Initial experience with dual-layer detector spectral CT for diagnosis of blood or contrast after endovascular treatment for ischemic stroke

Abstract

Purpose To determine whether spectral detector CT (SDCT) with a plain non-enhanced monochromatic CT, a water-weighted image after iodine removal, an iodine map, and Mono energetic images changes the diagnosis and classification of intracranial hemorrhage based on single energy CT after endovascular treatment (EVT) for ischemic stroke. Methods Two readers evaluated single energy and SD CT data collected from 63 patients within one week after EVT. They diagnosed ICH or contrast staining, and graded ICH according to the Heidelberg and Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) classification. Differences in diagnosis between single energy and SD CT were tested with Pearson's chi-squared test. Diagnostic values of single energy CT were calculated. Interrater agreement was based on Cohen's Kappa. Results When spectral data were added to single energy CT, the diagnosis of ICH changed in 8 CT scans (13%): in 4, the diagnosis of ICH was rejected and in 4, initially undetected ICH was diagnosed. In an additional 3 patients, the ICH grade was modified. CT alone had 88% sensitivity, 87% specificity, 88% positive diagnostic value, 87% negative diagnostic value, and 87% overall accuracy for ICH compared to SDCT. Interreader agreement on the presence of ICH was 0.84 (95% CI 0.51-0.86) for spectral CT and 0.84 (95% CI 0.73-0.97) for single energy CT. Conclusion SD CT after endovascular treatment contributes to the distinction between intracranial hemorrhage and contrast staining. KeywordsStroke • Endovascular treatment • Computed tomography • Spectral computed tomography • Intracerebral hemorrhage (ICH)

Why Does It Shine?—A Prognostic Analysis about Predisposing Factors for Blood–Brain Barrier Damage after Revascularisation of Cerebral Large-Vessel Occlusion

“…Out of these test items, only the extension of these lesions (in total volume as well as in the applied ASPECTS), the location of the ischemic area (white vs. grey matter) and the plasmatic coagulation system could be demonstrated as independent factors for the development of such hyperdense lesions. Furthermore, our results showed a prognostic association between the presence of these hyperdense lesions and the final extension of the infarct as well as the secondary rate of ICH development, as already demonstrated in previous publications [16][17][18][19][20][21][22][23].…”

“…These hyperdense lesions are seen as predictors for a later haemorrhagic transformation of ischemic brain tissue. Furthermore, these hyperdense areas demonstrate a correlation with the minimal size of the final infarct extension [16][17][18][19][20][21][22][23].…”

“…The two groups differed in a statistically significant way in the NHISS at admission (16 [12-20] vs. 14 [10][11][12][13][14][15][16][17][18][19][20], p < 0.001, Spearman-rho: 0.166) and in the known time window (173 min [68.8-426.3] vs. 96.5 min [60-263.3], p = 0.002, Spearman-rho: 0.15). Blood samples showed significant differences between our subgroups in haemostatic parameters (INR: 1.1 [1.0-1.3] vs. 1.1 [1.0-1.2], p = 0.019, Spearman-rho: 0.108; INR (rating); tendency towards too high in the hyperdense group (too high values 22.6% vs. 15.6%), p = 0.046; Spearman-rho: 0.092; aPTT (rating); and tendency towards too high in the hyperdense group (too high values 8% vs. 2.7%), p = 0.016, Spearman-rho: 0.111).…”