Grkovski, Risto; Acu, Leyla; Ahmadli, Uzeyir; Terziev, Robert; Schubert, Tilman; Wegener, Susanne; Kulcsar, Zsolt; Husain, Shakir; Alkadhi, Hatem; Winklhofer, Sebastian (2023). A Novel Dual-Energy CT Method for Detection and Differentiation of Intracerebral Hemorrhage From Contrast Extravasation in Stroke Patients After Endovascular Thrombectomy : Feasibility and First Results. Clinical neuroradiology, 33(1), pp. 171-177. Springer-Verlag 10.1007/s00062-022-01198-3
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PURPOSE
Dual-energy computed tomography (DECT) has been shown to be able to differentiate between intracranial hemorrhage (ICH) and extravasation of iodinated contrast media (contrast staining [CS]). TwinSpiral DECT is a recently introduced technique, which allows image acquisition at two different energy levels in two consecutive spiral scans. The aim of this study was to evaluate the feasibility and accuracy of TwinSpiral DECT to distinguish between ICH and CS after endovascular thrombectomy (EVT) in patients with acute ischemic stroke.
METHODS
This retrospective single-center study conducted between November 2019 and July 2020 included non-contrast TwinSpiral DECT scans (tube voltages 80 and 150Sn kVp) of 39 ischemic stroke patients (18 females, 21 males, mean age 69 ± 11 years) within 48-72 h after endovascular thrombectomy. Parenchymal hyperdensity was assessed for the presence of ICH or/and CS by two board certified and fellowship-trained, blinded and independent neuroradiologists using standard mixed images and virtual non-contrast (VNC) images with corresponding iodine maps from TwinSpiral DECT. Follow-up examinations (FU; CT or MRI) were used as a standard of reference. Sensitivity, specificity, and accuracy for the detection of ICH as well as the inter-reader agreement were calculated.
RESULTS
Parenchymal hyperdensities were detected in 17/39 (44%) patients. Using DECT, they were classified by both readers as ICH in 9 (53%), CS in 8 (47%), and mixture of both in 6 (35%) cases with excellent agreement (κ = 0.81, P < 0.0001). The sensitivity, specificity, and accuracy for the detection of ICH in DECT was 90% (95% confidence interval [CI]: 84-96%), 100% (95% CI 94-100%) and 95% (95% CI 89-100%), and in mixed images 90% (95% CI 84-96%), 86% (95% CI 80-92%) and 88% (95% CI 82-94%), respectively. Inter-reader agreement for detecting ICH on DECT compared to the mixed images was κ = 1.00 (P < 0.0001) vs. κ = 0.51 (P = 0.034).
CONCLUSION
TwinSpiral DECT demonstrates high accuracy and excellent specificity for differentiating ICH from CS in patients after mechanical thrombectomy due to acute ischemic stroke, and improves inter-reader agreement for detecting ICH compared to the standard mixed images.
Item Type: |
Journal Article (Original Article) |
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Division/Institute: |
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology |
UniBE Contributor: |
Ahmadli, Uzeyir |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
1869-1447 |
Publisher: |
Springer-Verlag |
Language: |
English |
Submitter: |
Martin Zbinden |
Date Deposited: |
31 Aug 2022 09:43 |
Last Modified: |
15 Mar 2023 00:12 |
Publisher DOI: |
10.1007/s00062-022-01198-3 |
PubMed ID: |
35960327 |
Uncontrolled Keywords: |
Brain hemorrhage Cerebrovascular accident Contrast extravasation Endovascular treatment Spectral computed tomography |
BORIS DOI: |
10.48350/172473 |
URI: |
https://boris.unibe.ch/id/eprint/172473 |
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