Characterization of thrombus composition with multimodality CT-based imaging: an in-vitro study.

Area of Science:

• Medical Imaging
• Radiology
• Biomedical Engineering

Background:

• Computed tomography (CT) is standard for acute ischemic stroke evaluation.
• Characterizing clot composition pre-operatively is of increasing interest.
• This study investigates CT techniques for differentiating clot types in vitro.

Purpose of the Study:

• To assess the ability of various CT techniques to differentiate between clot types with varying red blood cell (RBC) and fibrin densities.
• To compare the efficacy of single-energy, dual-energy, and photon-counting detector CT protocols.

Main Methods:

• Five in vitro clot types with distinct RBC/fibrin ratios were prepared.
• Clots were scanned using single-energy, dual-energy, and photon-counting detector CT protocols.
• Mean CT values were analyzed, with Martius Scarlett Blue staining confirming composition.

Main Results:

• CT values increased significantly with higher RBC content (75% and 95% RBC clots).
• Virtual monoenergetic images at 50 keV (Mono +50 keV) yielded the highest mean CT values across all clot types.
• Dual-energy CT with Mono +50 keV demonstrated the greatest attenuation differences between clot types.

Conclusions:

• Mono +50 keV dual-energy CT imaging shows promise for distinguishing between RBC-rich and fibrin-rich thrombi.
• This technique may aid in characterizing thrombus composition in large-vessel occlusion stroke.
• Further validation in clinical settings is warranted.