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Dual-Energy CT After Peri-interventional Subarachnoid Haemorrhage

A Feasibility Study

Dual-Energie-CT nach periinterventioneller Subarachnoidalblutung

Machbarkeitsstudie

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Abstract

Purpose:

The aim was to assess the feasibility of dual-energy computed tomography (DE-CT) for detection of peri-interventional re-bleeding in patients with aneurysmal subarachnoid hemorrhage (re-SAH).

Methods:

For in vitro-analyses DE-CT of partially clotted blood intermixed with fresh blood containing contrast agent was performed. In a clinical setting, 4 patients routinely underwent DE-CT after suspected peri-interventional re-SAH. DE-CT source data images, iodine maps and virtual non-contrast images (VNC) were analyzed and regions-of-interest (ROI) measurements of density values were performed.

Results:

In vitro experiments demonstrated the feasibility of DE-CT to discriminate between blood with and without contrast agent. In all patients peri-interventional re-SAH was confirmed by detection of extravasated iodine within the subarachnoid spaces in post-interventional DE-CT. Dual-energy CT allowed the discrimination of old blood clots of the initial SAH and blood originating from peri-interventional re-SAH. After subtraction of the iodine-related high density signal, VNC images optimized the estimation of the true amount of subarachnoid blood.

Conclusion:

Dual-energy CT allows the discrimination and subtraction of blood and iodine mixed within the subarachnoid spaces in patients with peri-interventional re-SAH. It helps to avoid overestimation of SAH after peri-interventional re-bleeding and therefore is a potentially valuable tool in the assessment of peri-interventional re-SAH.

Zusammenfassung

Zielsetzung:

Zielsetzung der Studie war es, den Einsatz der Dual-Energie-CT (DE-CT) zur Unterscheidung von jodhaltigem und nichtjodhaltigem Blut in vitro und bei Patienten mit periinterventioneller Subarachnoidalblutung (SAB) zu evaluieren.

Methoden:

Für die In-vitro-Experimente wurde mit Kontrastmittel versetztes Blut zu bereits geronnenem Blut (ohne Kontrastmittel) hinzugegeben. Die Probe wurde anschließend mithilfe der DE-CT untersucht. Bei 4 Patienten mit Zustand nach SAB und Verdacht auf periinterventionell erneut stattgehabter SAB wurde die reguläre postinterventionelle Kontroll-CT als DE-CT durchgeführt. Die nichtmodifizierten Quellbilder, die jodgewichteten Bilder sowie die Bilder nach Subtraktion des Jodsignals (virtuelle Nativbilder, VNC) wurden analysiert und Messungen der Dichtewerte des subarachnoidalen Blutes in Bereichen mit periinterventionell ausgetretenem Blut durchgeführt.

Ergebnisse:

Die In-vitro-Experimente belegen, dass mithilfe der DE-CT zwischen jodhaltigem und nichtjodhaltigem Blut unterschieden werden kann. Bei allen Patienten konnte in der DE-CT jodhaltiges Blut im Subarachnoidalraum nachgewiesen werden. Die DE-CT erlaubte eine Diskriminierung von alten Blutkoageln und periinterventionell neu hinzugekommenem kontrastmittelhaltigem Blut; dies ging mit einer besseren Beurteilbarkeit der Bilder einher.

Schlussfolgerung:

Die DE-CT ermöglicht die Identifizierung und Subtraktion von jodhaltigem Blut in vitro und in vivo. Damit ist die DE-CT eine für die Interpretation der Bilddaten von Patienten mit periprozeduraler SAB potentiell wertvolle Ergänzung.

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References

  1. de Rooij NK, Linn FH, van der Plas JA, Algra A, Rinkel GJ. Incidence of subarachnoid haemorrhage: a systematic review with emphasis on region, age, gender and time trends. J Neurol Neurosurg Psychiatry. 2007;78:1365–72.

    Article  CAS  PubMed  Google Scholar 

  2. Pobereskin LH. Incidence and outcome of subarachnoid haemorrhage: a retrospective population based study. J Neurol Neurosurg Psychiatry. 2001;70:340–3.

    Article  CAS  PubMed  Google Scholar 

  3. Ries T, Groden C. Endovascular treatment of intracranial aneurysms: long-term stability, risk factors for recurrences, retreatment and follow-up. Clin Neuroradiol. 2009;19:62–72.

    Article  PubMed  Google Scholar 

  4. Schumacher M, Weber J. Aneurysm treatment—a neuroradiologic success story. Clin Neuroradiol. 2008;18:203–15.

    Article  Google Scholar 

  5. Sommer WH, Johnson TR, Becker CR, Arnoldi E, Kramer H, Reiser MF, Nikolaou K. The value of dual-energy bone removal in maximum intensity projections of lower extremity computed tomography angiography. Invest Radiol. 2009;44:285–92.

    Article  PubMed  Google Scholar 

  6. Johnson TR, Nikolaou K, Wintersperger BJ, Leber AW, von Ziegler F, Rist C, Buhmann S, Knez A, Reiser MF, Becker CR. Dual-source CT cardiac imaging: initial experience. Eur Radiol. 2006;16:1409–15.

    Article  PubMed  Google Scholar 

  7. Johnson TR, Krauss B, Sedlmair M, Grasruck M, Bruder H, Morhard D, Fink C, Weckbach S, Lenhard M, Schmidt B, Flohr T, Reiser MF, Becker CR. Material differentiation by dual energy CT: initial experience. Eur Radiol. 2007;17:1510–17.

    Article  PubMed  Google Scholar 

  8. Fink C, Johnson TR, Michaely HJ, Morhard D, Becker C, Reiser M, Nikolaou K. Dual-energy CT angiography of the lung in patients with suspected pulmonary embolism: initial results. Rofo. 2008;180:879–83.

    CAS  PubMed  Google Scholar 

  9. Brockmann C, Jochum S, Sadick M, Huck K, Ziegler P, Fink C, Schoenberg SO, Diehl SJ. Dual-energy CT angiography in peripheral arterial occlusive disease. Cardiovasc Intervent Radiol. 2009;32:630–7.

    Article  PubMed  Google Scholar 

  10. Buerke B, Wittkamp G, Seifarth H, Heindel W, Kloska SP. Dual-energy CTA with bone removal for transcranial arteries intraindividual comparison with standard CTA without bone removal and TOF-MRA(1). Acad Radiol. 2009;16:1348–55.

    Article  PubMed  Google Scholar 

  11. Ferda J, Novak M, Mirka H, Baxa J, Ferdova E, Bednarova A, Flohr T, Schmidt B, Klotz E, Kreuzberg B. The assessment of intracranial bleeding with virtual unenhanced imaging by means of dual-energy CT angiography. Eur Radiol. 2009;19:2518–22.

    Article  PubMed  Google Scholar 

  12. Morhard D, Fink C, Graser A, Reiser MF, Becker C, Johnson TR. Cervical and cranial computed tomographic angiography with automated bone removal: dual energy computed tomography versus standard computed tomography. Invest Radiol. 2009;44:293–7.

    Article  PubMed  Google Scholar 

  13. Kalender WA. Computertomographie. 2nd ed. Erlangen: Publicis; 2006.

  14. Stolzmann P, Kozomara M, Chuck N, Muntener M, Leschka S, Scheffel H, Alkadhi H. In vivo identification of uric acid stones with dual-energy CT: diagnostic performance evaluation in patients. Abdom Imaging. 2010;35:629–35.

    Article  PubMed  Google Scholar 

  15. Fletcher JG, Takahashi N, Hartman R, Guimaraes L, Huprich JE, Hough DM, Yu L, McCollough CH. Dual-energy and dual-source CT: is there a role in the abdomen and pelvis? Radiol Clin North Am. 2009;47:41–57.

    Article  PubMed  Google Scholar 

  16. Park HK, Horowitz M, Jungreis C, Genevro J, Koebbe C, Levy E, Kassam A. Periprocedural morbidity and mortality associated with endovascular treatment of intracranial aneurysms. AJNR Am J Neuroradiol. 2005;26:506–14.

    PubMed  Google Scholar 

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Conflict of Interest Statement

The authors declare that there is no actual or potential conflict of interest in relation to this article.

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Authors and Affiliations

  1. Department of Neuroradiology, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    C. Brockmann, J. Scharf, I. S. Nölte, C. Groden & M. A. Brockmann

  2. Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria

    M. Seiz

Authors
  1. C. Brockmann
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  2. J. Scharf
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  3. I. S. Nölte
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  4. M. Seiz
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  5. C. Groden
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  6. M. A. Brockmann
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Corresponding author

Correspondence to M. A. Brockmann.

Additional information

Carolin Brockmann and Johann Scharf contributed equally to this work.

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Brockmann, C., Scharf, J., Nölte, I.S. et al. Dual-Energy CT After Peri-interventional Subarachnoid Haemorrhage. Clin Neuroradiol 20, 231–235 (2010). https://doi.org/10.1007/s00062-010-0036-3

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  • DOI: https://doi.org/10.1007/s00062-010-0036-3

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