Development and internal validation of an aneurysm rupture probability model based on patient characteristics and aneurysm location, morphology, and hemodynamics.
Development and internal validation of an aneurysm rupture probability model based on patient characteristics and aneurysm location, morphology, and hemodynamics.
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DOI：
10.1007/s11548-018-1837-0
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发表时间：
2018-11
影响因子：
3
通讯作者：
Cebral JR
中科院分区：
文献类型：
--
作者：
Detmer FJ;Chung BJ;Mut F;Slawski M;Hamzei-Sichani F;Putman C;Jiménez C;Cebral JR
未破裂的脑动脉瘤给医生带来了一个两难的境地，他们在决定治疗策略时需要权衡破坏性蛛网膜下腔出血的风险与手术或血管内治疗的风险及其并发症。预测模型可能会支持这样的治疗决策。本研究的目的是根据血流动力学和几何参数、动脉瘤位置以及患者性别和年龄开发并内部验证动脉瘤破裂模型。来自1，061名患者的横截面数据用于1，631个动脉瘤的基于图像的计算流体动力学和形状表征，以使用逻辑组Lasso回归训练动脉瘤破裂概率模型。基于受试者工作特征（ROC）的曲线下面积（AUC）和校准图，对模型的区分度和校准进行了内部验证。最终模型保留了11个血流动力学和12个形态学变量、动脉瘤位置以及患者年龄和性别。以较高的最大振荡剪切指数、较高的动能和较小的低剪切面积以及更复杂的动脉瘤形状为特征的不良血流动力学环境、男性和年轻人与破裂风险增加相关。模型的相应AUC为0.86（95% CI [0.85，0.86]，乐观校正后为0.84）。该模型结合了各个领域的变量，能够区分破裂和未破裂的动脉瘤，AUC为86%。内部验证表明，该模型在临床实践中的应用潜力与纵向数据评估后。
Unruptured cerebral aneurysms pose a dilemma for physicians who need to weigh the risk of a devastating subarachnoid hemorrhage against the risk of surgery or endovascular treatment and their complications when deciding on a treatment strategy. A prediction model could potentially support such treatment decisions. The aim of this study was to develop and internally validate a model for aneurysm rupture based on hemodynamic and geometric parameters, aneurysm location, and patient gender and age. Cross-sectional data from 1,061 patients were used for image-based computational fluid dynamics and shape characterization of 1,631 aneurysms for training an aneurysm rupture probability model using logistic group Lasso regression. The model’s discrimination and calibration were internally validated based on the area under the curve (AUC) of the receiver operating characteristic (ROC) and calibration plots. The final model retained 11 hemodynamic and 12 morphological variables, aneurysm location, as well as patient age and gender. An adverse hemodynamic environment characterized by a higher maximum oscillatory shear index, higher kinetic energy and smaller low shear area as well as a more complex aneurysm shape, male gender and younger age were associated with an increased rupture risk. The corresponding AUC of the model was 0.86 (95% CI [0.85, 0.86], after correction for optimism 0.84). The model combining variables from various domains was able to discriminate between ruptured and unruptured aneurysms with an AUC of 86%. Internal validation indicated potential for the application of this model in clinical practice after evaluation with longitudinal data.
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影响因子：
5.7
作者：
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DOI：
10.3174/ajnr.a3678
发表时间：
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期刊：
AJNR. American journal of neuroradiology
影响因子：
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作者：
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通讯作者：
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DOI：
10.1111/j.1467-9868.2007.00627.x
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2008-01-01
影响因子：
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作者：
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