Automated Cutting Plane Positioning for Intracranial Aneurysm Quantification

Aneurysm rupture risk can be assessed by its morphologic and hemodynamics features extracted based on angiographic images. Feature extraction entails aneurysm isolation, typically by manually positioning a cutting plane (MCP). To eliminate intra- and inter-rater variabilities, we propose automatic cutting plane (ACP) positioning based on the analysis of vascular surface mesh.

Innovative Hough-like and multi-hypothesis-based detection of aneurysm center, parent vessel inlets, and centerlines were proposed. These were used for initialization and iterative ACP positioning by geometry-inspired cost function optimization. For validation and baseline comparison, we tested MCP and manual neck curve-based isolation. Isolated aneurysm morphology was characterized by size, dome height, aspect ratio, and nonsphericity index.

Methods were applied to 55 intracranial saccular aneurysms from two sites, involving 3-D digital subtraction angiography, computed tomography angiography, and magnetic resonance angiography modalities. Isolation based on ACP resulted in smaller average inter-curve distances (AICDs), compared to those obtained by MCP. One case had AICD higher than 1.0 mm, while 90% of cases had AICD 0.5 mm. Intra- and inter-rater AICD variability of manual neck curves was higher compared to MCP, validating its robustness for clinical purposes.

The ACP method achieved high accuracy and reliability of aneurysm isolation, also confirmed by expert visual analysis. So extracted morphologic features were in good agreement with MCP-based ones, therefore, ACP has great potential for aneurysm morphology and hemodynamics quantification in clinical applications.

The novel method is angiographic modality agnostic; it delivers repeatable isolation important in follow-up aneurysm assessment; its performance is comparable to MCP; and re-evaluation is fast and simple.