Sage Journals: Discover world-class research

Abstract

Background

Cerebral aneurysms are often identified and characterized on non-invasive CT Angiography (CTA) images, but digital subtraction angiography (DSA) is the gold standard for aneurysm evaluation.

Objective

We compared cerebral aneurysm size measurements as measured from CTA processed by a semi-automated artificial intelligence software program (RAPID Aneurysm) and three-dimensional rotational DSA (3D-DSA).

Methods

We performed a retrospective cohort study of consecutive patients with a cerebral aneurysm who underwent CTA and DSA with 3D reformations. CTA images were processed by RAPID Aneurysm to determine aneurysm height, width, and neck width. The reference standard was aneurysm measurements on 3D-DSA as measured by two neurointerventionalists. Both readers were blinded to RAPID Aneurysm measurements. Correlation and bias between these measurements were determined.

Results

Results from 50 patients with 50 aneurysms were compared. 32 patients (64%) were female. Median age was 65 (IQR: 56.25–71.75). 37 patients (74%) presented with ruptured aneurysms. The aneurysms represented a range of aneurysm sizes (1.9–33.3 mm; IQR 3.6–7.2 mm). RAPID Aneurysm size measurements showed excellent correlation and low bias (correlation, mean difference) when compared to the reference standard for aneurysm height (0.98, −0.9 mm), width (0.98, 0.1 mm), and neck width (0.94, 1.1 mm). The inter-reader comparison between the two neurointerventionalists was similarly excellent for aneurysm height (0.97, −0.4 mm), width (0.98, −0.2 mm), and neck width (0.89, 0.8 mm).

Conclusion

RAPID Aneurysm measurement of cerebral aneurysm height, width, and neck width on CTA is strongly correlated to expert neurointerventionalist measurements on 3D-DSA.

Keywords

Aneurysm automated artificial intelligence CTA digital subtraction angiography (DSA)rupture size measurement

Get full access to this article

View all access options for this article.

References

Brown

. Unruptured intracranial aneurysms. Semin Neurol 2010; 30: 537–544.

Nakagawa

Hashi

. The incidence and treatment of asymptomatic, unruptured cerebral aneurysms. J Neurosurg 1994; 80: 217–223.

International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms–risk of rupture and risks of surgical intervention. International study of unruptured intracranial aneurysms investigators. N Engl J Med 1998; 339: 1725–1733.

Molyneux

Kerr

, et al. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 2005; 366: 809–817.

Villablanca

Duckwiler

Jahan

, et al. Natural history of asymptomatic unruptured cerebral aneurysms evaluated at CT angiography: growth and rupture incidence and correlation with epidemiologic risk factors. Radiology 2013; 269: 258–265.

Investigators

Morita

Kirino

, et al. The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med 2012; 366: 2474–2482.

McDonald

Kallmes

Lanzino

, et al. Use of CT angiography and digital subtraction angiography in patients with ruptured cerebral aneurysm: evaluation of a large multihospital data base. AJNR Am J Neuroradiol 2013; 34: 1774–1777.

Heit

Honce

Yedavalli

, et al. RAPID Aneurysm: artificial intelligence for unruptured cerebral aneurysm detection on CT angiography. J Stroke Cerebrovasc Dis 2022; 31: 106690.

Sahlein

Gibson

Scott

, et al. Artificial intelligence aneurysm measurement tool finds growth in all aneurysms that ruptured during conservative management. J Neurointerv Surg 2023; 15, 766–770.

10.

Heit

Gonzalez

Sabbag

, et al. Detection and characterization of intracranial aneurysms: a 10-year multidetector CT angiography experience in a large center. J Neurointerv Surg 2016; 8: 1168–1172.

11.

Philipp

McCracken

, et al. Comparison between CTA and digital subtraction angiography in the diagnosis of ruptured aneurysms. Neurosurgery 2017; 80: 769–777.

12.

Dammert

Krings

Moller-Hartmann

, et al. Detection of intracranial aneurysms with multislice CT: comparison with conventional angiography. Neuroradiology 2004; 46: 427–434.

13.

Ishida

Kawaguchi

Mizuno

, et al. The accuracy and usefulness of 3D-DSA and 3D-CT angiography for cerebral aneurysms. Interv Neuroradiol 2001; 7: 181–186.

14.

Kapsalaki

Brotis

Karagiorgas

, et al. Morphological characteristics of ruptured intracranial aneurysms: a comparative study between CTA and DSA. Hellenic Journal of Radiology 2020; 6: 13–27.

15.

Sui

Wang

Han

, et al. Application of computed tomography angiography for evaluating clinical morphology in intracranial aneurysms - monocentric study. J Int Med Res 2020; 48: 300060519894790.

16.

Chen

Yang

Xing

, et al. Applications of multislice CT angiography in the surgical clipping and endovascular coiling of intracranial aneurysms. J Biomed Res 2010; 24: 467–473.

17.

Hoh

Cheung

Rabinov

, et al. Results of a prospective protocol of computed tomographic angiography in place of catheter angiography as the only diagnostic and pretreatment planning study for cerebral aneurysms by a combined neurovascular team. Neurosurgery 2004; 54: 1329–1340.

18.

Hayashida

Sasao

Hirai

, et al.

Can sufficient preoperative information of intracranial aneurysms be obtained by using 320-row detector CT angiography alone?

Jpn J Radiol 2013; 31: 600–607.

19.

Gauvrit

Leclerc

Vermandel

, et al. 3D Rotational angiography: use of propeller rotation for the evaluation of intracranial aneurysms. AJNR Am J Neuroradiol 2005; 26: 163–165.

20.

van Rooij

Sprengers

de Gast

, et al. 3D Rotational angiography: the new gold standard in the detection of additional intracranial aneurysms. AJNR Am J Neuroradiol 2008; 29: 976–979.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.12 MB