Cerebral aneurysms (CAs) are tricky to manage, since their rupture is deadly, rupture rate is low and treatment complication risk is significant. The new guidelines for CA management by the American Heart/Stroke Association suggest the clinicians: consider morphological and hemodynamic characteristics of the aneurysm when discussing the risk of aneurysm rupture. However, morphometrics and hemodynamics require extensive engineering expertise to calculate. Currently there is no tool for clinicians to obtain such metrics. Through seamless collaboration between biomedical engineers from University's Clinical and Translational Research Center and neurosurgeons from the private healthcare provider Gates Vascular Institute in one building, we have developed the prototype of a clinical software platform, AView, for rapid assessment of patient-specific CA hemodynamics and morphometrics at the bedside. We have further deployed this prototype to 8 clinical centers to test its technical feasibility. All participating clinicians enthusiastically embraced this ground-breaking tool. All of them underscored the urgent need of such a tool to be integrated into the day-to-day clinical workflow in CA management. They further indicated that routine clinical use of AView requires to have minimal manual operation and to provide maximal clinical benefits. Therefore, in this grant we would like to take a leap to transform AView from the current prototype into a bedside tool to improve healthcare.
In Aim 1, we will automate image segmentation procedure. Specifically, a small number of seed spheres will be positioned on image slides, which will be automatically centered within the vessel as well as automatically resized. Furthermore, in this aim, we will implement a treatment planning module including coil density calculation and stent positioning measurement. Coil planning tool will guide users in choosing type and number of coils based on specific packing density, aneurysm volume and a built-in coil library. Stent planning tool will guide users in stent placement based on aneurysms morphology, vessel geometry and inflow jet.
In Aim 2, we will validate the morphometric and hemodynamic calculation of AView using experiments from 5 patient-specific CAs. For morphometric validation, we will compare key morphometrics from AView against the results from standard software. For hemodynamic validation, we will validate flow calculation by in vitro and clinical data from the same 5 CAs. We will compare flow solutions against Particle Image Velocimetry data from CA phantoms, and flow-derived virtual angiography against patient angiography. Successful completion of this project will transform AView into an easy-to-use, high-impact, and well-validated bedside tool. We believe AView will revolutionize the way how neurosurgeons approach CA at the bedside. Our long-term vision of AView is to extend this tool to every participating healthcare provider, in order to facilitate on-site treatment decision- making and planning.

Public Health Relevance

Cerebral aneurysms are tricky to manage since their rupture is devastating, rupture rate is low and treatment complication risk is significant. This project addresses our field's urgent need to transform a research prototype into an easy-to-use, high-impact, and well-validated bedside tool for aneurysm morphometrics and hemodynamics calculation. The bedside tool developed from this project is expected to directly impact on-site treatment decision-making and planning and to improve the care of patients suffering from this disease, reduce healthcare costs, and save lives.

Agency
National Institute of Health (NIH)
Institute
National Institute of Neurological Disorders and Stroke (NINDS)
Type
Small Research Grants (R03)
Project #
1R03NS090193-01A1
Application #
8969365
Study Section
Neuroscience and Ophthalmic Imaging Technologies Study Section (NOIT)
Program Officer
Koenig, James I
Project Start
2015-09-01
Project End
2017-08-31
Budget Start
2015-09-01
Budget End
2016-08-31
Support Year
1
Fiscal Year
2015
Total Cost
Indirect Cost
Name
State University of New York at Buffalo
Department
Neurosurgery
Type
Schools of Medicine
DUNS #
038633251
City
Amherst
State
NY
Country
United States
Zip Code
14228
Varble, Nicole; Tutino, Vincent M; Yu, Jihnhee et al. (2018) Shared and Distinct Rupture Discriminants of Small and Large Intracranial Aneurysms. Stroke 49:856-864
Varble, N; Rajabzadeh-Oghaz, H; Wang, J et al. (2017) Differences in Morphologic and Hemodynamic Characteristics for ""PHASES-Based"" Intracranial Aneurysm Locations. AJNR Am J Neuroradiol 38:2105-2110
Xiang, Jianping; Varble, Nicole; Davies, Jason M et al. (2017) Initial Clinical Experience with AView-A Clinical Computational Platform for Intracranial Aneurysm Morphology, Hemodynamics, and Treatment Management. World Neurosurg 108:534-542
Rajabzadeh-Oghaz, Hamidreza; Varble, Nicole; Davies, Jason M et al. (2017) Computer-Assisted Adjuncts for Aneurysmal Morphologic Assessment: Toward More Precise and Accurate Approaches. Proc SPIE Int Soc Opt Eng 10134:
Paliwal, Nikhil; Damiano, Robert J; Varble, Nicole A et al. (2017) Methodology for Computational Fluid Dynamic Validation for Medical Use: Application to Intracranial Aneurysm. J Biomech Eng 139:
Varble, Nicole; Xiang, Jianping; Lin, Ning et al. (2016) Flow Instability Detected by High-Resolution Computational Fluid Dynamics in Fifty-Six Middle Cerebral Artery Aneurysms. J Biomech Eng 138:061009
Xiang, Jianping; Yu, Jihnhee; Choi, Hoon et al. (2015) Rupture Resemblance Score (RRS): toward risk stratification of unruptured intracranial aneurysms using hemodynamic-morphological discriminants. J Neurointerv Surg 7:490-5