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Open Access 01-01-2021 | Stroke | Diagnostic Neuroradiology

Virtual monochromatic dual-energy CT reconstructions improve detection of cerebral infarct in patients with suspicion of stroke

Authors: Fasco van Ommen, Jan Willem Dankbaar, Guangming Zhu, Dylan N. Wolman, Jeremy J. Heit, Frans Kauw, Edwin Bennink, Hugo W. A. M. de Jong, Max Wintermark

Published in: Neuroradiology | Issue 1/2021

Abstract

Purpose

Early infarcts are hard to diagnose on non-contrast head CT. Dual-energy CT (DECT) may potentially increase infarct differentiation. The optimal DECT settings for differentiation were identified and evaluated.

Methods

One hundred and twenty-five consecutive patients who presented with suspected acute ischemic stroke (AIS) and underwent non-contrast DECT and subsequent DWI were retrospectively identified. The DWI was used as reference standard. First, virtual monochromatic images (VMI) of 25 patients were reconstructed from 40 to 140 keV and scored by two readers for acute infarct. Sensitivity, specificity, positive, and negative predictive values for infarct detection were compared and a subset of VMI energies were selected. Next, for a separate larger cohort of 100 suspected AIS patients, conventional non-contrast CT (NCT) and selected VMI were scored by two readers for the presence and location of infarct. The same statistics for infarct detection were calculated. Infarct location match was compared per vascular territory. Subgroup analyses were dichotomized by time from last-seen-well to CT imaging.

Results

A total of 80–90 keV VMI were marginally more sensitive (36.3–37.3%) than NCT (32.4%; p > 0.680), with marginally higher specificity (92.2–94.4 vs 91.1%; p > 0.509) for infarct detection. Location match was superior for VMI compared with NCT (28.7–27.4 vs 19.5%; p < 0.010). Within 4.5 h from last-seen-well, 80 keV VMI more accurately detected infarct (58.0 vs 54.0%) and localized infarcts (27.1 vs 11.9%; p = 0.004) than NCT, whereas after 4.5 h, 90 keV VMI was more accurate (69.3 vs 66.3%).

Conclusion

Non-contrast 80–90 keV VMI best differentiates normal from infarcted brain parenchyma.

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Title: Virtual monochromatic dual-energy CT reconstructions improve detection of cerebral infarct in patients with suspicion of stroke
Authors: Fasco van Ommen
Jan Willem Dankbaar
Guangming Zhu
Dylan N. Wolman
Jeremy J. Heit
Frans Kauw
Edwin Bennink
Hugo W. A. M. de Jong
Max Wintermark
Publication date: 01-01-2021
Publisher: Springer Berlin Heidelberg
Keyword: Stroke
Published in: Neuroradiology / Issue 1/2021
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI: https://doi.org/10.1007/s00234-020-02492-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Virtual monochromatic dual-energy CT reconstructions improve detection of cerebral infarct in patients with suspicion of stroke

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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