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Assessment of post-thrombectomy brain hemorrhage in acute ischemic stroke with dual-energy CT: how reliable is it in clinical practice?

  • Computed Tomography
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Abstract

Purpose

Acute ischemic stroke is currently among the main causes of mortality in Western countries. The current guidelines suggest different flowcharts of diagnostic work-up and treatment modalities, including endovascular thrombectomy. Immediately after intra-arterial recanalization, a brain CT scan is usually performed to assess for the presence of peri-procedural complications; in this setting, it is very hard, if possible, to differentiate blood from iodinated contrast material, which is normally present in ischemic tissue because of BBB disruption. Dual-energy CT may be used for this purpose, exploiting its ability to discriminate different materials.

Materials and methods

We retrospectively studied 44 patients with acute ischemic stroke who were treated with endovascular recanalization at San Giovanni Bosco Hospital in Turin and were then scanned with DECT technology. Subsequent scan was used as standard, since iodine from contrast staining is usually reabsorbed in 24 h and blood persists longer. A χ2 test of independence was performed to examine the relationship between blood detected by DECT scan after the endovascular procedure and the presence of blood in the same areas on the following scans, with a significant result: χ2 (1, N = 37) = 10.7086, p = 0.0010.

Results

Patients with blood detected on DECT scans had a double chance of having hemorrhagic infarction in follow-up scans, (RR 2.02). The sensitivity and specificity of DECT were respectively 70% and 90%, with an overall diagnostic accuracy of 76% and a positive and negative predictive value, respectively, of 95% and 53%.

Conclusion

Dual-energy CT scan after endovascular recanalization in ischemic stroke identifies early hemorrhagic infarction with excellent specificity and good overall diagnostic accuracy, representing a reliable diagnostic tool in everyday clinical practice.

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Authors and Affiliations

  1. Department of Radiology and Neuroradiology, San Giovanni Bosco Hospital, Piazza Donatore del Sangue 3, Turin, Italy

    Alberto Pacielli, Giacomo Paolo Vaudano, Adolfo Prochet, Paola Gollini & Maria Elena Perna

  2. Department of Surgical Sciences, University of Torino – A.O.U. Città della Salute e della Scienza di Torino, C.So Bramante 88, 10126, Turin, Italy

    Laura Bergamasco

Authors
  1. Alberto Pacielli
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  2. Giacomo Paolo Vaudano
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  3. Laura Bergamasco
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  4. Adolfo Prochet
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  5. Paola Gollini
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  6. Maria Elena Perna
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Correspondence to Alberto Pacielli.

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The authors declare that they have no conflict of interest.

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The authors did not seek informed consent or ethical committee approval, for the following reasons: the paper does not report on primary research. All data analyzed were collected as part of routine diagnosis and treatment. Patients were diagnosed and treated according to national guidelines and agreements. The paper does not report on the use of experimental or new protocols. Our analysis looked retrospectively at outcomes for a cohort of patients.

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Pacielli, A., Vaudano, G.P., Bergamasco, L. et al. Assessment of post-thrombectomy brain hemorrhage in acute ischemic stroke with dual-energy CT: how reliable is it in clinical practice?. Radiol med 129, 575–584 (2024). https://doi.org/10.1007/s11547-023-01749-9

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  • DOI: https://doi.org/10.1007/s11547-023-01749-9

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