Aneurysm Neck Overestimation has a Relatively Modest Impact on Simulated Hemodynamics.

Overestimation of intracranial aneurysm neck width by 3D angiography is a recognized clinical problem, and has long been a concern for image-based computational fluid dynamics (CFD). Recently, it was demonstrated that neck overestimation in 3D rotational angiography (3DRA) could be corrected via segmentation with upsampled resolution and gradient enhancement (SURGE). Our aim was to leverage this approach to determine whether and how neck overestimation actually impacts CFD-derived hemodynamics. A subset of 17 cases having the largest neck errors from a consecutive clinical sample of 60 was segmented from 3DRA using both standard watershed and SURGE methods. High-fidelity, pulsatile CFD was performed, and a variety of scalar hemodynamic parameters that have been associated with aneurysm growth and/or rupture status were derived. With a few exceptions, flow and wall shear stress (WSS) patterns were qualitatively similar between neck-overestimated and corrected models. Sac-averaged WSS values were significantly lower after neck correction (p = 0.0005) but were highly correlated with their neck-overestimated counterparts (R2 = 0.98). Jet impingement was significantly more concentrated in the neck-corrected vs. -uncorrected models (p = 0.0011), and only moderately correlated (R2 = 0.61). Parameters quantifying velocity or WSS fluctuations were not significantly different after neck correction, but this reflected their poorer correlations (R2 < 0.4). Nevertheless, for all hemodynamic parameters, median absolute differences were < 26%, and no parameter had more than 5/17 cases with absolute differences > 50%. Differences in hemodynamics due to neck width overestimation were found to be at most equal to, and often less than, those reported for other sources of error/uncertainty in intracranial aneurysm CFD, such as solver settings or assumed inflow rates.