Almqvist Håkan, Almqvist Niklas S, Holmin Staffan, Mazya Michael V
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.
Front Neurol. 2020 May 19;11:357. doi: 10.3389/fneur.2020.00357. eCollection 2020.
We aimed to determine whether dual-energy CT (DECT) follow-up can differentiate contrast staining (CS) from intracranial hemorrhage (ICH) in stroke patients treated with intravenous thrombolysis (IVT), who had undergone acute stroke imaging using CT angiography (CTA), and CT perfusion (CTP). : Between November 2012 and January 2018, 168 patients at our comprehensive stroke center underwent DECT follow-up within 36 h after IVT and acute CTA with or without CTP but did not receive intra-arterial imaging or treatment. Two independent readers evaluated plain monochromatic CT (pCT) alone and compared this with a second reading of a combined DECT approach using pCT and water- and iodine-weighted images, establishing and grading the ICH diagnosis, per Heidelberg and Safe Implementation of Treatments in Stroke Monitoring Study (SITS-MOST) classifications. On pCT alone within 36 h, 31/168 (18.5%) patients had findings diagnosed as ICH. Using combined DECT (cDECT) changed ICH diagnosis to "CS only" in 3/168 (1.8%) patients, constituting 3/31 (9.7%) of cases with initially pCT-diagnosed ICH. These three cases had pCT diagnoses of one SAH, one minor, and one more extensive petechial hemorrhage (hemorrhagic infarction types 1 and 2), respectively. pCT alone had a 100% sensitivity, 98% specificity, 90% positive predictive value (PPV), 100% negative predictive value (NPV), and 98% accuracy for any ICH, compared to the cDECT. Inter-reader agreement for ICH classification using pCT compared to DECT was weighted kappa 0.92 (95% CI 0.87-0.98) vs. 0.91 (0.85-0.95). Compared to pCT, DECT within 36 h after IV thrombolysis for acute ischemic stroke, changes the radiological diagnosis of post-treatment ICH to "CS only" in a small proportion of patients. Studies are warranted of whether the altered radiological reports have an impact on patient management, for example initiation timing of antithrombotic secondary prevention.
我们旨在确定双能CT（DECT）随访能否区分接受静脉溶栓（IVT）治疗的中风患者的对比剂染色（CS）和颅内出血（ICH），这些患者已接受了CT血管造影（CTA）和CT灌注（CTP）的急性中风成像检查。2012年11月至2018年1月期间，我们综合中风中心的168例患者在IVT后36小时内接受了DECT随访以及有或无CTP的急性CTA检查，但未接受动脉内成像或治疗。两名独立的阅片者单独评估平扫单色CT（pCT），并将其与使用pCT以及水加权和碘加权图像的DECT联合方法的第二次阅片结果进行比较，根据海德堡标准和中风监测研究安全实施治疗（SITS-MOST）分类法建立并分级ICH诊断。在36小时内单独使用pCT时，168例患者中有31例（18.5%）的检查结果被诊断为ICH。使用联合DECT（cDECT）后，168例患者中有3例（1.8%）的ICH诊断变为“仅为CS”，占最初pCT诊断为ICH病例的3/31（9.7%）。这三例病例的pCT诊断分别为1例蛛网膜下腔出血、1例轻微出血和1例更广泛的瘀点出血（出血性梗死1型和2型）。与cDECT相比，单独使用pCT对任何ICH的敏感性为100%、特异性为98%、阳性预测值（PPV）为90%、阴性预测值（NPV）为100%、准确性为98%。使用pCT与DECT进行ICH分类的阅片者间一致性加权kappa值分别为0.92（95%CI 0.87 - 0.98）和0.91（0.85 - 0.95）。与pCT相比，急性缺血性中风静脉溶栓后36小时内的DECT会使一小部分患者的治疗后ICH的放射学诊断变为“仅为CS”。有必要研究改变后的放射学报告是否会对患者管理产生影响，例如抗血栓二级预防的起始时机。
