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Screening For Cerebral Aneurysms I
Screening For Cerebral Aneurysms I
ANEURYSMS
Preliminary
presentation!!!
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:
• 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.
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 MRA 2. Segmentation
High curvature
Methods
3. Skeletonization 4. Curvature 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.