A Predictive Analysis of Wall Stress in Abdominal Aortic Aneurysms Using a Neural Network Model.

Rupture risk assessment of abdominal aortic aneurysms (AAAs) by means of quantifying wall stress is a common biomechanical strategy. However, the clinical translation of this approach has been greatly limited due to the complexity associated with the computational tools required for its implementation. Thus, being able to estimate wall stress using nonbiomechanical markers that can be quantified as a direct outcome of clinical image segmentation would be advantageous in improving the potential implementation of said strategy. In the present work, we investigated the use of geometric indices to predict patient-specific AAA wall stress by means of a novel neural network (NN) modeling approach. We conducted a retrospective review of existing clinical images of two patient groups: 98 asymptomatic and 50 symptomatic AAAs. The images were subject to a protocol consisting of image segmentation, processing, volume meshing, finite element modeling, and geometry quantification, from which 53 geometric indices and the spatially averaged wall stress (SAWS) were calculated. SAWS estimated from finite element analysis was considered the gold standard for the predictions. We developed feed-forward NN models composed of an input layer, two dense layers, and an output layer using Keras, a deep learning library in python. The NN models were trained, tested, and validated independently for both AAA groups using all geometric indices, as well as a reduced set of indices resulting from a variable reduction procedure. We compared the performance of the NN models with two standard machine learning algorithms (MARS: multivariate adaptive regression splines and GAM: generalized additive model) and a linear regression model (GLM: generalized linear model). With the reduced sets of indices, the NN-based approach exhibited the highest mean goodness-of-fit (for the symptomatic group 0.71 and for the asymptomatic group 0.79) and lowest mean relative error (17% for both groups). In contrast, MARS yielded a mean goodness-of-fit of 0.59 for the symptomatic group and 0.77 for the asymptomatic group, with relative errors of 17% for the symptomatic group and 22% for the asymptomatic group. GAM had a mean goodness-of-fit of 0.70 for the symptomatic group and 0.80 for the asymptomatic group, with relative errors of 16% for the symptomatic group and 20% for the asymptomatic group. GLM did not perform as well as the other algorithms, with a mean goodness-of-fit of 0.53 for the symptomatic group and 0.70 for the asymptomatic group, with relative errors of 19% for the symptomatic group and 23% for the asymptomatic group. Nevertheless, the NN models required a reduced set of 15 and 13 geometric indices to predict SAWS for the symptomatic and asymptomatic AAA groups, respectively. This was in contrast to the reduced set of nine and eight geometric indices required to predict SAWS with the MARS and GAM algorithms for each AAA group, respectively. The use of NN modeling represents a promising alternative methodology for the estimation of AAA wall stress using geometric indices as surrogates, in lieu of finite element modeling. The performance metrics of NN models are expected to improve with significantly larger group sizes, given the suitability of NN modeling for "big data" applications.