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European Radiology
Published in: European Radiology 3/2017

Open Access 01-03-2017 | Computed Tomography

Prediction of infarction development after endovascular stroke therapy with dual-energy computed tomography

Authors: Tanja Djurdjevic, Rafael Rehwald, Michael Knoflach, Benjamin Matosevic, Stefan Kiechl, Elke Ruth Gizewski, Bernhard Glodny, Astrid Ellen Grams

Published in: European Radiology | Issue 3/2017

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Abstract

Objectives

After intraarterial recanalisation (IAR), the haemorrhage and the blood-brain barrier (BBB) disruption can be distinguished using dual-energy computed tomography (DECT). The aim of the present study was to investigate whether future infarction development can be predicted from DECT.

Methods

DECT scans of 20 patients showing 45 BBB disrupted areas after IAR were assessed and compared with follow-up examinations. Receiver operator characteristic (ROC) analyses using densities from the iodine map (IM) and virtual non-contrast (VNC) were performed.

Results

Future infarction areas are denser than future non-infarction areas on IM series (23.44 ± 24.86 vs. 5.77 ± 2.77; p < 0.0001) and more hypodense on VNC series (29.71 ± 3.33 vs. 35.33 ± 3.50; p < 0.0001). ROC analyses for the IM series showed an area under the curve (AUC) of 0.99 (cut-off: <9.97 HU; p < 0.05; sensitivity 91.18 %; specificity 100.00 %; accuracy 0.93) for the prediction of future infarctions. The AUC for the prediction of haemorrhagic infarctions was 0.78 (cut-off >17.13 HU; p < 0.05; sensitivity 90.00 %; specificity 62.86 %; accuracy 0.69). The VNC series allowed prediction of infarction volume.

Conclusions

Future infarction development after IAR can be reliably predicted with the IM series. The prediction of haemorrhages and of infarction size is less reliable.

Key Points

• The IM series (DECT) can predict future infarction development after IAR.
• Later haemorrhages can be predicted using the IM and the BW series.
• The volume of definable hypodense areas in VNC correlates with infarction volume.
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Metadata
Title
Prediction of infarction development after endovascular stroke therapy with dual-energy computed tomography
Authors
Tanja Djurdjevic
Rafael Rehwald
Michael Knoflach
Benjamin Matosevic
Stefan Kiechl
Elke Ruth Gizewski
Bernhard Glodny
Astrid Ellen Grams
Publication date
01-03-2017
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 3/2017
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-016-4412-5

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