ON THE ORIGIN OF CEREBRAL

ANEURYSMS

Preliminary
presentation!!!
Collaborators:

1. David F. Kallmes, M.D.

Neuroradiology Research Laboratory,
Department of Radiology, Mayo Clinic,
Rochester, Minnesota.
2. Geoff Dougherty PhD,
Professor of Applied Physics and
Medical Imaging; California State
University Channel Islands.
3. Yohai bar sinai, MSc.
Physics Department, the Hebrew
university, Israel
R

Mrs. Tamburo
Literature:
 Questions:
 What is the pathogenesis of cerebral aneurysms?
 Why are they distributed in an anatomical fashion?
 Why do one individual develops an aneurysm, and
another does not?
 Could we screen for cerebral aneurysm, given the
horrible prognosis. (45% dead in one month)
 Why do a certain individual develops an aneurysm, in
a certain location and not in another?
 Economical Facts
 Mean hospital charges, for ruptured aneurysm: 170000$ 1
 27000 cases of SAH per year.2
 At least the surviving, underwent coiling or clipping. (55%)
 27000*170000*55%=2.3billion$ Annually, in hospital bills
only!!!
 Other charges: Life insurance, lifetime care, loss of
incomes…
1: 2010;41;337-342; Stroke
2: N Engl J Med 2006;355:928-39.
 Economical Facts
MRI cost:

 In Outpatient Imaging Centers (4) - $700-$10001

 USA Population- Jul 2009 : 307,006,550

 Screening the whole USA population with MRI:

 307,006,550x100$=30billion $

 Reimbersement in 15 years,

 Porobably a lot less

 http://blog.remakehealth.com/blog_Healthcare_Consumers-0/bid/6658/How-much-does-an-MRI-scan-cost
 Qualy calculations:
 Annually, 27000 ruptures per year
 Mean age at rupture 57
 45% 30 Day mortality
 USA Life expectancy: M-75 F-80.4
 30% of the survivors have moderate to severe disability
 Qualys lost annualy:18000*(80-57)+9000*(75-57)=576000 Years
(only for the dying individuals)
 CTA Cost~1800$, retail value
 MATLAB
(matrix laboratory) is a
numerical computing
environment and a
programming language,
developed by
Mathworks.

MATLAB allows matrix

manipulations, plotting
of functions and data,
implementation of
algorithms, creation of
user interfaces, and
interfacing with
programs written in
other computer
languages.
100 Normal MRA: “The perfect group”
Demographics
Normal no 1
Normal no 2
Are they similar???
 Following rigid image registration

Red: 54 Y/O W F
Green: 22Y/O W M
Notice the 3d structural difference
Notice the 3d structural difference
 The wall stresses
Blood Jet
hits the
arterial wall

Aneurysms
Why is the 3d structure so preserved?
The 3d mutual-angles principle
 The curvature:
Intuitively, the curvature is the amount by
which a geometric object deviates from being
flat, or straight
The curvature:
 Methods
1. Original 2.
MRA Segmentation
 High curvature
Methods
3. 4. Curvature
Skeletonization calculation

Low
curvature
 Preliminary conclusions:
 Practically, all normal individuals, have the same 3d
arterial structure.
 The ones with aneurysms, have aberrant 3d structure,
and hence develop aneurysms.
 This “Suboptimal” 3d structure, increases the wall stress,
and aneurysms are the body’s way of trying to decrease
this stress.
Preliminary conclusions: (cont)
• These individuals (who will develop aneurysms) could be
screened, even in the prenatal period.
• A simple computer algorithm, using a CTA or an MRA
(maybe TCD) could predict whether or not, an individual
would develop an aneurysm.
• This could even predict, where the aneurysm would develop.