Stability Assessment of Intracranial Aneurysms Using Machine Learning Based on Clinical and Morphological Features

Machine learning (ML) as a novel approach could help clinicians address the challenge of accurate stability assessment of unruptured intracranial aneurysms (IAs). We developed multiple ML models for IA stability assessment and compare their performances. We enrolled 1897 consecutive patients with unstable ( n  = 528) and stable ( n  = 1539) IAs. Thirteen patient-specific clinical features and eighteen aneurysm morphological features were extracted to generate support vector machine (SVM), random forest (RF), and feed-forward artificial neural network (ANN) models. The discriminatory performances of the models were compared with statistical logistic regression (LR) model and the PHASES score in IA stability assessment. Based on the receiver operating characteristic (ROC) curve and area under the curve (AUC) values for each model in the test set, the AUC values for RF, SVM, and ANN were 0.850 (95% CI 0.806–0.893), 0.858 (95 %CI 0.816–0.900), and 0.867 (95% CI 0.828–0.906), demonstrating good discriminatory ability. All ML models exhibited superior performance compared with the statistical LR and the PHASES score (the AUC values were 0.830 and 0.589, respectively; RF versus PHASES, P  < 0.001; RF versus LR, P  = 0.038). Important features contributing to the stability discrimination included three clinical features (location, sidewall/bifurcation type, and presence of symptoms) and three morphological features (undulation index, height-width ratio, and irregularity). These findings demonstrate the potential of ML to augment the clinical decision-making process for IA stability assessment, which may enable more optimal management for patients with IAs in the future.