Dual-energy CT Immediately after Endovascular Stroke Intervention: Prognostic Implications
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Posttreatment intracerebral hemorrhage (ICH) after recanalization therapy of acute ischemic stroke increases morbidity and mortality. Dual-energy (DE) computed tomography (CT) allows differentiation of blood–brain barrier disruption (BBBD) and ICH. We evaluated the incidence of ICH and BBBD immediately after endovascular recanalization therapy, the correlation between BBBD and final infarction or ICH size, and the prognostic value of postinterventional BBBD.
Imaging data sets (pretreatment CT, posttreatment DE-CT, and follow-up imaging by CT and/or magnetic resonance imaging) of 60 consecutive patients after endovascular recanalization therapy of acute ischemic stroke were retrospectively analyzed. After material differentiation, areas of increase attenuation in posttreatment DE-CT were correlated to ICH and infarction in follow-up imaging.
Areas of hyperattenuation were observed in 80.0 % (48 of 60) of all posttreatment CT. In 10.4 % (5 of 48) of these, hyperattenuating areas matched the hyperdensities on virtual nonenhanced CT and were rated as hemorrhage. The remaining 89.6 % (43 of 48) of scans with hyperattenuating areas demonstrated hyperdensities exclusively on iodine-only images and were rated as BBBD. All suspected ICH on DE-CT were proven in follow-up imaging. There were no false-positive or false-negative findings of ICH in DE-CT. In 98.3 % (59 of 60) of cases, at least small ischemic infarctions were identified in follow-up imaging. No correlation between the extent of BBBD and the final infarct size and/or early ICH size was found.
BBBD is a frequent finding after endovascular revascularization therapy. DE-CT allows for a reliable differentiation between frequent BBBD and rare ICH immediately after endovascular recanalization therapy.
KeywordsNeurointerventions Stroke therapy Brain Neurological Nervous system Stroke
Conflict of interest
Prof. Birgit Ertl-Wagner reports, outside the submitted work, personal fees from board membership, Philips Healthcare, Bracco, and Springer Medical Publisher; personal fees from consultancy, Munich Medical International and Philips Healthcare; personal fees from employment, University of Munich; grants from Eli Lily, Genentech, Guerbet, and Merck Serono; personal fees from payment for lectures, Siemens and Bayer Schering; personal fees from royalties, Springer Medical Publisher and Thieme Medical Publisher. The other authors declare that they have no conflict of interest.
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