Monitoring Dynamic Morphological Changes With Electrocardiography-Gated Dynamic 4-Dimensional Computed Tomography Angiography to Predict Intraoperative Rupture of Intracranial Aneurysms

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This study aims to evaluate dynamic morphological changes of intracranial aneurysms to predict intraoperative aneurysm rupture (IAR) during clipping.


Included in this study were 153 patients, who had ruptured and microsurgical-clipped aneurysms. All patients underwent dual-source computed tomography examination of electrocardiography-gated dynamic 4-dimensional computed tomography angiography before clipping. Original scanning data were reconstructed to produce 20 data sets of cardiac cycles with 5% time intervals. The aneurysm neck, transverse and longitudinal diameters, and volume from the 20 groups of images were measured to calculate their respective change rates. In addition, other data and clinical characteristics were recorded. Data were analyzed by logistic regression to identify factors associated with IAR.


Of the 153 patients, 24 patients experienced IAR. Multivariable analysis revealed that the aneurysm neck change rate (P = 0.0001; odds ratio, 1.276) and aspect ratio (height/neck ratio, P = 0.025; odds ratio, 2.387) are predictors for IAR. When the change rate was greater than or equal to 60%, and the sensitivity and specificity were 91.7% and 76.7%, respectively.


Aneurysm neck change rate is independent predictor of IAR.

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