients with multiple cerebral aneurysms. Neurosurgery 61:716–722, 2007.
Hoi, Y., H. Meng, S. H. Woodward, B. R. Bendok, R. A. Hanel, L. R. Guterman, and L. N. Hopkins. Effects of arterial geometry on aneurysm growth: three-dimensional computational fluid dynamics study. J. Neurosurg. 101:676–681, 2004.
Larrabide, I., M. C. Villa-Uriol, R. Cardenes, M. J. Pozo, J. Macho, L. S. Roman, J. Blasco, E. Vivas, A. Manzo, D. R. Hose, and A. F. Frangi. Three dimensional morphological analysis of intracranial aneurysms: a fully automated method for aneurysm sac isolation and quantification. Med. Phys. 38:2439–2449, 2011.
Lauric, A., E. L. Miller, M. I. Baharoglu, and A. M. Malek. 3D shape analysis of intracranial aneurysms using the writhe number as a discriminant for rupture. Ann. Biomed. Eng. 39:1457–1469, 2011.
Ma, B., R. E. Harbaugh, and M. L. Raghavan. Three-dimensional geometrical characterization of cerebral aneurysms. Ann. Biomed. Eng. 32:264–273, 2004.
Ma, D., M. Tremmel, R. A. Paluch, E. I. Levy, H. Meng, and J. Mocco. Size ratio for clinical assessment of intracranial aneurysm rupture risk. Neurol. Res. 32:482–486, 2010.
Mantha, A. R., G. Benndorf, A. Hernandez, and R. W. Metcalfe. Stability of pulsatile blood flow at the ostium of cerebral aneurysms. J. Biomech. 42:1081–1087, 2009.
Parlea, L. P., R. Fahrig, D. W. Holdsworth, and S. P. Lownie. An analysis of the geometry of saccular intracranial aneurysms. AJNR Am. J. Neuroradiol. 20:1079–1089, 1999.
Passerini, T., L. Sangalli, S. Vantini, M. Piccinelli, S. Bacigaluppi, L. Antiga, E. Boccardi, P. Secchi, and A. Veneziani. An integrated statistical investigation of internal carotid arteries of patients affected by cerebral aneurysms. Cardiovasc. Eng. Technol. 3:26–40, 2012.
Piccinelli, M., S. Bacigaluppi, E. Boccardi, B. Ene-Iordache, A. Remuzzi, A. Veneziani, and L. Antiga. Geometry of internal carotid artery and recurrent patterns in location, orientation and rupture status of lateral aneurysms: an image-based computational study. Neurosurgery 68(5):1270–1285, 2011.
Piccinelli, M., A. Veneziani, D. A. Steinman, A. Remuzzi, and L. Antiga. A framework for geometric analysis of vascular structures: application to cerebral aneurysms. IEEE Trans. Med. Imaging 28:1141–1155, 2009.
R Development Core Team. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing, 2005. http://www.R-project.org. Accessed 20 Apr 2012.
Raghavan, M. L., B. Ma, and R. E. Harbaugh. Quantified aneurysm shape and ruptured risk. J. Neurosurg. 102:355–362, 2005.
Raghavan, M. L., J. Torner, J. Zhang, I. Meissner, D. Piepgras, J. Huston, and R. Brown. Assessment of intracranuial aneurysms morphology in a large patient population. In: 6th World Congress of Biomechanics 2010, Singapore.
Ryu, C. W., O. K. Kwon, J. S. Koh, and E. J. Kim. Analysis of aneurysm rupture in relation to the geometric indices: aspect ratio, volume, and volume-to-neck ratio. Neuroradiology 53(11):883–889, 2011.
Sangalli, M. L., P. Secchi, S. Vantini, and A. Veneziani. A case study in exploratory functional data analysis: geometrical features of the internal carotid artery. J. Am. Stat. Assoc. 104:37–48, 2009.
Sgouritsa E., A. Mohamed, H. Morsi, H. Shaltoni, M. Mawad, and I. Kakadiaris. Neck localization and geometry quantification of intracranial aneurysms. In: IEEE International Symposium on Biomedical Imaging, 2010, pp. 1057–1060.
Tateshima, A., A. Chien, J. Sayre, J. Cebral, and F. Vinuela. The effect of aneurysm geometry on the intra-aneurysmal flow condition. Neuroradiology 52:1135–1141, 2010.
Ujiie, H., H. Tachibana, O. Hiramatsu, A. L. Hazel, T. Matsumoto, Y. Ogasawara, H. Nakajima, T. Hori, K. Takakura, and F. Kajiya. Effects of size and shape (aspect ratio) on the hemodynamics of saccular aneurysms: a possible index for surgical treatment of intracranial aneurysms. Neurosurgery 45:119–129, 1999.
Weir, J. P. Quantifying test-reliability using the intraclass correlation coefficient and the SEM. J. Strength Cond. Res. 19:231–240, 2005.
Xiang, J., S. K. Natarajan, M. Tremmel, D. Ma, J. Mocco, L. N. Hopkins, A. H. Siddiqui, E. I. Levy, and H. Meng. Hemodynamic-morphologic discriminants for intracranial aneurysm rupture. Stroke 42:144–152, 2011.
Yasuda, R., C. M. Strother, W. Taki, K. Shinki, K. Royalty, K. Pulfer, and C. Karmonik. Aneurysm volume-to-ostium area ratio: a parameter useful in discriminating the rupture status of intracranial aneurysms. Neurosurgery 68:310–317, 2011.
Acknowledgments
This study was supported by a grant from the Canadian Institutes of Health Research. YH and DAS also acknowledge the support of, respectively, a Research Fellowship and Career Investigator Award from the Heart & Stroke Foundation of Canada. Aneurisk (2005–2008) was a joint project developed at MOX-Politecnico di Milano for the development of geometric, computational and statistical tools for the analysis of cerebral aneurysms supported by Fondazione Politecnico di Milano and Siemens Medical Solutions Italy. MP and AV acknowledge the support of the Brain Aneurysm Foundation. This study was also supported by a grant from the Emory University Research Committee (URC).
Author information
Authors and Affiliations
Corresponding author
Additional information
Associate Editor Joan Greve oversaw the review of this article.
Rights and permissions
About this article
Cite this article
Piccinelli, M., Steinman, D.A., Hoi, Y. et al. Automatic Neck Plane Detection and 3D Geometric Characterization of Aneurysmal Sacs. Ann Biomed Eng 40, 2188–2211 (2012). https://doi.org/10.1007/s10439-012-0577-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10439-012-0577-5