Morphological Variables Associated With Ruptured Middle Cerebral Artery Aneurysms

Area of Science:

• Neurosurgery
• Radiology
• Medical Imaging

Background:

• Geometric factors of intracranial aneurysms and surrounding vasculature may influence rupture risk.
• Large-scale, location-specific studies on morphological parameters and intracranial aneurysm rupture are limited.

Purpose of the Study:

• To investigate specific morphological characteristics associated with ruptured middle cerebral artery (MCA) aneurysms.
• To identify key features that can aid in the risk evaluation of MCA aneurysms.

Main Methods:

• Analysis of 638 MCA aneurysms from 561 patients using computed tomography angiography (CTA) and 3D reconstruction.
• Evaluation of morphological parameters including projection, irregularity, daughter dome, A1 artery status, PCoA status, dimensions, and vessel angles.
• Application of univariable, multivariable statistical analyses, and logistic regression to develop a predictive MCA score.

Main Results:

• Increased bottleneck and size ratio, irregular, multilobed, and temporally projecting MCA aneurysms were linked to higher rupture risk.
• Higher M1/M2 ratio, larger width, and hypoplastic posterior communicating arteries (PCoA) were inversely associated with rupture.
• The developed MCA score demonstrated good predictive capacity (area under the receiver operating curve = 0.88).

Conclusions:

• Specific morphological parameters of MCA aneurysms are readily assessable from 3D reconstructions.
• These parameters can assist clinicians in evaluating the rupture risk of MCA aneurysms.
• The findings contribute to improved risk stratification for patients with MCA aneurysms.