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Published on: July 28, 2018
SAD score of intracranial aneurysms for rupture risk assessment based on high-resolution vessel wall imaging
Xinman Liu1, Zhuhao Li2, Linfeng Liu1
1Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China.
Insights
A new SAD model integrates aneurysm site, wall enhancement, and shape to predict rupture risk. This tool helps manage unruptured intracranial aneurysms effectively.
Area of Science:
- Neurosurgery
- Radiology
- Medical Imaging
Background:
- Intracranial aneurysms pose a significant rupture risk.
- Accurate assessment of rupture risk is crucial for patient management.
- Existing models may not fully integrate key predictive factors.
Purpose of the Study:
- To develop a comprehensive model for assessing intracranial aneurysm rupture risk.
- To integrate radiological, morphological, and clinical factors into a predictive tool.
- To validate the model's performance in distinguishing ruptured from unruptured aneurysms.
Main Methods:
- Prospective enrollment of patients with intracranial saccular aneurysms.
- High-resolution vessel wall imaging (HR-VWI) for aneurysm assessment.
- Logistic regression analysis to identify independent risk factors, including aneurysm wall enhancement scale (AWES).
Main Results:
- The SAD model, incorporating non-ICA site, AWES, and lobulated shape, independently predicted rupture.
- SAD scores demonstrated a strong correlation with observed rupture rates (0-100%).
- The SAD model achieved an area under the receiver operating characteristic curve of 0.8822.
Conclusions:
- The SAD model effectively distinguishes aneurysm rupture status.
- This model can aid in the clinical management of unruptured intracranial aneurysms.
- Further validation in larger cohorts is recommended to confirm predictive applicability.
Objective:
We aimed to develop a comprehensive model that integrates the radiological, morphological, and clinical factors to assess rupture risk for intracranial aneurysms.
Methods:
We prospectively enrolled patients with intracranial saccular aneurysms who underwent high-resolution vessel wall imaging (HR-VWI) preoperatively. Clinical characteristics, aneurysm features and aneurysm wall enhancement scale (AWES) were recorded. AWES was categorized into three grades (no/faint/strong enhancement) by comparing AWE to enhancement of the pituitary infundibulum or choroid plexus on HR-VWI. Univariate and multivariate logistic regression analyses were performed to determine risk factors associated with aneurysmal rupture.
Results:
A total of 25 ruptured and 116 unruptured aneurysms were included. Multivariate logistic regression analysis revealed that non-ICA site (OR 6.25, 95% CI 1.35-28.30, P = 0.019), AWES (OR 5.99, 95% CI 2.51-14.29, P < 0.001) and daughter sac or lobulated shape (OR 6.22, 95% CI 1.68-23.16, P = 0.006) were independent factors associated with ruptured aneurysms. The "SAD" model was generated and named after the first letters of each of these factors. SAD scores of 0-4 predicted 0, 2%, 12%, 42% and 100% ruptured aneurysms, respectively. The area under the receiver operating characteristic curve for the SAD model was 0.8822.
Conclusion:
The SAD model aids in distinguishing aneurysm rupture status and in managing unruptured aneurysms. Larger cohort studies are needed to confirm its applicability in predicting the rupture risk of unruptured aneurysms.
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