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Abstract
Objective 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.
Method 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.
Result 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]).
Conclusion 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.
Glossary
- AHA/ASA=
- American Heart Association/American Stroke Association;
- AIS=
- acute ischemic stroke;
- ARTIS=
- Antiplatelet Therapy in Combination With rt-PA Thrombolysis in Ischemic Stroke;
- CASES=
- Canadian Activase for Stroke Effectiveness Study;
- CI=
- confidence interval;
- CS=
- contrast staining;
- cDECT=
- combined DECT;
- DECT=
- dual energy CT;
- ECASS=
- European Cooperative Acute Stroke Study;
- EVT=
- endovascular thrombectomy;
- ICH=
- intracranial hemorrhage;
- iDECT=
- iodine-weighted DECT;
- IVH=
- intraventricular hemorrhage;
- IVT=
- IV thrombolysis;
- MR CLEAN=
- Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands;
- NIHSS=
- NIH Stroke Scale;
- pCT=
- plain monochromatic noncontrast CT;
- SECT=
- single energy CT;
- SICH=
- symptomatic ICH;
- SITS-MOST=
- Safe Implementation of Thrombolysis in Stroke–Monitoring Study;
- SWIFT-PRIME=
- Solitaire™ With the Intention for Thrombectomy as Primary Endovascular Treatment;
- wDECT=
- water-weighted DECT
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
CME Course: NPub.org/cmelist
- Received December 7, 2018.
- Accepted in final form April 16, 2019.
- © 2019 American Academy of Neurology
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