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Publication type: Article in scientific journal
Type of review: Peer review (publication)
Title: Shape irregularity of the intracranial aneurysm lumen exhibits diagnostic value
Authors: Juchler, Norman
Schilling, Sabine
Bijlenga, Philippe
Morel, Sandrine
Rüfenacht, Daniel
Kurtcuoglu, Vartan
Hirsch, Sven
et. al: No
DOI: 10.1007/s00701-020-04428-0
Published in: Acta Neurochirurgica
Volume(Issue): 162
Issue: 9
Page(s): 2261
Pages to: 2270
Issue Date: 4-Jun-2020
Publisher / Ed. Institution: Springer
ISSN: 0001-6268
Language: English
Subjects: Intracranial aneurysm; Irregularity; Quantitative morphology; Rating study
Subject (DDC): 616: Internal medicine and diseases
Abstract: Background: Morphological irregularity is linked to intracranial aneurysm wall instability and manifests in the lumen shape. Yet there is currently no consent on how to assess shape irregularity. The aims of this work are to quantify irregularity as perceived by clinicians, to break down irregularity into morphological attributes, and to relate these to clinically relevant factors such as rupture status, aneurysm location, and patient age or sex. Methods: Thirteen clinicians and 26 laypersons assessed 134 aneurysm lumen segmentations in terms of overall perceived irregularity and five different morphological attributes (presence/absence of a rough surface, blebs, lobules, asymmetry, complex geometry of the parent vasculature). We examined rater agreement and compared the ratings with clinical factors by means of regression analysis or binary classification. Results: Using rank-based aggregation, the irregularity ratings of clinicians and laypersons did not differ statistically. Perceived irregularity showed good agreement with curvature (coefficient of determination R2 = 0.68 ± 0.08) and was modeled very accurately using the five morphological rating attributes plus shape elongation (R2 = 0.95 ± 0.02). In agreement with previous studies, irregularity was associated with aneurysm rupture status (AUC = 0.81 ± 0.08); adding aneurysm location as an explanatory variable increased the AUC to 0.87 ± 0.09. Besides irregularity, perceived asymmetry, presence of blebs or lobules, aneurysm size, non-sphericity, and curvature were linked to rupture. No association was found between morphology and any of patient sex, age, and history of smoking or hypertension. Aneurysm size was linked to morphology. Conclusions: Irregular lumen shape carries significant information on the aneurysm’s disease status. Irregularity constitutes a continuous parameter that shows a strong association with the rupture status. To improve the objectivity of morphological assessment, we suggest examining shape through six different morphological attributes, which can characterize irregularity accurately.
Further description: Erworben im Rahmen der Schweizer Nationallizenzen (
Fulltext version: Published version
License (according to publishing contract): Licence according to publishing contract
Restricted until: 2025-10-01
Departement: Life Sciences and Facility Management
Organisational Unit: Institute of Computational Life Sciences (ICLS)
Published as part of the ZHAW project: AneuX
Appears in collections:Publikationen Life Sciences und Facility Management

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Juchler, N., Schilling, S., Bijlenga, P., Morel, S., Rüfenacht, D., Kurtcuoglu, V., & Hirsch, S. (2020). Shape irregularity of the intracranial aneurysm lumen exhibits diagnostic value. Acta Neurochirurgica, 162(9), 2261–2270.
Juchler, N. et al. (2020) ‘Shape irregularity of the intracranial aneurysm lumen exhibits diagnostic value’, Acta Neurochirurgica, 162(9), pp. 2261–2270. Available at:
N. Juchler et al., “Shape irregularity of the intracranial aneurysm lumen exhibits diagnostic value,” Acta Neurochirurgica, vol. 162, no. 9, pp. 2261–2270, Jun. 2020, doi: 10.1007/s00701-020-04428-0.
JUCHLER, Norman, Sabine SCHILLING, Philippe BIJLENGA, Sandrine MOREL, Daniel RÜFENACHT, Vartan KURTCUOGLU und Sven HIRSCH, 2020. Shape irregularity of the intracranial aneurysm lumen exhibits diagnostic value. Acta Neurochirurgica. 4 Juni 2020. Bd. 162, Nr. 9, S. 2261–2270. DOI 10.1007/s00701-020-04428-0
Juchler, Norman, Sabine Schilling, Philippe Bijlenga, Sandrine Morel, Daniel Rüfenacht, Vartan Kurtcuoglu, and Sven Hirsch. 2020. “Shape Irregularity of the Intracranial Aneurysm Lumen Exhibits Diagnostic Value.” Acta Neurochirurgica 162 (9): 2261–70.
Juchler, Norman, et al. “Shape Irregularity of the Intracranial Aneurysm Lumen Exhibits Diagnostic Value.” Acta Neurochirurgica, vol. 162, no. 9, June 2020, pp. 2261–70,

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