Detection of Hemodynamic Characteristics Before Growth in Growing Cerebral Aneurysms by Analyzing Time-of-Flight Magnetic Resonance Angiography Images Alone: Preliminary Results.

Objective: Cerebral aneurysm growth often precedes rupture. Definite contributors to aneurysm growth have not been determined even by means of recently developed commercially available computational fluid dynamics (CFD) software. We developed an original CFD tool that can analyze data from time-of-flight magnetic resonance angiography (TOF-MRA) before growth in the growing aneurysms and investigate possible factors for aneurysm growth in the near future.

Methods: We retrospectively reviewed unruptured aneurysms that were treated at our institute because of aneurysm growth (growing group) between April 2013 and March 2017. Stable aneurysms that had demonstrated no growth for more than 5 years were selected (stable group). TOF-MRA data of these aneurysms were retrospectively converted to 3-dimensional vessel geometric data; 3 hemodynamic indices including streamline, wall shear stress (WSS), and oscillatory shear index were calculated by our original CFD tool using the lattice Boltzmann method to quantitatively compare the 2 groups.

Results: Six growing aneurysms and 6 stable aneurysms were analyzed. Of the 6 growing aneurysms, WSS on the focal aneurysmal sac increased temporally in the vicinity of the constant low WSS area at the peak systolic phase. By contrast, WSS did not increase during any part of the cardiac cycle in 3 of the 6 stable aneurysms. The peak values of WSS were significantly different between the 2 groups.

Conclusions: A focal increase in WSS in the peak systolic phase may be a risk factor for aneurysm enlargement in the near future.