• Cornelissen B M W BM From the MIRA Institute for Biomedical Engineering and Technical Medicine (B.M.W.C., C.H.S.), University of Twente, Enschede, the Netherlands Departm, J J Schneiders, W V Potters, R van den Berg, B K Velthuis, G J E Rinkel, C H Slump, E VanBavel, C B L M Majoie, and H A Marquering.
• From the MIRA Institute for Biomedical Engineering and Technical Medicine (B.M.W.C., C.H.S.), University of Twente, Enschede, the Netherlands Departments of Radiology (B.M.W.C., J.J.S., W.V.P., R.v.d.B., C.B.L.M.M., H.A.M.) Biomedical Engineering and Physics (B.M.W.C, E.V., H.A.M.), Academic Medical Center, Amsterdam, the Netherlands b.m.cornelissen@amc.uva.nl.
• AJNR Am J Neuroradiol. 2015 Oct 1; 36 (10): 1927-33.

Background And PurposeRupture risk of intracranial aneurysms may depend on hemodynamic characteristics. This has been assessed by comparing hemodynamic data of ruptured and unruptured aneurysms. However, aneurysm geometry may change before, during, or just after rupture; this difference causes potential changes in hemodynamics. We assessed changes in hemodynamics in a series of intracranial aneurysms, by using 3D imaging before and after rupture.Materials And MethodsFor 9 aneurysms in 9 patients, we used MRA, CTA, and 3D rotational angiography before and after rupture to generate geometric models of the aneurysm and perianeurysmal vasculature. Intra-aneurysmal hemodynamics were simulated by using computational fluid dynamics. Two neuroradiologists qualitatively assessed flow complexity, flow stability, inflow concentration, and flow impingement in consensus, by using flow-velocity streamlines and wall shear stress distributions.ResultsHemodynamics changed in 6 of the 9 aneurysms. The median time between imaging before and after rupture was 678 days (range, 14-1461 days) in these 6 cases, compared with 151 days (range, 34-183 days) in the 3 cases with unaltered hemodynamics. Changes were observed for flow complexity (n = 3), flow stability (n = 3), inflow concentration (n = 2), and region of flow impingement (n = 3). These changes were in all instances associated with aneurysm displacement due to rupture-related hematomas, growth, or newly formed lobulations.ConclusionsHemodynamic characteristics of intracranial aneurysms can be altered by geometric changes before, during, or just after rupture. Associations of hemodynamic characteristics with aneurysm rupture obtained from case-control studies comparing ruptured with unruptured aneurysms should therefore be interpreted with caution.© 2015 by American Journal of Neuroradiology.

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