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Morphological factors affecting vortex core instability on 4D flow MRI of unruptured cerebral aneurysms

ABSTRACT Objective The spatiotemporal instability of intra-aneurysmal vortex flow may be associated with unruptured cerebral aneurysm rupture. We identified morphological factors that affect intra-aneurysmal vortex core patterns classified based on the instability on four-dimensional (4D) flow magnetic resonance imaging (MRI) and determined cutoff values for the factors to discriminate unstable core patterns. Methods We classified vortex core patterns of 40 unruptured aneurysms on 4D flow MRI into stable, stable with a flapping tip, continuously deforming wave-or-coil-like, and non-visualized. We statistically compared nine morphological parameters among aneurysm groups with individual patterns. Results The vortex cores were stable (n = 16) (group A), stable with a flapping tip (n = 15) (group B), wave-or-coil-like (n = 7) (group C), and non-visualized (n = 2) (group D). Since there were no statistically significant differences between groups A and B, we compared the difference between the groups A and B and the other groups. Multivariate logistic regression analyses found that size ratio (SR) was an only independently significant parameter (p < 0.05). The receiver-operating characteristic analysis between groups A and B and group C and between groups A and B and groups C and D revealed that the area under the curve value for SR was the highest (0.829 [95% CI, 0.642–1.0]; 0.867 [95% CI, 0.715–1.0], respectively) among morphological factors; the cutoff value for SR was 1.72 (specificity 0.714, sensitivity 0.756; specificity 0.806, sensitivity 0.778, respectively). Conclusion SR was an independent morphological factor contributing to vortex core instability based on the vortex core patterns on 4D flow MRI. Abbreviations: CFD: computational fluid dynamics; 3D: three-dimensional; 4D: four-dimensional; MRI: magnetic resonance imaging; MRA: magnetic resonance angiography; ICA: internal carotid artery; AR: aspect ratio; SR: size ratio; CI: confidence interval; AUC: area under the curve; ROC: receiver-operating characteristic