Semmes-Murphey Clinic, Memphis, Tennessee, USA.
Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee, USA.
J Neuroimaging. 2023 May-Jun;33(3):368-374. doi: 10.1111/jon.13098. Epub 2023 Mar 14.
The risk of symptomatic intracranial hemorrhage (ICH) approaches 5% despite mechanical thrombectomy (MT) efficacy for ischemic stroke secondary to large vessel occlusion. Flat-panel detector CT (FDCT) imaging with Syngo Dyna CT imaging (Siemens Medical Solutions, Malvern, PA) can be used immediately following MT to detect ICH.
To evaluate the accuracy and reliability of FDCT imaging with Dyna CT compared to conventional post-MT CT and MRI.
Head FDCT (20 second, 70 kV) was performed immediately following MT on 26 consecutive patients; postprocedural CT or MRI was obtained ∼24 hours later. Two blinded, independent neuroradiologists evaluated all imaging, identifying ICH, stroke, and presence of subarachnoid contrast. Cohen's κ statistic was used to assess interrater agreement for each imaging outcome and compared the FDCT to conventional imaging.
FDCT for ICH demonstrated a strong degree of interrater reliability (κ = 0.896; 95% confidence interval [CI], 0.734-1.057). Negligible reliability was seen for ischemia determination on immediate post-MT FDCT (κ = 0.149; 95% CI, -0.243 to 0.541). ICH evaluation between FDCT and post-MT conventional CT revealed modest interrater reliability (κ = 0.432; 95% CI, -0.100 to 0.965), which did not reach statistical significance. There was no substantive reliability in the evaluation of ICH between FDCT and post-MT MRI (κ = 0.118, 95% CI, -0.345 to 0.580).
FDCT, such as Dyna CT, immediately post-MT is a promising tool that can expedite the detection of ICH with a high degree of reliability, although the detection of ischemic parenchymal changes is limited.
尽管机械取栓（MT）对大血管闭塞引起的缺血性脑卒中有效，但症状性颅内出血（ICH）的风险仍接近 5%。平板探测器 CT（FDCT）成像与 Syngo Dyna CT 成像（西门子医疗解决方案，美国马文）可在 MT 后立即用于检测 ICH。
评估 FDCT 成像与常规 MT 后 CT 和 MRI 相比的准确性和可靠性。
对 26 例连续患者在 MT 后立即进行头部 FDCT（20 秒，70 kV）；在大约 24 小时后获得术后 CT 或 MRI。两名独立的神经放射科医师对所有影像进行了评估，识别 ICH、卒中以及蛛网膜下腔对比剂的存在。采用 Cohen's κ 统计量评估每种成像结果的观察者间一致性，并将 FDCT 与常规成像进行比较。
FDCT 检测 ICH 的观察者间可靠性较强（κ=0.896；95%置信区间[CI]，0.734-1.057）。MT 后即刻 FDCT 检测缺血的可靠性较低（κ=0.149；95%CI，-0.243 至 0.541）。FDCT 与 MT 后常规 CT 之间的 ICH 评估显示观察者间可靠性中等（κ=0.432；95%CI，-0.100 至 0.965），但未达到统计学意义。FDCT 与 MT 后 MRI 之间的 ICH 评估在可靠性方面没有实质性差异（κ=0.118，95%CI，-0.345 至 0.580）。
MT 后立即进行的 FDCT，如 Dyna CT，是一种很有前途的工具，可高度可靠地快速检测 ICH，但对缺血性实质变化的检测有限。
