Cerebral aneurysm hemodynamics indicative of instability are associated with heterogeneous wall motion measured by...

The prediction of rupture in intracranial aneurysms is challenging. Aneurysm growth has been identified as a strong risk factor for rupture and aneurysm wall motion is a potential biomarker for growth, but visualizing aneurysm wall motion using conventional imaging techniques is difficult. Computational fluid dynamic simulations have been used to identify hemodynamic risk factors of intracranial aneurysm instability, but often lack observable and quantifiable biomechanical correlates that can be directly measured in vivo.

In this retrospective case-control study of matched patients, cohorts with growing (n=6) and stable (n=6) unruptured intracranial aneurysms were selected from our institutional database of 4D Flow MRI scans. The amplified Flow algorithm was used to extract maps of wall motion for each aneurysm. Hemodynamics within the aneurysm dome were calculated using established computational fluid dynamic methods, and hemodynamic variables were evaluated against wall motion for stable and growing aneurysms.

Several hemodynamic variables were found to be both significant predictors of aneurysm growth and highly correlated with aneurysm wall motion. The hemodynamic variable most correlated with both the maximum value of aneurysm wall motion and spatial variance of aneurysm wall motion, the time coefficient of variance of the directional wall shear stress gradient (representing changing directions of wall shear stress), was also the best hemodynamic predictor of aneurysm growth.

Spatial variance of wall motion and hemodynamic variables are increased in growing aneurysms, and the fluctuations in the directional wall shear stress correlate directly with wall motion, indicating that heterogeneous wall motion and hemodynamics are interrelated and play a critical role in aneurysm instability.