The aim was to investigate whether dual-energy computed tomography (DECT) reconstructions optimised for oedema visualisation (oedema map; EM) facilitate an improved detection of early infarctions after endovascular stroke therapy (EST).
Forty-six patients (21 women; 25 men; mean age: 63 years; range 24–89 years) were included. The brain window (BW), virtual non-contrast (VNC) and modified VNC series based on a three-material decomposition technique optimised for oedema visualisation (EM) were evaluated. Follow-up imaging was used as the standard for comparison. Contralateral side to infarction differences in density (CIDs) were determined. Infarction detectability was assessed by two blinded readers, as well as image noise and contrast using Likert scales. ROC analyses were performed and the respective Youden indices calculated for cut-off analysis.
The highest CIDs were found in the EM series (73.3 ± 49.3 HU), compared with the BW (-1.72 ± 13.29 HU) and the VNC (8.30 ± 4.74 HU) series. The EM was found to have the highest infarction detection rates (area under the curve: 0.97 vs. 0.54 and 0.90, p < 0.01) with a cut-off value of < 50.7 HU, despite slightly more pronounced image noise. The location of the infarction did not affect detectability (p > 0.05 each).
The EM series allows higher contrast and better early infarction detection than the VNC or BW series after EST.
• Dual-energy CT EM allows better early infarction detection than standard brain window.
• Dual-energy CT EM series allow better early infarction detection than VNC series.
• Dual-energy CT EM are modified VNC based on water content of tissue.
Wintermark M, Sanelli PC, Albers GW et al (2013) Imaging recommendations for acute stroke and transient ischemic attack patients: a joint statement by the American Society of Neuroradiology, the American College of Radiology and the Society of NeuroInterventional Surgery. J Am Coll Radiol 10:828–832 CrossRef
Pexman JH, Barber PA, Hill MD et al (2001) Use of the Alberta Stroke Program Early CT Score (ASPECTS) for assessing CT scans in patients with acute stroke. AJNR Am J Neuroradiol 22:1534–1542 PubMed
Djurdjevic T, Rehwald R, Knoflach M et al (2017) Prediction of infarction development after endovascular stroke therapy with dual-energy computed tomography. Eur Radiol 27:907–917 CrossRef
Gupta R, Phan CM, Leidecker C et al (2010) Evaluation of dual-energy CT for differentiating intracerebral hemorrhage from iodinated contrast material staining. Radiology 257:205–211 CrossRef
Phan CM, Yoo AJ, Hirsch JA, Nogueira RG, Gupta R (2012) Differentiation of hemorrhage from iodinated contrast in different intracranial compartments using dual-energy head CT. AJNR Am J Neuroradiol 33:1088–1094 CrossRef
Tijssen MP, Hofman PA, Stadler AA et al (2014) The role of dual energy CT in differentiating between brain haemorrhage and contrast medium after mechanical revascularisation in acute ischaemic stroke. Eur Radiol 24:834–840 CrossRef
Brockmann C, Scharf J, Nolte IS, Seiz M, Groden C, Brockmann MA (2010) Dual-energy CT after peri-interventional subarachnoid haemorrhage: a feasibility study. Clin Neuroradiol 20:231–235 CrossRef
Mohammed MF, Marais O, Min A et al (2018) Unenhanced dual-energy computed tomography: visualization of brain edema. Invest Radiol 53:63–69 CrossRef
Noguchi K, Itoh T, Naruto N, Takashima S, Tanaka K, Kuroda S (2017) A novel imaging technique (X-Map) to identify acute ischemic lesions using noncontrast dual-energy computed tomography. J Stroke Cerebrovasc Dis 26:34–41 CrossRef
Chavez JC, Hurko O, Barone FC, Feuerstein GZ (2009) Pharmacologic interventions for stroke: looking beyond the thrombolysis time window into the penumbra with biomarkers, not a stopwatch. Stroke 40:e558–e563 CrossRef
Simard JM, Kent TA, Chen M, Tarasov KV, Gerzanich V (2007) Brain oedema in focal ischaemia: molecular pathophysiology and theoretical implications. Lancet Neurol 6:258–268 CrossRef
Postma AA, Das M, Stadler AA, Wildberger JE (2015) Dual-energy CT: what the neuroradiologist should know. Curr Radiol Rep 3:16 CrossRef
Coursey CA, Nelson RC, Boll DT et al (2010) Dual-energy multidetector CT: how does it work, what can it tell us, and when can we use it in abdominopelvic imaging? Radiographics 30:1037–1055 CrossRef
McCollough CH, Leng S, Yu L, Fletcher JG (2015) Dual- and multi-energy CT: principles, technical approaches, and clinical applications. Radiology 276:637–653 CrossRef
Ferda J, Novak M, Mirka H et al (2009) The assessment of intracranial bleeding with virtual unenhanced imaging by means of dual-energy CT angiography. Eur Radiol 19:2518–2522 CrossRef
Karcaaltincaba M, Aktas A (2011) Dual-energy CT revisited with multidetector CT: review of principles and clinical applications. Diagn Interv Radiol 17:181–194 PubMed
Aran S, Daftari Besheli L, Karcaaltincaba M, Gupta R, Flores EJ, Abujudeh HH (2014) Applications of dual-energy CT in emergency radiology. AJR Am J Roentgenol 202:W314–W324 CrossRef
Morhard D, Ertl L, Gerdsmeier-Petz W, Ertl-Wagner B, Schulte-Altedorneburg G (2014) Dual-energy CT immediately after endovascular stroke intervention: prognostic implications. Cardiovasc Intervent Radiol 37:1171–1178 CrossRef
Morimoto LN, Kamaya A, Boulay-Coletta I et al (2017) Reduced dose CT with model-based iterative reconstruction compared to standard dose CT of the chest, abdomen, and pelvis in oncology patients: intra-individual comparison study on image quality and lesion conspicuity. Abdom Radiol (NY) 42:2279–2288 CrossRef
Willemink MJ, Habets J, de Jong PA et al (2013) Iterative reconstruction improves evaluation of native aortic and mitral valves by retrospectively ECG-gated thoracoabdominal CTA. Eur Radiol 23:968–974 CrossRef
Ruopp MD, Perkins NJ, Whitcomb BW, Schisterman EF (2008) Youden Index and optimal cut-point estimated from observations affected by a lower limit of detection. Biom J 50:419–430 CrossRef
Kim SJ, Lim HK, Lee HY et al (2012) Dual-energy CT in the evaluation of intracerebral hemorrhage of unknown origin: differentiation between tumor bleeding and pure hemorrhage. AJNR Am J Neuroradiol 33:865–872 CrossRef
Gariani J, Cuvinciuc V, Courvoisier D et al (2015) Diagnosis of acute ischemia using dual energy CT after mechanical thrombectomy. J Neurointerv Surg. https://doi.org/10.1136/neurintsurg-2015-011988 CrossRef
Jauch EC, Saver JL, Adams HP Jr et al (2013) Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 44:870–947 CrossRef
- Improved visualisation of early cerebral infarctions after endovascular stroke therapy using dual-energy computed tomography oedema maps
Astrid Ellen Grams
Elke Ruth Gizewski
- Springer Berlin Heidelberg
Neu im Fachgebiet Radiologie
Meistgelesene Bücher aus der Radiologie
e.Med Kampagnen-Visual, Mail Icon II