Can Dual-Energy CT Be Easily Adopted in Clinical Practice for Predicting Hemorrhagic Complications?
Kyubong Lee1, Jung Hoon Han2, Keon-Joo Lee1
1Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea, Republic of.
Background And Purpose:
Hemorrhagic transformation after endovascular thrombectomy (EVT) for acute ischemic stroke is associated with poor outcomes. Dual-energy CT (DECT) iodine maps may predict hemorrhagic transformation. Therefore, we investigated the predictive value of DECT for hemorrhagic complications and evaluated whether DECT can be adopted in clinical practice.
Methods:
We retrospectively analyzed 306 patients with anterior circulation stroke who underwent DECT after EVT (July 2017-March 2025). Maximal ROI values were measured bilaterally, and an ipsilateral-to-contralateral ratio was calculated. Analyses were focused on DECT within 1 h and DECT between 2-3 h after EVT. The association between the ROI ratio and hemorrhagic complications was evaluated using multivariable logistic regression. Predictive performance of DECT for any hemorrhage and parenchymal hematoma (PH) on follow-up MRI was assessed using AUC, sensitivity, specificity, and accuracy.
Results:
Mean age was 70.3 years; 85.6% achieved successful reperfusion (mTICI ≥ 2b). Any hemorrhage occurred in 52.0%, and PH in 16.0%. The ROI ratio was significantly associated with hemorrhagic complications. Early DECT (within 1 h) better predicted any hemorrhage (AUC = 0.884), whereas delayed DECT (2-3 h) better predicted parenchymal hematoma (AUC = 0.813). Among patients without apparent hemorrhage on DECT, early DECT also better predicted any hemorrhage (AUC = 0.861), whereas delayed DECT better predicted parenchymal hematoma (AUC = 0.920).
Conclusions:
DECT comparably predicts hemorrhagic complications. Early DECT better predicts any hemorrhage, whereas delayed DECT better predicts PH, particularly in patients without immediate hemorrhagic findings.
