Differentiation between Cerebral Hemorrhage and Contrast Extravasation Using Dual Energy Computed Tomography after Intra-Arterial Neuro Interventional Procedures

Abstract

To evaluate the value of dual-energy computed tomography (DECT) in differentiating cerebral hemorrhage from blood brain barrier (BBB) disruption after neuro-interventional procedures with intraarterial injection of iodinated contrast material. Material and methods: This prospective study was approved by the local ethics committee, and informed consent was obtained for all patients. Thirty five patients with acute ischemic stroke or un-ruptured brain aneurysm who had received intra-arterial administration of iodinated contrast material were evaluated using DECT at 80 and 150 kV immediately after the procedure. A three-material decomposition algorithm was used to obtain virtual non-contrast (VNC) images and iodine overlay maps (IOM). A follow-up examination (brain magnetic resonance imaging MRI or conventional CT) was used as the standard of reference for hemorrhage, defined as a persistant hyperdensity on a conventional CT or T2* hypo-intensity on brain MRI. The diagnostic values of DECT in differentiating hemorrhage and iodinated contrast material were obtained. Results: Mixed images obtained with DECT showed intra-parenchymal or subarachnoid hyperattenuation in 18/35 patients. Among these, 16 were classified (according to VNC images and IOM) as contrast extravasations and two with a mixture of hemorrhage and contrast material. On follow-up imaging, there were two patients with hemorrhage. The sensitivity, specificity, and accuracy of DECT in the identifying hemorrhage was calculated as 67% (2/3), 100% (32/32) and 97% (32/33) respectively. Conclusion: DECT allows an early and accurate differentiation between cerebral hemorrhage and BBB disruption after intra-arterial neuro-interventional procedures.

Prognostic value of contrast staining on dual-energy CT after endovascular therapy in acute ischemic stroke: a meta-analysis

“…One study had no follow-up images as reference standards and one study was duplicate publication. Finally, a total of 11 studies were included in the final analysis [ 8 – 10 , 16 – 23 ].…”

“…Eventually, 46.1% of the patients (546/1184) were diagnosed with CS only. Of the 11 studies included, 10 studies outlined the correlation between CS and HT [ 8 – 10 , 16 – 19 , 21 – 23 ], along with four studies on sHT [ 8 , 16 , 19 , 20 ], while four studies reported the relationship between CS and poor functional outcome [ 8 , 10 , 16 , 20 ]. One of the studies [ 16 ] evaluated the anterior circulation stroke and the posterior circulation stroke separately, so we extracted the data as if it were two separate studies.…”

“…Compared with Non-CS patients, CS significantly increased the risk of HT (OR = 2.22; 95% CI 1.41–3.51; P = 0.001), with moderate heterogeneity ( P = 0.057, I 2 = 45.4%) [ 8 , 10 , 16 – 19 , 21 – 23 ]. The association between CS and HT was still significant in the subgroup analysis, including studies that had underwent the index test time interval within 1 h (OR = 1.86; 95% CI: 1.07–3.23; P = 0.028; test of heterogeneity: P = 0.146, I 2 = 37.0%) [ 10 , 17 – 19 , 21 – 23 ] and studies with anterior circulation stroke (OR = 2.40; 95% CI: 1.66–3.48; P < 0.001; test of heterogeneity: P = 0.372, I 2 = 6.1%) [ 8 , 15 , 17 , 18 , 20 ] (Fig. 2 ).…”

“…Patients with CS had a higher incidence of HT at follow-up (OR = 6.56; 95% CI: 3.39–12.69; P < 0.001; test of heterogeneity: P = 0.307, I 2 = 15.7%) than No-HDA patients [ 9 , 10 , 17 – 19 , 21 – 23 ].…”

Hemorrhagic Transformation Rates following Contrast Media Administration in Patients Hospitalized with Ischemic Stroke

“…We were reliant on the radiologists, neurologists, and coders at each hospital for the outcomes reported as HT; coding errors, misdiagnoses, and discordant findings are, therefore, possible. 32,33 This study was not able to track other factors that may impact HT rates or the severity of the HT, such as procedural factors (use of different catheters, catheter placement), heparin volume, and size of the infarct. It is also possible that there was a bias in the use of the contrast agents, depending on the initial evaluation of the patient, including imaging findings, large-core infarct area, and NIHSS scores.…”