Pilot clinical study of aneurysm rupture using image-based computational fluid dynamics models

Although the natural history of cerebral aneurysms remains unknown, hemodynamics is thought to play an important role in their initiation, growth and rupture. This paper describes a pilot clinical study of the association between intraaneurysmal hemodynamic characteristics and the rupture of cerebral aneurysms. A total of 62 patient-specific models of cerebral aneurysms were constructed from 3D angiography images. Computational fluid dynamics simulations were performed under pulsatile flow conditions. The aneurysms were classified into different categories depending on the complexity and stability of the flow pattern, the location and size of the flow impingement region, and the size of the inflow jet. These features were analyzed for associations with history of rupture. A large variety of flow patterns was observed. It was found that 72% of ruptured aneurysms had complex or unstable flow patterns, 80% had small impingement regions and 76% had small jet sizes. Conversely, unruptured aneurysms accounted for 73%, 82% and 75% of aneurysms with simple stable flow patterns, large impingement regions and large jet sizes, respectively.