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European Radiology
Published in: European Radiology 4/2014

01-04-2014 | Neuro

The role of dual energy CT in differentiating between brain haemorrhage and contrast medium after mechanical revascularisation in acute ischaemic stroke

Authors: M. P. M. Tijssen, P. A. M. Hofman, A. A. R. Stadler, W. van Zwam, R. de Graaf, R. J. van Oostenbrugge, E. Klotz, J. E. Wildberger, A. A. Postma

Published in: European Radiology | Issue 4/2014

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Abstract

Objectives

To assess the feasibility of dual energy computed tomography (DE-CT) in intra-arterially treated acute ischaemic stroke patients to discriminate between contrast extravasation and intracerebral haemorrhage.

Methods

Thirty consecutive acute ischaemic stroke patients following intra-arterial treatment were examined with DE-CT. Simultaneous imaging at 80 kV and 140 kV was employed with calculation of mixed images. Virtual unenhanced non-contrast (VNC) images and iodine overlay maps (IOM) were calculated using a dedicated brain haemorrhage algorithm. Mixed images alone, as “conventional CT”, and DE-CT interpretations were evaluated and compared with follow-up CT.

Results

Eight patients were excluded owing to a lack of follow-up or loss of data. Mixed images showed intracerebral hyperdense areas in 19/22 patients. Both haemorrhage and residual contrast material were present in 1/22. IOM suggested contrast extravasation in 18/22 patients; in 16/18 patients this was confirmed at follow-up. The positive predictive value (PPV) of mixed imaging alone was 25 %, with a negative predictive value (NPV) of 91 % and accuracy of 63 %. The PPV for detection of haemorrhage with DE-CT was 100 %, with an NPV of 89 % and accuracy improved to 89 %.

Conclusions

Dual energy computed tomography improves accuracy and diagnostic confidence in early differentiation between intracranial haemorrhage and contrast medium extravasation in acute stroke patients following intra-arterial revascularisation.

Key Points

• Contrast material and haemorrhage have similar density on conventional 120-kV CT.
• Contrast material hinders interpretation of CT in stroke patients after recanalisation.
• Iodine and haemorrhage have different attenuation at lower kVs.
• Dual energy CT improves accuracy in early differentiation of haemorrhage and contrast extravasation.
• Early differentiation between iodine and haemorrhage helps to initiate therapy promptly.
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Metadata
Title
The role of dual energy CT in differentiating between brain haemorrhage and contrast medium after mechanical revascularisation in acute ischaemic stroke
Authors
M. P. M. Tijssen
P. A. M. Hofman
A. A. R. Stadler
W. van Zwam
R. de Graaf
R. J. van Oostenbrugge
E. Klotz
J. E. Wildberger
A. A. Postma
Publication date
01-04-2014
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 4/2014
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-013-3073-x

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