Dual-Energy CT in Acute Stroke: Could Non-Contrast CT Be Replaced by Virtual Non-Contrast CT? A Feasibility Study

Area of Science:

• Radiology
• Neurology
• Medical Imaging

Background:

• Acute cerebral ischemia diagnosis relies on non-contrast CT (NCCT).
• Intravenous contrast-enhanced dual-energy CT (iv-DECT) is increasingly used.
• Virtual non-contrast CT (VNCCT) can be reconstructed from iv-DECT data.

Purpose of the Study:

• To evaluate if VNCCT can substitute NCCT for diagnosing acute cerebral ischemia.
• To compare the diagnostic performance of VNCCT and NCCT.

Main Methods:

• Retrospective analysis of patients with suspected acute cerebral ischemia.
• Comparison of NCCT and VNCCT using the Alberta Stroke Program Early CT Score (ASPECTS).
• Assessment of ASPECTS for anterior and posterior circulation, hemorrhage, and alternative findings.

Main Results:

• VNCCT demonstrated high intraclass correlation with NCCT (0.97 anterior, 0.77 posterior circulation).
• VNCCT showed higher sensitivity (41%) than NCCT (33%) for detecting acute ischemia.
• Similar specificity was observed for both techniques (VNCCT 94%, NCCT 98%).

Conclusions:

• VNCCT from iv-DECT achieves comparable diagnostic performance to NCCT.
• VNCCT is a viable alternative to NCCT for evaluating acute cerebral ischemia.
• This can potentially streamline the diagnostic workflow for stroke patients.