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Neurosurg Focus. 2019 Jul 1;47(1):E16. doi: 10.3171/2019.4.FOCUS19145.

Extending statistical learning for aneurysm rupture assessment to Finnish and Japanese populations using morphology, hemodynamics, and patient characteristics.

Author information

1Bioengineering Department and.
2Department of Mathematical Sciences, Montclair State University, Montclair, New Jersey.
3Statistics Department, George Mason University, Fairfax, Virginia.
4Institute of Applied Simulation, ZHAW University of Applied Sciences, Wädenswil, Switzerland.
5The Interface Group, Institute of Physiology, University of Zürich, Switzerland.
6Clinical Neurosciences Department, University of Geneva, Switzerland.
7Graduate School of Mechanical Engineering, Tokyo University of Science, Tokyo, Japan.
Departments of8Innovation for Medical Information Technology and.
9Department of Mechanical Engineering, Tokyo University of Science, Tokyo, Japan; and.
10Neurosurgery, The Jikei University of Medicine, Tokyo, Japan.
11Hemorrhagic Brain Pathology Research Group, Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland.



Incidental aneurysms pose a challenge for physicians, who need to weigh the rupture risk against the risks associated with treatment and its complications. A statistical model could potentially support such treatment decisions. A recently developed aneurysm rupture probability model performed well in the US data used for model training and in data from two European cohorts for external validation. Because Japanese and Finnish patients are known to have a higher aneurysm rupture risk, the authors' goals in the present study were to evaluate this model using data from Japanese and Finnish patients and to compare it with new models trained with Finnish and Japanese data.


Patient and image data on 2129 aneurysms in 1472 patients were used. Of these aneurysm cases, 1631 had been collected mainly from US hospitals, 249 from European (other than Finnish) hospitals, 147 from Japanese hospitals, and 102 from Finnish hospitals. Computational fluid dynamics simulations and shape analyses were conducted to quantitatively characterize each aneurysm's shape and hemodynamics. Next, the previously developed model's discrimination was evaluated using the Finnish and Japanese data in terms of the area under the receiver operating characteristic curve (AUC). Models with and without interaction terms between patient population and aneurysm characteristics were trained and evaluated including data from all four cohorts obtained by repeatedly randomly splitting the data into training and test data.


The US model's AUC was reduced to 0.70 and 0.72, respectively, in the Finnish and Japanese data compared to 0.82 and 0.86 in the European and US data. When training the model with Japanese and Finnish data, the average AUC increased only slightly for the Finnish sample (to 0.76 ± 0.16) and Finnish and Japanese cases combined (from 0.74 to 0.75 ± 0.14) and decreased for the Japanese data (to 0.66 ± 0.33). In models including interaction terms, the AUC in the Finnish and Japanese data combined increased significantly to 0.83 ± 0.10.


Developing an aneurysm rupture prediction model that applies to Japanese and Finnish aneurysms requires including data from these two cohorts for model training, as well as interaction terms between patient population and the other variables in the model. When including this information, the performance of such a model with Japanese and Finnish data is close to its performance with US or European data. These results suggest that population-specific differences determine how hemodynamics and shape associate with rupture risk in intracranial aneurysms.


AUC = area under the receiver operating characteristic curve; BL = bulge location; CFD = computational fluid dynamics; HWR = height/width ratio; IA = intracranial aneurysm; KE = kinetic energy; LSA = low shear area; MLN = mean surface curvature; NSI = nonsphericity index; OSImax = maximum oscillatory shear stress; SAH = subarachnoid hemorrhage; WSS = wall shear stress; cerebral aneurysm; hemodynamics; morphology; risk; rupture


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