Dual-Energy Computed Tomography (DECT) for Diagnosing Contrast-Induced Encephalopathy (CIE) Mimicking Intracranial
Yuhong Shen1,2, Tianhe Ye1,2
1Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
Insights
Dual-energy CT (DECT) accurately diagnosed contrast-induced encephalopathy (CIE) by identifying contrast medium extravasation, distinguishing it from intracranial hemorrhage. This imaging technique aids in safe post-PCI management.
Area of Science:
- Neurology
- Radiology
- Cardiology
Background:
- Contrast-induced encephalopathy (CIE) is a rare complication following percutaneous coronary intervention (PCI).
- Computed tomography (CT) findings of CIE can mimic intracranial hemorrhage (ICH) and other cerebrovascular conditions.
- Accurate differentiation is crucial for appropriate patient management and treatment.
Purpose of the Study:
- To highlight the diagnostic value of dual-energy CT (DECT) in a case of suspected CIE after PCI.
- To demonstrate how DECT differentiates CIE from ICH based on contrast medium (CM) behavior.
Main Methods:
- A case report of a 74-year-old woman who developed symptoms suggestive of CIE post-PCI.
- Conventional non-contrast CT initially showed a lesion indistinguishable from ICH.
- Dual-energy CT (DECT) was utilized, employing material decomposition techniques for analysis.
Main Results:
- DECT successfully identified contrast medium extravasation, confirming CIE.
- Virtual non-contrast maps, iodine concentration maps, and effective atomic number maps aided in diagnosis.
- The patient's symptoms resolved spontaneously, and follow-up CT showed complete lesion disappearance.
Conclusions:
- DECT is a valuable tool for distinguishing CIE from ICH, especially when CT findings are ambiguous.
- Identifying transient CM extravasation via DECT supports a diagnosis of CIE over persistent hemorrhage.
- Accurate diagnosis guides safe continuation of antiplatelet therapy after PCI.
Abstract:
Contrast-induced encephalopathy (CIE) is a rare complication after percutaneous coronary intervention (PCI) that mimics intracranial hemorrhage (ICH). Its computed tomography (CT) findings (cortical contrast enhancement, sulci effacement) overlap with cerebrovascular conditions (e.g., cerebral infarction, subarachnoid hemorrhage). Dual-energy CT (DECT) differentiates blood/calcification from iodinated contrast medium (CM) extravasation via material decomposition, contributing to the accurate diagnosis of CIE. We report a CIE case highlighting DECT's value. A 74-year-old woman underwent PCI. 50 min post-PCI, she had moderate headache (Numeric Rating Scale 4), dizziness, non-projectile vomiting (no seizures); vital signs were stable, no focal deficits, mannitol ineffective. Non-contrast CT demonstrated a left parietal 75 Hounsfield unit (HU) high-attenuation lesion, indistinguishable from acute intracerebral hemorrhage. Conventional non-contrast CT revealed a high-attenuation lesion (75 HU) in the left parietal lobe-indistinguishable from ICH. DECT clarified the diagnosis: virtual non-contrast maps showed CM extravasation, iodine concentration maps confirmed focal CM accumulation, and effective atomic number maps improved lesion visualization. The patient's headache resolved within 5 h; follow-up non-contrast CT at 24 h showed complete disappearance of the lesion. She resumed clopidogrel, discharged day 3 without sequelae. This case underscores DECT's role in distinguishing CIE (transient CM, normal neuro exam) from ICH (persistent hemorrhage), guiding safe post-PCI antiplatelet therapy.
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