Stability of unruptured intracranial aneurysms in the anterior circulation: nomogram models for risk assessment

Qingyuan Liu; Xinyi Leng; Junhua Yang; Yi Yang; Pengjun Jiang; Maogui Li; Shaohua Mo; Shuzhe Yang; Jun Wu; Hongwei He; Shuo Wang

doi:10.3171/2021.10.JNS211709

Stability of unruptured intracranial aneurysms in the anterior circulation: nomogram models for risk assessment

J Neurosurg. 2022 Jan 21:1-10. doi: 10.3171/2021.10.JNS211709. Online ahead of print.

Authors

Qingyuan Liu^{1

2}, Xinyi Leng³, Junhua Yang^{1

2}, Yi Yang^{1

2}, Pengjun Jiang^{1

2}, Maogui Li^{1

2}, Shaohua Mo^{1

2}, Shuzhe Yang^{1

2}, Jun Wu¹, Hongwei He⁴, Shuo Wang^{1

2}

Affiliations

¹ 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing.
² 2China National Clinical Research Center for Neurological Diseases, Beijing.
³ 4Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
⁴ 3Department of Neurointervention, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; and.

PMID: 35061990
DOI: 10.3171/2021.10.JNS211709

Abstract

Objective: The probable stability of the lesion is critical in guiding treatment decisions in unruptured intracranial aneurysms (IAs). The authors aimed to develop multidimensional predictive models for the stability of unruptured IAs.

Methods: Patients with unruptured IAs in the anterior circulation were prospectively enrolled and regularly followed up. Clinical data were collected, IA morphological features were assessed, and adjacent hemodynamic features were quantified with patient-specific computational fluid dynamics modeling. Based on multivariate logistic regression analyses, nomograms incorporating these factors were developed in a primary cohort (patients enrolled between January 2017 and February 2018) to predict aneurysm rupture or growth within 2 years. The predictive accuracies of the nomograms were compared with the population, hypertension, age, size, earlier rupture, and site (PHASES) and earlier subarachnoid hemorrhage, location, age, population, size, and shape (ELAPSS) scores and validated in the validation cohort (patients enrolled between March and October 2018).

Results: Among 231 patients with 272 unruptured IAs in the primary cohort, hypertension, aneurysm location, irregular shape, size ratio, normalized wall shear stress average, and relative resident time were independently related to the 2-year stability of unruptured IAs. The nomogram including clinical, morphological, and hemodynamic features (C+M+H nomogram) had the highest predictive accuracy (c-statistic 0.94), followed by the nomogram including clinical and morphological features (C+M nomogram; c-statistic 0.89), PHASES score (c-statistic 0.68), and ELAPSS score (c-statistic 0.58). Similarly, the C+M+H nomogram had the highest predictive accuracy (c-statistic 0.94) in the validation cohort (85 patients with 97 unruptured IAs).

Conclusions: Hemodynamics have predictive values for 2-year stability of unruptured IAs treated conservatively. Multidimensional nomograms have significantly higher predictive accuracies than conventional risk prediction scores.

Keywords: hemodynamics; multidimensional predictive model; nomograms; stability; unruptured intracranial aneurysm; vascular disorders.