Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan.
Department of Radiology, Faculty of Medicine, Saga University, Saga, Japan.
J Neurointerv Surg. 2019 Sep;11(9):898-902. doi: 10.1136/neurintsurg-2018-014486. Epub 2019 Jan 22.
CT scans often reveal post-interventional cerebral hyperdensities (PCHDs) immediately after intra-arterial thrombectomy (IAT) for ischemic stroke. Dual energy CT (DE-CT) can indicate whether PCHDs are caused by hemorrhage or iodinated contrast. Hyperdense lesions, detected on DE-CT with the use of iodinated contrast, could be associated with delayed hemorrhagic transformation and poor outcome. However, the quantitative indicators in DE-CT for predicting delayed hemorrhagic transformation remain unclear. We assessed such indicators for predicting delayed hemorrhagic transformation.
We retrospectively analyzed 52 consecutive acute ischemic stroke patients who underwent IAT. Simulated conventional CT (sCCT) images were obtained immediately after a DE-CT scan. Virtual, unenhanced, non-contrast (VNC) imaging was performed after reconstruction. Hounsfield units (HU) of the infarct areas observed on the sCCT were measured. The association of HU on sCCT with hemorrhage on VNC and delayed parenchymal hemorrhage (PH) was evaluated.
The HU of sCCT with hemorrhage on VNC was significantly higher than without it (377.9±385 HU vs 83.5±37.9 HU; P<0.0001). The cut-off index was 80 HU, which displayed 100% sensitivity, 63.8% specificity, 22.3% positive predictive value, and 100% negative predictive value (P=0.0001, area under the curve (AUC)=0.89). The HU with delayed PH was substantially higher than without it (250.8±382.2 HU vs 93.7±64.8 HU; P=0.01). The cut-off index was 78 HU, which showed 100% sensitivity, 61% specificity, 25% positive predictive value, and 100% negative predictive value (P=0.049, AUC=0.76).
sCCT images on DE-CT are useful for excluding intracerebral hemorrhage and delayed PH.
在缺血性脑卒中的动脉内血栓切除术（IAT）后，CT 扫描常显示术后颅内高密度影（PCHD）。双能 CT（DE-CT）可表明 PCHD 是由出血还是碘造影剂引起的。DE-CT 上使用碘造影剂检测到的高密度病变可能与迟发性出血性转化和不良预后相关。然而，DE-CT 中预测迟发性出血性转化的定量指标仍不清楚。我们评估了这些指标来预测迟发性出血性转化。
我们回顾性分析了 52 例连续接受 IAT 的急性缺血性脑卒中患者。DE-CT 扫描后立即获得模拟常规 CT（sCCT）图像。重建后进行虚拟非增强非对比（VNC）成像。测量 sCCT 上梗死区的亨氏单位（HU）。评估 sCCT 上的 HU 与 VNC 上的出血和迟发性实质血肿（PH）的关系。
VNC 上有出血的 sCCT 的 HU 明显高于无出血的 HU（377.9±385 HU 比 83.5±37.9 HU；P<0.0001）。截断指数为 80 HU，其具有 100%的灵敏度、63.8%的特异性、22.3%的阳性预测值和 100%的阴性预测值（P=0.0001，曲线下面积（AUC）=0.89）。有迟发性 PH 的 HU 明显高于无迟发性 PH 的 HU（250.8±382.2 HU 比 93.7±64.8 HU；P=0.01）。截断指数为 78 HU，其具有 100%的灵敏度、61%的特异性、25%的阳性预测值和 100%的阴性预测值（P=0.049，AUC=0.76）。
DE-CT 的 sCCT 图像有助于排除颅内出血和迟发性 PH。
