From the Departments of Clinical Neuroscience (H.A., S.H., M.V.M.), Neuroradiology (H.A., S.H.), and Neurology (M.V.M.), Karolinska University Hospital, Stockholm, Sweden.
Neurology. 2019 Sep 10;93(11):e1068-e1075. doi: 10.1212/WNL.0000000000008093. Epub 2019 Aug 13.
To determine whether dual energy CT with a combined approach (cDECT) using a plain noncontrast monochromatic CT (pCT), a water-weighted image after iodine removal, and an iodine-weighted image changes the diagnosis and classification of intracranial hemorrhage (ICH) after endovascular thrombectomy (EVT) in acute ischemic stroke compared to a pCT image alone without separate water and iodine weighting.
During 2012 to 2016, 372 patients at our comprehensive stroke center underwent DECT scans within 36 hours after EVT. Two readers evaluated pCT compared to a second reading with cDECT, establishing the diagnosis of ICH and grading it per the Heidelberg and Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) classifications.
Using cDECT changed the ICH diagnosis to contrast staining only in 34% (52 of 152), modified the ICH grade in 10% (15 of 152), and diagnosed initially undetected ICH in 2% (5 of 220). pCT alone had 95% sensitivity, 80% specificity, 66% positive predictive value, 98% negative predictive value, and 85% accuracy for ICH compared to cDECT. Interreader agreement on the presence of ICH increased with cDECT compared to pCT (Cohen κ = 0.77 [95% confidence interval 0.69-0.84] vs 0.68 [0.61-0.76]).
cDECT within 36 hours after EVT changes the radiologic report regarding posttreatment ICH in a considerable proportion of patients undergoing EVT compared to pCT alone. This could affect decision-making regarding monitoring, secondary prevention, and prognostication. The cDECT scan could improve the interpretation consistency of high-attenuating changes on post-EVT images.
比较单纯使用平扫非增强单能量 CT（pCT）、碘去除后的水相图和碘相图的联合方法（cDECT）与单纯使用 pCT 对急性缺血性卒中血管内血栓切除术（EVT）后颅内出血（ICH）的诊断和分类的影响。
2012 年至 2016 年，我们综合卒中中心的 372 例患者在 EVT 后 36 小时内行 DECT 扫描。两位读者评估了 pCT 与使用 cDECT 的第二次阅读结果，根据海德堡和安全实施溶栓治疗监测研究（SITS-MOST）分类来建立 ICH 的诊断和分级。
使用 cDECT 将 ICH 诊断改变为单纯对比染色的占 34%（52/152），改变 ICH 分级的占 10%（15/152），最初未检测到的 ICH 诊断占 2%（5/220）。与 cDECT 相比，pCT 对 ICH 的单独检测具有 95%的敏感性、80%的特异性、66%的阳性预测值、98%的阴性预测值和 85%的准确性。与 pCT 相比，cDECT 增加了读者对 ICH 存在的一致性（Cohen κ=0.77[95%置信区间 0.69-0.84] vs 0.68[0.61-0.76]）。
与单纯使用 pCT 相比，EVT 后 36 小时内行 cDECT 可改变相当一部分行 EVT 患者的术后 ICH 放射学报告。这可能会影响监测、二级预防和预后的决策。cDECT 扫描可以提高对 EVT 后高信号改变图像的解释一致性。
