Kau T, Hauser M, Obmann S M, Niedermayer M, Weber J R, Hausegger K A
From the Institute of Diagnostic and Interventional Radiology (T.K., M.H., M.N., K.A.H.)
From the Institute of Diagnostic and Interventional Radiology (T.K., M.H., M.N., K.A.H.).
AJNR Am J Neuroradiol. 2014 Sep;35(9):1759-64. doi: 10.3174/ajnr.A4021. Epub 2014 Jun 19.
Flat panel detector CT in the angiography suite may be valuable for the detection of intracranial hematomas; however, abnormal contrast enhancement frequently mimics hemorrhage. We aimed to assess the accuracy of flat panel detector CT in detecting/excluding intracranial bleeding after endovascular stroke therapy and whether it was able to reliably differentiate hemorrhage from early blood-brain barrier disruption.
Seventy-three patients were included for retrospective evaluation following endovascular stroke therapy: 32 after stent-assisted thrombectomy, 14 after intra-arterial thrombolysis, and 27 after a combination of both. Flat panel CT images were assessed for image quality and the presence and type of intracranial hemorrhage and BBB disruption by 2 readers separately and in consensus. Follow-up by multisection head CT, serving as the reference standard, was evaluated by a single reader.
Conventional head CT revealed intracranial hematomas in 12 patients (8 subarachnoid hemorrhages, 7 cases of intracerebral bleeding, 3 SAHs plus intracerebral bleeding). Image quality of flat panel detector CT was considered sufficient in all cases supratentorially and in 92% in the posterior fossa. Regarding detection or exclusion of intracranial hemorrhage, flat panel detector CT reached a sensitivity, specificity, positive and negative predictive values, and accuracy of 58%, 85%, 44%, 91%, and 81%, respectively. Maximum attenuation measurements were not valuable for the differentiation of hemorrhage and BBB disruption.
Flat panel CT after endovascular stroke treatment was able to exclude the rare event of an intracranial hemorrhage with a high negative predictive value. Future studies should evaluate the predictive value of BBB disruptions in flat panel detector CT for the development of relevant hematomas.
血管造影套件中的平板探测器CT对颅内血肿的检测可能具有重要价值；然而，异常的对比增强常常会模拟出血。我们旨在评估平板探测器CT在血管内卒中治疗后检测/排除颅内出血的准确性，以及它是否能够可靠地区分出血与早期血脑屏障破坏。
73例患者在血管内卒中治疗后纳入回顾性评估：32例接受支架辅助血栓切除术，14例接受动脉内溶栓，27例接受两者联合治疗。由2名阅片者分别并共同评估平板CT图像的质量以及颅内出血和血脑屏障破坏的存在情况及类型。以多层面头部CT随访作为参考标准，由1名阅片者进行评估。
传统头部CT显示12例患者存在颅内血肿（8例蛛网膜下腔出血，7例脑内出血，3例蛛网膜下腔出血合并脑内出血）。平板探测器CT的图像质量在幕上所有病例中均被认为足够，在后颅窝为92%。关于颅内出血的检测或排除，平板探测器CT的敏感性、特异性、阳性和阴性预测值以及准确性分别为58%、85%、44%、91%和81%。最大衰减测量值对于区分出血和血脑屏障破坏没有价值。
血管内卒中治疗后的平板CT能够以较高的阴性预测值排除罕见的颅内出血事件。未来的研究应评估平板探测器CT中血脑屏障破坏对相关血肿发生的预测价值。
