Rupture risk assessment for cerebral aneurysm using interpretable machine learning on multidimensional data

Chubin Ou, Jiahui Liu, Yi Qian, Winston Chong, Xin Zhang, Wenchao Liu, Hengxian Su, Nan Zhang, Jianbo Zhang, Chuan-Zhi Duan, Xuying He

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Background: Assessment of cerebral aneurysm rupture risk is an important task, but it remains challenging. Recent works applying machine learning to rupture risk evaluation presented positive results. Yet they were based on limited aspects of data, and lack of interpretability may limit their use in clinical setting. We aimed to develop interpretable machine learning models on multidimensional data for aneurysm rupture risk assessment.

Methods: Three hundred seventy-four aneurysms were included in the study. Demographic, medical history, lifestyle behaviors, lipid profile, and morphologies were collected for each patient. Prediction models were derived using machine learning methods (support vector machine, artificial neural network, and XGBoost) and conventional logistic regression. The derived models were compared with the PHASES score method. The Shapley Additive Explanations (SHAP) analysis was applied to improve the interpretability of the best machine learning model and reveal the reasoning behind the predictions made by the model.

Results: The best machine learning model (XGBoost) achieved an area under the receiver operating characteristic curve of 0.882 [95% confidence interval (CI) = 0.838–0.927], significantly better than the logistic regression model (0.779; 95% CI = 0.729–0.829; P = 0.002) and the PHASES score method (0.758; 95% CI = 0.713–0.800; P = 0.001). Location, size ratio, and triglyceride level were the three most important features in predicting rupture. Two typical cases were analyzed to demonstrate the interpretability of the model.

Conclusions: This study demonstrated the potential of using machine learning for aneurysm rupture risk assessment. Machine learning models performed better than conventional statistical model and the PHASES score method. The SHAP analysis can improve the interpretability of machine learning models and facilitate their use in a clinical setting.
Original languageEnglish
Article number570181
Pages (from-to)1-9
Number of pages9
JournalFrontiers in Neurology
Publication statusPublished - 23 Dec 2020

Bibliographical note

Copyright the Author(s) 2020. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.


  • intracranial aneurysm
  • machine learning
  • rupture
  • subarachnoid hemorrhage
  • stroke


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