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Early prediction of final infarct volume with material decomposition images of dual-energy CT after mechanical thrombectomy

  • Diagnostic Neuroradiology
  • Published:
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Abstract

Purpose

Evaluation of water material density images (wMDIm) of dual-energy CT (DECT) for earlier prediction of final infarct volume (fiV) in follow-up single-energy CT (SECT) and correlation with clinical outcome.

Methods

Fifty patients (69 years, ± 12.1, 40–90, 50% female) with middle cerebral artery (MCA) occlusions were included. Early infarct volumes were analyzed in monoenergetic images (MonoIm) and wMDIm at 60 keV and compared with the fiV in SECT 4.9 days (± 4) after thrombectomy. Association between infarct volume and functional outcome was tested by linear regression analysis.

Results

wMDIm shows a prior visible infarct demarcation (60.7 ml, ± 74.9 ml) compared with the MonoIm (37.57 ml, ± 76.7 ml). Linear regression analysis, Bland–Altman plots and Pearson correlation coefficients show a close correlation of infarct volume in wMDIm to the fiV in SECT (r = 0.86; 95% CI 0.76–0.92), compared with MonoIm and SECT (r = 0.81; 95% CI 0.69–0.89). The agreement with SECT is substantially higher in patients with infarct volumes < 70 ml (n = 33; 66%). Coefficients were smaller with r = 0.59 (95% CI 0.31; 0.78) for MonoIm and SECT compared with r = 0.77 (95% CI 0.57; 0.88) for wMDIm and SECT. At admission, the mean NIHSS score and mRS were 17.02 (± 4.7) and 4.9 (± 0.2). mRS ≤ 2 was achieved in 56% at 90 days with a mean mRS of 2.5 (± 0.8) at discharge.

Conclusion

Material decomposition allows earlier visibility of the final infarct volume. This promises an earlier evaluation of the dimension and severity of infarction and may lead to faster initiation of secondary stroke prophylaxis.

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Abbreviations

wMDIm:

Water material density images

MonoIm:

Monoenergetic images

DECT:

Dual-energy CT

fiV:

Final infarct volume

MCA:

Middle cerebral artery

SECT:

Single-energy CT

IodMDIm:

Iodine material density image

NIHSS:

National Institutes of Health Stroke Scale

mRS:

Modified Rankin Scale

ECASS:

European Cooperative Acute Stroke Study

mTICI:

Modified treatment in cerebral infarction score

AsiR:

Adaptive statistical iterative reconstruction

ASPECTS:

Alberta stroke program early CT score

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Funding

No funding was received for this study.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology and Neuroradiology, Diakonissenhospital Flensburg, Knuthstraße 1, 24939, Flensburg, Germany

    Silke Hopf-Jensen, Max Anraths, Stephanie Lehrke & Stefan Müller-Hülsbeck

  2. Institute of Medical Informatics and Statistics, Kiel University, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany

    Silke Szymczak

  3. Faculty of Agricultural and Nutritional Sciences, Kiel University, Kiel, Germany

    Mario Hasler

Authors
  1. Silke Hopf-Jensen
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  2. Max Anraths
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  3. Stephanie Lehrke
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  4. Silke Szymczak
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  6. Stefan Müller-Hülsbeck
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Correspondence to Silke Hopf-Jensen.

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Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The institutional review board granted approval of this study with a waiver of informed consent for this retrospective study. Written informed consent for data collection was obtained from all patients or their legal representatives.

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Informed consent was obtained from all individual participants in the study

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Hopf-Jensen, S., Anraths, M., Lehrke, S. et al. Early prediction of final infarct volume with material decomposition images of dual-energy CT after mechanical thrombectomy. Neuroradiology 63, 695–704 (2021). https://doi.org/10.1007/s00234-020-02563-0

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  • DOI: https://doi.org/10.1007/s00234-020-02563-0

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