Pulsatility of an Intracavernous Aneurysm Demonstrated by Dynamic 320-detector Row CTA at High Temporal Resolution
Bibliographic record
Abstract
Studying the flow dynamics of intracranial aneurysms and the associated pulsatility of the aneurysm wall may help to risk-stratify unruptured aneurysms. Currently, in-vivo methods that visualize aneurysm wall movement at high temporal resolution are not yet fully established. We describe a patient with an intracavernous aneurysm in whom the area of increased aneurysm pulsatility as demonstrated by high-temporal resolution CTA was identical to the area of aneurysm growth on follow-up. A 35-year-old man presented with headaches and a sixth nerve palsy. CT including dynamic CTA demonstrated a pulsating intracavernous aneurysm. On follow-up one week later, the patient had developed hypesthesia in his V1 and V2 distribution and repeat imaging demonstrated aneurysm growth in the aneurysm part that demonstrated pulsatile movements on dynamic CTA. Stent-assisted coiling of the aneurysm was performed and led to clinical improvement. Dynamic CTA was performed using a 320-detector row CT following continuous rotational scanning during the administration of contrast with subsequent image reconstructions at 100 msec intervals. Dynamic CTA can demonstrate aneurysm pulsations that, as in the present case of a patient with a giant intracavernous aneurysm, were associated with aneurysm growth in the area of maximum pulsation. We hypothesize that this technique may predict aneurysm growth and may therefore be helpful in the non-invasive in vivo assessment of individual aneurysm features such as dome and bleb pulsations in both unruptured and ruptured aneurysms. Zusammenfassung Die Untersuchung der Flussdynamik und der Aneurysmawandpulsationen intrakranieller Aneurysmen kann einen Beitrag zur Risikoabschätzung inzidenteller Aneurysmen liefern. Bislang sind in-vivo Methoden zur zeitlich hochaufgelösten Darstellung von Aneurysmapulsationen jedoch nicht etabliert. Wir beschreiben den Fall eines Patienten mit einem intracavernösen Aneurysma, bei dem die Technik der zeitlich hochaufgelösten CT-Angiographie umschriebene Aneurysmapulsationen in dem Abschnitt des Aneurysmas zeigen konnte, in dem im zeitlichen Verlauf eine Größenprogredienz festgestellt wurde. Ein 35-jähriger Patient stellte sich mit Kopfschmerzen und einer Abduzensparese vor. Dynamische CTA zeigte ein nichtrupturiertes umschrieben pulsierendes intracavernöses Aneurysma. Eine Woche nach initialer Präsentation beklagte der Patient eine progressive Hypästhesie des Gesichtes und die Verlaufsbildgebung zeigte ein umschriebenes Aneurysmawachstum in dem Bereich, im dem vorher die Pulsationen festgestellt wurden. Stentassistierte Platinspiralembolisation konnte problemlos durchgeführt werden und führte zu klinischer Verbesserung. Die dynamische CTA wurde mittels 320-Detektor-CT mit kontinuierlicher Rotation nach i. v. Injektion von Kontrastmittel durchgeführt. Bildrekonstruktion erfolgte in 100 msec Intervallen. Wir konnten in diesem Fallbericht zeigen, dass die dynamische CTA Aneurysmapulsationen zeigen kann. Zudem wiesen wir nach, dass das Areal der Aneurysmapulsation identisch mit dem Bereich ist, der im Verlauf eine Größenprogredienz aufwies. Deshalb ist es unsere Hypothese, dass die dynamische CTA Aneurysmawachstum prädizieren kann und deshalb hilfreich in der nicht-invasiven Beurteilung von nichtrupturierten Aneurysmen sein wird.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".