Journal of Capital Medical University ›› 2018, Vol. 39 ›› Issue (2): 173-177.doi: 10.3969/j.issn.1006-7795.2018.02.004

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Application of dual-energy CT in differentiating hemorrhage from contrast medium extravasation after endovascualr treatment of acute ischemic stroke

Guo Shuang1,2, Li Qing1, Wu Fang1, Liu Jiabin1, Li Yan1, Du Xiangying1, Lu Jie1, Li Kuncheng1   

  1. 1. Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing Key Cab of MRI and Brain Informatics, Beijing 100053, China;
    2. Department of Radiology, Dongfang Hospital of Beijing Traditional Chinese Medicine University, Beijing 100078, China
  • Received:2018-02-27 Online:2018-03-21 Published:2018-04-14
  • Supported by:
    This study was supported by National Natural Science Foundation of China(81671651),Beijing Health System Top Level Health Technical Personnel Training Plan(2015-3-082),Beijing Municipal Administration of Hospitals Incubating Program(PX2016035).

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Abstract: Objective To explore the value of dual-energy CT (DE-CT) in differentiating intracerebral hemorrhage from extravasation of iodine contrast medium after endovascular treatment of acute ischemic stroke. Methods Patients with acute ischemic stroke who underwent endovascular treatment and follow-up dual-energy brain CT within 24 hours were included. Mixed energy images (MIX), virtual unenhanced non-contrast images(VNC)and iodine overlay maps (IOM) were reconstructed and evaluated. Follow-up conventional CT 72 hours after intervention was obtained to serve as the reference. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of dual-energy CT to differentiate hemorrhage from contrast extravasation were calculated. CT values of hemorrhage and contrast extravasation on MIX images were measured and ROC analysis was performed to obtain the cut-off value for differential diagnosis with MIX images alone and its accuracy. Results Dual-energy brain CT was performed on 60 patients after endovascular treatment, including 30 cases without intracerebral high density on CT. Among the 30 cases[22 male, 8 female, 40-80 years old, (62.4±10.1 years)] with high density on MIX images, 15 cases of hemorrhage, 14 cases of contrast extravasation and 1 case of hemorrhage with contrast extravasation were diagnosed with dual-energy CT. Compared with CT images 72 hours after intervention, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of diagnosing hemorrhage with dual-energy CT image analysis were 88%, 100%, 100%, 86% and 93%, respectively. The mean CT values of hemorrhage and contrast extravasation on MIX images were (56.6±11.7)Hu and (90.9±39.9)Hu, respectively. Based on ROC analysis, the best cutoff value was 74.0 Hu, the AUC value for differentiating hemorrhage and contrast extravasation with CT value was 0.781 (95% CI:0.661-0.950), (sensitivity 50%, specificity 92.9%). Conclusion DE-CT should be recommended for differentiation of hemorrhage from contrast extravasation after endovascular treatment of acute ischemic stroke. CT value can be used for differentiation in most occasions when DE-CT was not available.

Key words: acute ischemic stroke, intracranial hemorrhage, contrast extravasation, dual-energy CT, endovascular treatment

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