Given the considerable risk of treating unruptured intracranial aneurysms (IAs), as well as the known severe morbidity of aneurysm rupture, elucidating those aneurysms that require prophylactic treatment can be a quandary. Traditionally, decision-making to treat an unruptured aneurysm was largely based on the Size of the aneurysm, but recent studies have failed to show significant correlation of Size with IA rupture, and a large number of ruptured aneurysms are small in Size.[1] Consequently, shape-based morphologic metrics have been explored in current investigations, and complex shapes have been correlated with rupture.[1] With the advancement of 3D angiography, and computational fluid dynamics (CFD) technology, patient-specific hemodynamics analysis has become feasible. Intra-aneurysmal hemodynamic factors, including wall shear stress (WSS), impingement regions, and oscillatory shear index (OSI), have been proposed as indicators for IA rupture risk.[2, 3] No study has rigorously examined both morphology-based and hemodynamics-based parameters from a uniform cohort to compare their relative importance. Our aim, therefore, was to identify significant morphologic and hemodynamic parameters that correlate with an aneurysm’s rupture status and examine whether hemodynamic parameters can separate ruptured and unruptured aneurysms better than morphologic parameters.

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