Thrombus discrimination with electron density: potential implications for non-contrast computed tomography imaging.

Area of Science:

• Medical Imaging
• Radiology
• Biomedical Engineering

Background:

• Dual-layer spectral computed tomography (CT) allows for direct estimation of electron density (ED) imaging.
• The clinical utility of ED imaging for thrombus identification remains underexplored.
• Accurate thrombus detection is crucial for effective treatment of acute ischemic stroke (AIS).

Purpose of the Study:

• To investigate the potential of ED imaging to improve thrombus identification compared to conventional imaging methods.
• To evaluate the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of ED imaging versus conventional and monoenergetic CT.
• To assess the feasibility of ED imaging for visualizing thrombectomy material in an in vitro setting.

Main Methods:

• Mechanical thrombectomy material from AIS patients was fixed and placed in polystyrene tubes.
• Samples were imaged using a dual-layer detector CT scanner, acquiring conventional CT (120 kVp), 40 keV monoenergetic, and ED images.
• Fifty-eight tubes (52 with thrombus, 6 controls) were analyzed for material presence, SNR, and CNR.

Main Results:

• ED imaging accurately identified thrombus material in all analyzed tubes, outperforming conventional CT which missed 3% of samples.
• ED imaging demonstrated a significantly higher signal-to-noise ratio (490.0±304.5) compared to conventional (10.4±7.0) and 40 keV (11.5±8.4) imaging.
• A substantial increase in contrast-to-noise ratio (CNR) was observed with ED imaging (37.8±29.1) versus conventional (4.3±4.3) and 40 keV (5.7±11.2) imaging (P<0.001).

Conclusions:

• In vitro, ED imaging significantly enhances the visualization of thrombus material compared to conventional and low monoenergetic CT imaging.
• The superior CNR provided by ED imaging suggests its potential for improved diagnostic accuracy in clinical applications.
• Further research is warranted to explore the clinical utility of ED imaging in diagnosing and managing conditions involving thrombus.