Morphology of Ruptured and Unruptured Intracranial Aneurysms

Tammam Abboud; Jihad Rustom; Maxim Bester; Patrick Czorlich; Eik Vittorazzi; Hans O Pinnschmidt; Manfred Westphal; Jan Regelsberger

doi:10.1016/j.wneu.2016.12.053

Morphology of Ruptured and Unruptured Intracranial Aneurysms

World Neurosurg. 2017 Mar:99:610-617. doi: 10.1016/j.wneu.2016.12.053. Epub 2016 Dec 23.

Authors

Tammam Abboud¹, Jihad Rustom², Maxim Bester³, Patrick Czorlich⁴, Eik Vittorazzi⁵, Hans O Pinnschmidt⁵, Manfred Westphal⁴, Jan Regelsberger⁴

Affiliations

¹ Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Electronic address: tabboud@uke.de.
² Department of Internal Medicine, Klinikum Itzehoe, Itzehoe, Germany.
³ Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
⁴ Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
⁵ Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

PMID: 28017741
DOI: 10.1016/j.wneu.2016.12.053

Abstract

Background: In addition to size and location, the morphology of intracranial aneurysms has been proposed to predict rupture. This study was undertaken to compare morphologic features between ruptured and unruptured aneurysms and identify those associated with greater risk of rupture.

Methods: Between 2010 and 2014, 301 patients with subarachnoid hemorrhage and 204 with unruptured aneurysms were admitted to our hospital. Two investigators reviewed 3-dimensional angiograms of all aneurysms. Risk factors for rupture were identified. Morphology was classified into single-sac aneurysms with smooth margin, single-sac aneurysms with irregular margin, aneurysms with a daughter sac, and multilobulated aneurysms. The value of morphology in predicting rupture was tested with the use of logistic regression.

Results: A total of 420 aneurysms met the inclusion criteria. Multilobulated aneurysm was the most frequent finding among ruptured aneurysms, followed by single sac with irregular margin, aneurysm with daughter sac, and single sac with smooth margin (44.9%, 25.9%, 18%, and 11.2%, respectively). Among unruptured aneurysms, single sac with smooth margin was the most frequent finding, followed by single sac with irregular margin, multilobulated aneurysm, and aneurysm with daughter sac (38.1%, 29.8%, 20.9%, and 11.2%, respectively). Morphology was an independent predictor of rupture (receiver operating characteristic-area under the curve 0.693, P < 0.001). Risk of rupture increased by factor of 3 (5, 95% confidence interval [CI] 1.6-5.3) from single sac with regular margin to irregular margin, by factor of 5.5 (5, 95% CI 2.8-11.0) to daughter sac, and by factor of 7.3 (5, 95% CI 4.1-13.1) to multilobulated aneurysm.

Conclusions: Morphology might have an independent predictive value of aneurysm rupture. Risk of rupture might increase according to extent of morphologic change. Prospective studies will be necessary to evaluate the influence of aneurysm morphology on natural history.

Keywords: Aneurysm rupture; Intracranial aneurysm; Morphology; Subarachnoid hemorrhage.

MeSH terms

Adult
Aged
Aged, 80 and over
Aneurysm, Ruptured / complications
Aneurysm, Ruptured / diagnostic imaging*
Area Under Curve
Carotid Artery, Internal / diagnostic imaging*
Cerebral Angiography
Computed Tomography Angiography
Female
Humans
Imaging, Three-Dimensional
Intracranial Aneurysm / complications
Intracranial Aneurysm / diagnostic imaging*
Logistic Models
Male
Middle Aged
Middle Cerebral Artery / diagnostic imaging*
ROC Curve
Retrospective Studies
Risk Assessment
Risk Factors
Subarachnoid Hemorrhage / diagnostic imaging*
Subarachnoid Hemorrhage / etiology
Young Adult