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. 2023 Mar;33(1):171-177.
doi: 10.1007/s00062-022-01198-3. Epub 2022 Aug 12.

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

Risto Grkovski  1   2   3 , Leyla Acu  1 , Uzeyir Ahmadli  1 , Robert Terziev  1   4 , Tilman Schubert  1 , Susanne Wegener  4 , Zsolt Kulcsar  1 , Shakir Husain  1 , Hatem Alkadhi  5 , Sebastian Winklhofer  6
Affiliations

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

Risto Grkovski et al. Clin Neuroradiol. 2023 Mar.

Abstract

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.

Keywords: Brain hemorrhage; Cerebrovascular accident; Contrast extravasation; Endovascular treatment; Spectral computed tomography.

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Conflict of interest statement

R. Grkovski, L. Acu, U. Ahmadli, R. Terziev, T. Schubert, S. Wegener, Z. Kulcsár, S. Husain, H. Alkadhi and S. Winklhofer declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Schematic mode of operation of a single-source TwinSpiral dual-energy CT: Two consecutive scans at a different energies (low and a high kV scan) are performed directly one after the other. From these two datasets, conventional mixed CT images (a), as well as dedicated reconstructions, such as color-coded iodine overlay images (b) and virtual non-contrast (VNC) images (c) can be postprocessed
Fig. 2
Fig. 2
A standard native non-contrast computed tomography (CT) mixed image from TwinSpiral dual-energy CT shows a hyperdensity in the Sylvian cortex on the right side (blue arrow) in an acute ischemic stroke patient after endovascular thrombectomy (a). The hyperdensity is also seen in the same location on the virtual non-contrast (VNC) image (b). No hyperdensity is seen on the iodine map (c). Follow-up magnetic resonance image (MRI) (d) showing a susceptibility artifact (blue arrow) on a susceptibility-weighted imaging (SWI) corresponding to the hyperdense area seen on the standard mixed and VNC images, but not on the iodine map, thus proving an intracerebral hemorrhage
Fig. 3
Fig. 3
A hyperdensity is seen in the left basal ganglia (blue arrow) on a standard non-contrast mixed image from TwinSpiral dual-energy CT image in an acute ischemic stroke patient after endovascular thrombectomy (a). No hyperdensity is seen in the same location on the VNC image (b). Hyperdensity is seen on the iodine map (c). Follow-up non-contrast CT (d) showing no hyperdensity at the corresponding location (blue arrow), thus indicating the contrast extravasation resorbed in follow-up imaging
Fig. 4
Fig. 4
Performance of the TwinSpiral DECT compared to the standard mixed images for detecting an ICH
See this image and copyright information in PMC

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