T Kau1, M Hauser2, S M Obmann3, M Niedermayer2, J R Weber3, K A Hausegger2. 1. From the Institute of Diagnostic and Interventional Radiology (T.K., M.H., M.N., K.A.H.) t.kau@gmx.at. 2. From the Institute of Diagnostic and Interventional Radiology (T.K., M.H., M.N., K.A.H.). 3. Department of Neurology (S.M.O., J.R.W.), Klinikum Klagenfurt, Klagenfurt, Austria.
Abstract
BACKGROUND AND PURPOSE: Flat panel detector CT in the angiography suite may be valuable for the detection of intracranial hematomas; however, abnormal contrast enhancement frequently mimics hemorrhage. We aimed to assess the accuracy of flat panel detector CT in detecting/excluding intracranial bleeding after endovascular stroke therapy and whether it was able to reliably differentiate hemorrhage from early blood-brain barrier disruption. MATERIALS AND METHODS: Seventy-three patients were included for retrospective evaluation following endovascular stroke therapy: 32 after stent-assisted thrombectomy, 14 after intra-arterial thrombolysis, and 27 after a combination of both. Flat panel CT images were assessed for image quality and the presence and type of intracranial hemorrhage and BBB disruption by 2 readers separately and in consensus. Follow-up by multisection head CT, serving as the reference standard, was evaluated by a single reader. RESULTS: Conventional head CT revealed intracranial hematomas in 12 patients (8 subarachnoid hemorrhages, 7 cases of intracerebral bleeding, 3 SAHs plus intracerebral bleeding). Image quality of flat panel detector CT was considered sufficient in all cases supratentorially and in 92% in the posterior fossa. Regarding detection or exclusion of intracranial hemorrhage, flat panel detector CT reached a sensitivity, specificity, positive and negative predictive values, and accuracy of 58%, 85%, 44%, 91%, and 81%, respectively. Maximum attenuation measurements were not valuable for the differentiation of hemorrhage and BBB disruption. CONCLUSIONS: Flat panel CT after endovascular stroke treatment was able to exclude the rare event of an intracranial hemorrhage with a high negative predictive value. Future studies should evaluate the predictive value of BBB disruptions in flat panel detector CT for the development of relevant hematomas.
BACKGROUND AND PURPOSE: Flat panel detector CT in the angiography suite may be valuable for the detection of intracranial hematomas; however, abnormal contrast enhancement frequently mimics hemorrhage. We aimed to assess the accuracy of flat panel detector CT in detecting/excluding intracranial bleeding after endovascular stroke therapy and whether it was able to reliably differentiate hemorrhage from early blood-brain barrier disruption. MATERIALS AND METHODS: Seventy-three patients were included for retrospective evaluation following endovascular stroke therapy: 32 after stent-assisted thrombectomy, 14 after intra-arterial thrombolysis, and 27 after a combination of both. Flat panel CT images were assessed for image quality and the presence and type of intracranial hemorrhage and BBB disruption by 2 readers separately and in consensus. Follow-up by multisection head CT, serving as the reference standard, was evaluated by a single reader. RESULTS: Conventional head CT revealed intracranial hematomas in 12 patients (8 subarachnoid hemorrhages, 7 cases of intracerebral bleeding, 3 SAHs plus intracerebral bleeding). Image quality of flat panel detector CT was considered sufficient in all cases supratentorially and in 92% in the posterior fossa. Regarding detection or exclusion of intracranial hemorrhage, flat panel detector CT reached a sensitivity, specificity, positive and negative predictive values, and accuracy of 58%, 85%, 44%, 91%, and 81%, respectively. Maximum attenuation measurements were not valuable for the differentiation of hemorrhage and BBB disruption. CONCLUSIONS: Flat panel CT after endovascular stroke treatment was able to exclude the rare event of an intracranial hemorrhage with a high negative predictive value. Future studies should evaluate the predictive value of BBB disruptions in flat panel detector CT for the development of relevant hematomas.
Authors: Vitor M Pereira; Jan Gralla; Antoni Davalos; Alain Bonafé; Carlos Castaño; René Chapot; David S Liebeskind; Raul G Nogueira; Marcel Arnold; Roman Sztajzel; Thomas Liebig; Mayank Goyal; Michael Besselmann; Antonio Moreno; Alfredo Moreno; Gerhard Schroth Journal: Stroke Date: 2013-08-01 Impact factor: 7.914
Authors: Maxim Mokin; Travis M Dumont; Erol Veznedaroglu; Mandy J Binning; Kenneth M Liebman; Richard D Fessler; Chiu Yuen To; Raymond D Turner; Aquilla S Turk; M Imran Chaudry; Adam S Arthur; Benjamin D Fox; Ricardo A Hanel; Rabih G Tawk; Peter Kan; John R Gaughen; Giuseppe Lanzino; Demetrius K Lopes; Michael Chen; Roham Moftakhar; Joshua T Billingsley; Andrew J Ringer; Kenneth V Snyder; L Nelson Hopkins; Adnan H Siddiqui; Elad I Levy Journal: Neurosurgery Date: 2013-07 Impact factor: 4.654
Authors: Carlos A Molina; José Alvarez-Sabín; Joan Montaner; Sonia Abilleira; Juan F Arenillas; Pilar Coscojuela; Francisco Romero; Agusti Codina Journal: Stroke Date: 2002-06 Impact factor: 7.914
Authors: Johannes Pfaff; Christian Herweh; Mirko Pham; Silvia Schönenberger; Julian Bösel; Peter A Ringleb; Sabine Heiland; Martin Bendszus; Markus Möhlenbruch Journal: J Neurointerv Surg Date: 2015-05-02 Impact factor: 5.836
Authors: Rastislav Pjontek; Belgin Önenköprülü; Bernhard Scholz; Yiannis Kyriakou; Gerrit A Schubert; Omid Nikoubashman; Ahmed Othman; Martin Wiesmann; Marc A Brockmann Journal: J Neurointerv Surg Date: 2015-09-07 Impact factor: 5.836