Iodine Extravasation Quantification on Dual-Energy CT of the Brain Performed after Mechanical Thrombectomy for Acute Ischemic Stroke Can Predict Hemorrhagic Complications

Bonatti, Matteo; Lombardo, Fábio; Zamboni, Giuseppe; Vittadello, Fabio; Dossi, Roberto Currò; Bonetti, Bruno; Mucelli, R. Pozzi; Bonatti, Giampietro

doi:10.3174/ajnr.a5513

Cited by 56 publications

(55 citation statements)

References 31 publications

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“…The former finding is similar to the report from Almqvist et al's ( 7 ) study of DECT. The latter finding of pure contrast staining proportion is higher than in three previously published studies of a post-interventional DECT strategy within 30, 60, or 120 min (68, 47, and 32%, respectively) ( 8 , 13 , 14 ).…”

Section: Discussioncontrasting

confidence: 59%

The Role of Dual Energy CT in Evaluating Hemorrhagic Complications at Different Stages After Thrombectomy

et al. 2020

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Background: Contrast media extravasation can mimic hemorrhage after endovascular thrombectomy (EVT). Dual energy CT (DECT) has the potential to distinguish hemorrhage from iodine contrast. Methods: We retrospectively examined clinical and radiological data from 106 consecutive acute ischemic stroke patients who received EVT and underwent DECT immediately and 24 h after EVT. Iodine overlay map, virtual non-contrast, and mixed images are reconstructed. Results: With the use of DECT, the proportion of all patients diagnosed with hemorrhagic transformation on mixed images immediately after EVT was reduced from 74.5% (79 of 106) to 10.4% (11 of 106), with a very poor consistency (κ = 0.076, p = 0.041). Correspondingly, hemorrhagic transformation on mixed images 24 h after EVT was reduced from 41.5% (44 of 106) to 30.2% (32 of 106), with a moderate consistency (κ = 0.757, p < 0.001). Conclusions: The use of DECT both immediately and 24 h after EVT changes the diagnosis of hemorrhagic transformation in a considerable proportion of acute ischemic stroke patients with EVT. This could affect decision making with respect to antithrombotic strategy.

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Section: Discussioncontrasting

confidence: 59%

The Role of Dual Energy CT in Evaluating Hemorrhagic Complications at Different Stages After Thrombectomy

et al. 2020

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“…Bonatti et al showed that parenchymal hyperdensity with absolute maximum iodine concentration of >1.35mg/mL measured with three-material iodine quantification techniques could predict hemorrhagic complication with 100% sensitivity and 68% specificity. 37 A subsequent study showed that the relative percentage of iodine concentration within parenchymal hyperdensity compared to the superior sagittal sinus within one-hour post-EVT may be a more reliable biomarker of hemorrhage development than maximum iodine concentration. This method was thought to account for variability in iodine concentration depending on factors such as patient size, cardiac output, renal function, and volume of contrast medium administered.…”

Section: Ischemic Strokementioning

confidence: 99%

A Review of the Applications of Dual-Energy CT in Acute Neuroimaging

et al. 2020

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Dual-energy computed tomography (CT) is a promising tool with increasing availability and multiple emerging and established clinical applications in neuroradiology. With its ability to allow characterization of materials based on their differential attenuation when imaged at two different energy levels, dual-energy CT can help identify the composition of brain, neck, and spinal components. Virtual monoenergetic imaging allows a range of simulated single energy-level reconstructions to be created with postprocessing. Low-energy reconstructions can aid identification of edema, ischemia, and subtle lesions due to increased soft tissue contrast as well as increasing contrast-to-noise ratios on angiographic imaging. Higher energy reconstructions can reduce image artifact from dental amalgam, aneurysm clips and coils, spinal hardware, dense contrast, and dense bones. Differentiating iodine from hemorrhage may help guide management of patients after thrombectomy and aid diagnosis of enhancing tumors within parenchymal hemorrhages. Iodine quantification may predict hematoma expansion in aneurysmal bleeds and outcomes in traumatic brain injury. Calcium and bone subtraction can be used to distinguish hemorrhage from brain parenchymal mineralization as well as improving visualization of extra-axial lesions and vessels adjacent to dense plaque or skull. This article reviews the basics of dual-energy CT and highlights many of its clinical applications in the evaluation of acute neurological presentations.

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“…These studies suggest that the presence or amount of contrast staining after EST may have predictive value for the clinical outcome. However, in some studies, clinical parameters were not considered and follow-up imaging was inconsistent with regard to time interval and imaging method [38][39][40].…”

Section: Prediction Of Infarction Development or Future Hemorrhagic Tmentioning

confidence: 99%

Dual-energy computed tomography in acute ischemic stroke: state-of-the-art

et al. 2020

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Dual-energy computed tomography (DECT) allows distinguishing between tissues with similar X-ray attenuation but different atomic numbers. Recent studies demonstrated that this technique has several areas of application in patients with ischemic stroke and a potential impact on patient management. After endovascular stroke therapy (EST), hyperdense areas can represent either hemorrhage or contrast staining due to blood-brain barrier disruption, which can be differentiated reliably by DECT. Further applications are improved visualization of early infarctions, compared to single-energy computed tomography, and prediction of transformation into infarction or hemorrhage in contrast-enhancing areas. In addition, DECT allows detection and evaluation of the material composition of intra-arterial clots after EST. This review summarizes the clinical state-of-the-art of DECT in patients with stroke, and features some prospects for future developments. Key points • Dual-energy computed tomography (DECT) allows differentiation between tissues with similar X-ray attenuation but differentatomic numbers. • DECT has several areas of application in patients with ischemic stroke and a potential impact on patient management. • Prospects for future developments in DECT may improve treatment decision-making.

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Iodine Extravasation Quantification on Dual-Energy CT of the Brain Performed after Mechanical Thrombectomy for Acute Ischemic Stroke Can Predict Hemorrhagic Complications

Abstract: The presence of parenchymal hyperdensity with a maximum iodine concentration of >1.35 mg/mL may identify patients developing intracerebral hemorrhage with 100% sensitivity and 67.6% specificity.

Cited by 56 publications

References 31 publications

The Role of Dual Energy CT in Evaluating Hemorrhagic Complications at Different Stages After Thrombectomy

The Role of Dual Energy CT in Evaluating Hemorrhagic Complications at Different Stages After Thrombectomy

A Review of the Applications of Dual-Energy CT in Acute Neuroimaging

Dual-energy computed tomography in acute ischemic stroke: state-of-the-art

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