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. 2025 Jan 14;15(1):1965.
doi: 10.1038/s41598-024-85066-9.

Fluid structure Interaction analysis for rupture risk assessment in patients with middle cerebral artery aneurysms

Jozsef Nagy  1 , Wolfgang Fenz  2 , Stefan Thumfart  2 , Julia Maier  3 , Zoltan Major  3 , Harald Stefanits  4 , Maria Gollwitzer  4 , Johannes Oberndorfer  4 , Nico Stroh  4 , Michael Giretzlehner  2 , Michael Sonnberger  5 , Andreas Gruber  4   6 , Philip-Rudolf Rauch  7 , Matthias Gmeiner  4   6
Affiliations

Fluid structure Interaction analysis for rupture risk assessment in patients with middle cerebral artery aneurysms

Jozsef Nagy et al. Sci Rep. .

Abstract

Accurate rupture risk assessment is essential for optimizing treatment decisions in patients with cerebral aneurysms. While computational fluid dynamics (CFD) has provided critical insights into aneurysmal hemodynamics, most analyses focus on blood flow patterns, neglecting the biomechanical properties of the aneurysm wall. To address this limitation, we applied Fluid-Structure Interaction (FSI) analysis, an integrative approach that simulates the dynamic interplay between hemodynamics and wall mechanics, offering a more comprehensive risk assessment. In this study, we used advanced FSI techniques to investigate the rupture risk of middle cerebral artery bifurcation (MCA) aneurysms, analyzing a cohort of 125 patients treated for a MCA aneurysm at Kepler University Hospital, Linz, Austria. Multivariate analysis identified two significant rupture predictors: High Equivalent Stress Area (HESA; p = 0.049), which quantifies stress distribution relative to the aneurysm surface, and Gaussian curvature (GLN; p = 0.031), which captures geometric complexity. We also introduce the HGD index, a novel composite metric combining HESA, GLN, and Maximum Wall Displacement, designed to enhance predictive accuracy. With a threshold of 0.075, the HGD index exhibited excellent diagnostic performance; in internal validation, 24 of 25 ruptured aneurysms surpassed this threshold, yielding a sensitivity of 0.96. In a 5-fold cross validation the reliability of results was confirmed. Our findings demonstrate that the HGD index provides superior rupture risk stratification compared to conventional single-parameter models, offering a more robust tool for the assessment of complex aneurysmal structures. Further multicenter studies are warranted to refine and validate the HGD index, advancing its potential for clinical application and improving patient outcomes.

Keywords: Cerebral aneurysm; Fluid-structure Interaction; Middle Cerebral Artery; Rupture risk.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Author contribution statement: The Authors confirm contribution to the paper as follows: Study Conception and design: JN, MaG, WF, ST. Verification of the analytical methods: JN, WF, MaG, ZM, AG. JM. Data collection: WF, MG, JO, NS, MSo, PR. Analysis and interpretation of results: JN, MaG, PR, AG, ZM, WF, ST, JM. Design of the model and the computational framework: AM, SK and ST. Draft manuscript preparation: JN, MaG, PR, HS. Supervision of the project: JN, MaG, MG, ZM, AG. All authors reviewed the results and approved the final version of the manuscript.

Figures

Fig. 1
Fig. 1
Receiver operating characteristic (ROC) curves including Area Under the Curve (AUC) values for Dmax, HESA, Size and GLN (a) and additionally defined parameters (b).
Fig. 2
Fig. 2
Two exemplary aneurysms (unruptured aneurysm (a), ruptured aneurysm (b)) with similar aspect ratio (AR = 1.7) however significantly different hemodynamic and structural mechanical behaviour (images generated with Paraview 5.11.2 URL: https://www.paraview.org).
Fig. 3
Fig. 3
6 Step Workflow for Image-Based Modeling and Analysis.
See this image and copyright information in PMC

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