Coil compaction and aneurysm growth: Image-based quantification using non-rigid registration

Endovascular treatment of intracranial aneurysms is a minimally-invasive technique recognized as a valid alternative to surgical clipping. However, endovascular treatment can be associated to aneurysm recurrence, either due to coil compaction or aneurysm growth. The quantification of coil compaction or aneurysm growth is usually performed by manual measurements or visual inspection of images from consecutive follow-ups. Manual measurements permit to detect large global deformation but might have insufficient accuracy for detecting subtle or more local changes between images. Image inspection permits to detect a residual neck in the aneurysm but do not differentiate aneurysm growth from coil compaction. In this paper, we propose to quantify independently coil compaction and aneurysm growth using non-rigid image registration. Local changes of volume between images at successive time points are identified using the Jacobian of the non-rigid transformation. Two different non-rigid registration strategies are applied in order to explore the sensitivity of Jacobian-based volume changes against the registration method, FFD registration based on mutual information and Demons. This volume-variation measure has been applied to four patients of which a series of 3D Rotational Angiography (3DRA) images obtained at different controls separated from two months to two years were available. The evolution of coil and aneurysm volumes along the period has been obtained separately, which allows distinguishing between coil compaction and aneurysm growth. On the four cases studied in this paper, aneurysm recurrence was always associated to aneurysm growth, as opposed to strict coil compaction.