Incremental contribution of size ratio as a discriminant for rupture status in cerebral aneurysms: comparison with size, height, and vessel diameter.
Neurosurgery
; 70(4): 944-51; discussion 951-2, 2012 Apr.
Article
in En
| MEDLINE
| ID: mdl-21997542
ABSTRACT
BACKGROUND:
Aneurysm size ratio (SR), variably defined as the ratio of dome height (H) or maximal dimension (D(max)) over average parent vessel diameter (PV) diameter, has been proposed as a promising aneurysm rupture status predictor.OBJECTIVE:
To evaluate the incremental contribution of SR to retrospective rupture status determination in a large high-resolution aneurysm database.METHODS:
Measurements were performed on catheter 3D-rotational angiographic volumetric datasets for 267 aneurysms (98 ruptured). SR was computed both as H/PV (SR1) and as D(max)/PV (SR2), and its discriminant performance was evaluated on the whole dataset, on aneurysm-type subsets (bifurcation [BIF] vs sidewall [SW]), and at specific aneurysm locations. Univariate and multivariate statistical analyses were performed by the use of area under the curve (AUC) of the receiver-operating characteristics.RESULTS:
Neither SR1 nor SR2 were statistically correlated to rupture status in the BIF group, where only PV (AUC = 0.61) achieved significance. All parameters were statistically significant in the combined group, but with modest performance (AUC range, 0.62-0.74). SR1 (AUC = 0.84) and SR2 (AUC = 0.78) were strong predictors in the SW group, similar to H (AUC = 0.83) and D(max) (AUC = 0.77). Multivariate statistics failed to support SR as an incremental independent parameter from PV, D(max), and H.CONCLUSION:
SR provides an uneven performance that depends strongly on the BIF/SW distribution of the data and is not useful for bifurcation lesions. In the SW subset, the incremental contribution of the SR over its H or D(max) individual component measurements could not be validated, suggesting prior findings of its utility to be the result of aneurysm-type selection bias.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Cerebral Angiography
/
Intracranial Aneurysm
/
Aneurysm, Ruptured
Type of study:
Prognostic_studies
Limits:
Humans
Language:
En
Journal:
Neurosurgery
Year:
2012
Document type:
Article
Affiliation country:
United States
Country of publication:
EEUU
/
ESTADOS UNIDOS
/
ESTADOS UNIDOS DA AMERICA
/
EUA
/
UNITED STATES
/
UNITED STATES OF AMERICA
/
US
/
USA