DiNitto Julie, Feldman Michael, Grimaudo Heather, Mummareddy Nishit, Ahn Seoiyoung, Bhamidipati Akshay, Anderson Drew, Ramirez-Giraldo Juan Carlos, Fusco Matthew, Chitale Rohan, Froehler Michael T
33573Siemens Medical Solutions, Malvern, PA, USA.
Department of Neurosurgery, 12326University of Tennessee Health and Science Center, Memphis, TN, USA.
Interv Neuroradiol. 2023 Feb 14:15910199231157462. doi: 10.1177/15910199231157462.
Management of large vessel occlusion (LVO) patients after thrombectomy is affected by the presence of intracranial hemorrhage (ICH) on post-procedure imaging. Differentiating contrast staining from hemorrhage on post-procedural imaging has been facilitated by dual-energy computed tomography (DECT), traditionally performed in dedicated computed tomography (CT) scanners with subsequent delays in treatment. We employed a novel method of DECT using the Siemens cone beam CT (DE-CBCT) in the angiography suite to evaluate for post-procedure ICH and contrast extravasation.
After endovascular treatment for LVO was performed and before the patient was removed from the operating table, DE-CBCT was performed using the Siemens Q-biplane system, with two separate 20-second CBCT scans at two energy levels: 70 keV (standard) and 125 keV with tin filtration (nonstandard). Post-procedurally, patients also underwent a standard DECT using Siemens SOMATOM Force CT scanner. Two independent reviewers blindly evaluated the DE-CBCT and DECT for hemorrhage and contrast extravasation.
We successfully performed intra-procedural DE-CBCT in 10 subjects with no technical failure. The images were high-quality and subjectively useful to differentiate contrast from hemorrhage. The one hemorrhage seen on standard DECT was very small and clinically silent. The interrater reliability was 100% for both contrast and hemorrhage detection.
We demonstrate that intra-procedural DE-CBCT after thrombectomy is feasible and provides clinically meaningful images. There was close agreement between findings on DE-CBCT and standard DECT. Our findings suggest that DE-CBCT could be used in the future to improve stroke thrombectomy patient workflow and to more efficiently guide the postoperative management of these patients.
血栓切除术后大血管闭塞（LVO）患者的管理受到术后影像学检查中颅内出血（ICH）的影响。传统上，在专用计算机断层扫描（CT）扫描仪中进行的双能计算机断层扫描（DECT）有助于在术后影像学检查中区分对比剂染色与出血，但会导致治疗延迟。我们采用了一种在血管造影套件中使用西门子锥形束CT（DE-CBCT）的新型DECT方法，以评估术后ICH和对比剂外渗情况。
在对LVO进行血管内治疗后，且患者尚未离开手术台之前，使用西门子Q双平面系统进行DE-CBCT检查，在两个能量水平下进行两次单独的20秒CBCT扫描：70 keV（标准）和125 keV并使用锡滤过（非标准）。术后，患者还使用西门子SOMATOM Force CT扫描仪进行了标准DECT检查。两名独立的审阅者对DE-CBCT和DECT进行了盲法评估，以确定出血和对比剂外渗情况。
我们成功地对10名受试者进行了术中DE-CBCT检查，没有技术故障。图像质量很高，在区分对比剂和出血方面具有主观实用性。在标准DECT上发现的一处出血非常小，临床上无症状。对比剂和出血检测的观察者间可靠性均为100%。
我们证明了血栓切除术后术中DE-CBCT是可行的，并能提供具有临床意义的图像。DE-CBCT和标准DECT的检查结果之间有密切的一致性。我们的研究结果表明，DE-CBCT未来可用于改善卒中血栓切除术患者的工作流程，并更有效地指导这些患者的术后管理。
