Clinical characterization of three-dimensional (3D) advanced visualization (AV) modeling in intracranial aneurysms

Introduction: The advent of 3D rendering has transformed traditional clinical imaging that utilized 2D planar imaging. Advanced visualization (AV) modeling of complex pathologies can overcome limitations of 2D imaging through patient-specific AV models that can be viewed easily using software like 3D Viewer, Mixed Reality, and/or 3D Printing (3DP). In this study, we aim to understand the interplay between clinical features of intracranial aneurysms (IAs) and the application of these tools in their management.

Methods: A retrospective chart review was conducted for patients treated for IAs at Ochsner Hospital between 2019 and 2022. AV models were based on DICOM datasets procured via routine clinical imaging, which were then segmented using image processing into 3D files. Descriptive statistics were used to characterize associated clinical attributes

Results: A total of 192 IAs in 109 patients were included in the study. Six physicians requested 84 AV models and 93 (85.3%) were 3DP. The average IA diameter and neck size were 5.9mm and 3.8mm respectively. 86 of 192 aneurysms (45%) were located along the internal carotid artery (ICA), often in the ophthalmic segment. The middle cerebral and anterior cerebral arteries were other prevalent locations. 38 (19.75%) were recurrent pathologies, while hemorrhagic rupture was seen in 36 (18.75%). Surgical treatment was implemented for 82 of 109 patients (75.22%). Of these, 70 (85.37%) were treated endovascularly, particularly, 33(47.14%) with flow diverters and 24(34.29%) with primary coils. The rest 12 (14.46%) underwent microsurgical clipping. Mean procedural time was 132.22 minutes. For radiation, the average contrast dose was 109.95 cc of visipaque, air kerma was 1907.17 mGy and fluoroscopy time was 20 mins. The mean length of ICU stay was 6.58 days.

Conclusion : This study characterized the clinical attributes of intracranial aneurysms instrumental in designing customized AV models. Future directions involve evaluating the potential of AV models for procedural planning & execution.