Evaluation of aneurysm rupture risk based upon flowrate-independent hemodynamic parameters: a multi-center pilot study
Evaluation of aneurysm rupture risk based upon flowrate-independent hemodynamic parameters: a multi-center pilot study
复制标题
DOI：
10.1136/neurintsurg-2022-018691
复制
发表时间：
2022-06
影响因子：
4.8
通讯作者：
Mingzi Zhang;Xiaoxi Hou;Y. Qian;W. Chong;Xin Zhang;C. Duan;Chubin Ou
中科院分区：
文献类型：
--
作者：
Mingzi Zhang;Xiaoxi Hou;Y. Qian;W. Chong;Xin Zhang;C. Duan;Chubin Ou
背景动脉瘤血流动力学模拟中的通用流动边界条件对动脉瘤破裂风险的评估产生了很大程度的不确定性。在此，我们提出了使用流量无关的参数来区分不稳定的动脉瘤，并将其预后性能与传统的绝对参数进行了比较。方法本回顾性研究包括从三个国际中心收集的186个动脉瘤，其中稳定的动脉瘤至少随访24个月。与流量无关的动脉壁剪切应力（WSS）和能量损失（EL）被定义为表征各自参数与载瘤动脉流量之间关系的二阶多项式的系数。定量了与流速无关的参数在使用逻辑回归、Adaboost和支持向量机（SVM）方法鉴别不稳定动脉瘤中的性能，并在灵敏度、特异性和曲线下面积（AUC）方面与常规参数进行了比较。结果在鉴别不稳定动脉瘤方面，与流量无关的EL具有最高的敏感性（0.833，95% CI 0.586至0.964）和特异性（0.833，95% CI 0.672至0.936），AUC优于传统EL 0.133（95% CI 0.039至0.226，p=0.006）。同样，在AUC方面，流量非依赖性WSS优于传统WSS（差异：0.137，95% CI 0.033 - 0.241，p=0.010）。结论与流量无关的血流动力学参数在预测动脉瘤稳定性方面优于常规参数，可作为一组有前途的血流动力学指标，用于在生理真实的血管边界条件不可用的情况下预测动脉瘤破裂风险。
Background Specifying generic flow boundary conditions in aneurysm hemodynamic simulations yields a great degree of uncertainty for the evaluation of aneurysm rupture risk. Herein, we proposed the use of flowrate-independent parameters in discriminating unstable aneurysms and compared their prognostic performance against that of conventional absolute parameters. Methods This retrospective study included 186 aneurysms collected from three international centers, with the stable aneurysms having a minimum follow-up period of 24 months. The flowrate-independent aneurysmal wall shear stress (WSS) and energy loss (EL) were defined as the coefficients of the second-order polynomials characterizing the relationships between the respective parameters and the parent-artery flows. Performance of the flowrate-independent parameters in discriminating unstable aneurysms with the logistic regression, Adaboost, and support-vector machine (SVM) methods was quantified and compared against that of the conventional parameters, in terms of sensitivity, specificity, and area under the curve (AUC). Results In discriminating unstable aneurysms, the proposed flowrate-independent EL achieved the highest sensitivity (0.833, 95% CI 0.586 to 0.964) and specificity (0.833, 95% CI 0.672 to 0.936) on the SVM, with the AUC outperforming the conventional EL by 0.133 (95% CI 0.039 to 0.226, p=0.006). Likewise, the flowrate-independent WSS outperformed the conventional WSS in terms of the AUC (difference: 0.137, 95% CI 0.033 to 0.241, p=0.010). Conclusion The flowrate-independent hemodynamic parameters surpassed their conventional counterparts in predicting the stability of aneurysms, which may serve as a promising set of hemodynamic metrics to be used for the prediction of aneurysm rupture risk when physiologically real vascular boundary conditions are unavailable.