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The role of dual energy CT in prediction of hemorrhagic complications after mechanical thrombectomy for acute Ischemic stroke
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Abstract
Purpose: Evaluate the characteristics of Dual-energy CT of the brain performed after mechanical thrombectomy. Acess the capability of iodine extravasation quantification on DECT to predict hemorrhagic complications.
Material and methods: Retrospective descriptive study. Thirty consecutive patients who underwent brain dual-energy CT right after mechanical thrombectomy for acute ischemic stroke between July 2019 and September 2020 in Radiology Center, Bach Mai hospital, were included. Maximum iodine concentration was measured. Follow-up CT or MRI examinations performed at 24hrs after intervention were reviewed for intracerebral hemorrhage development. The correlation between dualenergy
CT parameters and intracerebral hemorrhage development was analyzed by the Mann-Whitney U test and Fisher exact test. Receiver operating characteristic curves were generated for continuous variables.
Result: Nineteen of 30 patients (63.3%) developed hemorrhage in different grades. On postoperative dual-energy CT, parenchymal hyperdensities and iodine extravasation were present in 19 (100%) of the 19 patients who developed intracerebral hemorrhage and in 7 (63.6%) of the 11 patients who did not (P = 0.0012). Signs of bleeding were present in 5 (45.4%) of the 19 patients who developed intracerebral hemorrhage and in none of the patients who did not. Median density of contrast extravasation in hemorrhage and non-hemorrhage is 108.8HU and 33.6HU (P=0.001). Median maximum iodine concentration was 2.9 mg/mL in the patients who developed intracerebral hemorrhage and 0.59 mg/mL in the patients who did not (P = 0.003). Maximum iodine concentration showed an area under the curve of 0.9 for identifying patients developing intracerebral hemorrhage.
Conclusion: DECT helps differentiating haemorrhage from contrast extravasation. The presence of parenchymal hyperdensity with a maximum iodine concentration of >1.1 mg/mL may identify patients developing intracerebral hemorrhage with 94.7% sensitivity and 81.8% specificity.
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Keywords
Dual – energy CT, thrombectomy, iodine extravasation
References
2. Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke; a journal of cerebral circulation. 2019;50(12):e344-e418.
3. Khatri P, Wechsler LR, Broderick JP. Intracranial hemorrhage associated with revascularization therapies. Stroke; a journal of cerebral circulation. 2007;38(2):431-440.
4. Hu R, Padole A, Gupta R. Dual-energy computed tomographic applications for differentiation of intracranial hemorrhage, calcium, and iodine. Neuroimaging Clinics. 2017;27(3):401-409.
5. Van Hedent S, Hokamp NG, Laukamp K, et al. Differentiation of hemorrhage from iodine using spectral detector CT: a phantom study. American Journal of Neuroradiology. 2018;39(12):2205-2210.
6. Bonatti M, Lombardo F, Zamboni GA, et al. Iodine Extravasation Quantification on Dual-Energy CT of the Brain Performed after Mechanical Thrombectomy for Acute Ischemic Stroke Can Predict Hemorrhagic Complications. American Journal of Neuroradiology. 2018;39(3):441-447.
7. Byrne D, Walsh JP, Schmiedeskamp H, et al. Prediction of Hemorrhage after Successful Recanalization in Patients with Acute Ischemic Stroke: Improved Risk Stratification Using Dual-Energy CT Parenchymal Iodine Concentration Ratio Relative to the Superior Sagittal Sinus. AJNR American journal of neuroradiology. 2020;41(1):64-70.