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Differentiation of hemorrhage from iodinated contrast in different intracranial compartments using dual-energy head
C M Phan1, A J Yoo, J A Hirsch
1Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. cmphan@partners.org
Insights
Dual-energy CT (DECT) accurately distinguishes intracranial hemorrhage (ICH) from iodinated contrast after stroke therapy. This imaging technique aids in guiding antithrombotic management without additional radiation exposure.
Area of Science:
- Radiology
- Medical Imaging
- Neuroradiology
Background:
- Accurate identification of intracranial hemorrhage (ICH) is crucial for managing patients, especially after ischemic stroke therapy.
- Contrast staining or extravasation can mimic ICH, complicating diagnosis and treatment decisions.
- Distinguishing true ICH from contrast is essential for appropriate antithrombotic management.
Purpose of the Study:
- To evaluate the diagnostic accuracy of dual-energy CT (DECT) in differentiating intracranial hemorrhage (ICH) from iodinated contrast material.
- To assess DECT's performance across various intracranial compartments (parenchymal, subarachnoid, extra-axial, intraventricular, intra-arterial).
- To determine if DECT can reliably guide antithrombotic therapy decisions post-contrast administration.
Main Methods:
- Forty patients who received iodinated contrast (intracranial or intravenous) underwent DECT scanning at 80kV and 140kV.
- A 3-material decomposition algorithm generated virtual noncontrast images and iodine overlay images.
- DECT findings were compared with routine clinical follow-up imaging to calculate sensitivity, specificity, and accuracy.
Main Results:
- DECT correctly classified 142 out of 148 hyperattenuation foci.
- Sensitivity, specificity, and accuracy for hemorrhage detection ranged from 100%, 84.4%-100%, and 87.2%-100%, respectively, across different compartments.
- DECT accurately differentiated ICH from contrast, with failures noted only in cases of diffuse calcification or metallic artifact.
Conclusions:
- Dual-energy CT (DECT) effectively differentiates intracranial hemorrhage (ICH) from iodinated contrast material after administration.
- The technique provides accurate diagnostic information without requiring additional radiation exposure.
- DECT is a valuable tool for clarifying hyperdense lesions in patients who have received contrast media.
Background And Purpose:
Identification of ICH, particularly after ischemic stroke therapy, is important for guiding subsequent antithrombotic management and is often confounded by contrast staining or extravasations within intracerebral or extra-axial compartments. This study evaluates the accuracy of DECT in distinguishing ICH from iodinated contrast in patients who received contrast via IA or IV delivery.
Materials And Methods:
Forty patients who had received IA or IV contrast were evaluated using a DECT scanner at 80kV and 140kV to distinguish hyperdensities secondary to contrast staining or extravasation from those representing ICH. A 3-material decomposition algorithm was used to obtain virtual noncontrast images and iodine overlay images. Sensitivity, specificity, and accuracy of DECT in prospectively distinguishing intracranial contrast from hemorrhage within parenchymal, subarachnoid, extra-axial, intraventricular, and intra-arterial compartments were computed using routine clinical follow-up imaging as the standard of reference.
Results:
A total of 148 foci of intracranial hyperattenuation were identified. Of these, 142 were correctly classified for the presence of hemorrhage by DECT. The sensitivity, specificity, and accuracy for identifying hemorrhage, depending on the compartment being considered, were 100%, 84.4%-100%, and 87.2%-100%, respectively. The only instances where DECT failed to correctly identify the source of hyperattenuation was in the presence of diffuse parenchymal calcification (n = 5) and a metallic streak artifact (n = 1).
Conclusion:
After IA and/or IV contrast administration, DECT can accurately differentiate all types of ICH from iodinated contrast without employing any additional radiation.
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