D Byrne1,2, J P Walsh3,2, H Schmiedeskamp4, F Settecase5,2, M K S Heran5,2, B Niu6, A K Salmeen7, B Rohr2, T S Field7,2, N Murray3,2, A Rohr5,2. 1. From the Division of Neuroradiology (D.B., F.S., M.K.S.H., A.R.) dbyrne.radiology@gmail.com. 2. University of British Columbia (D.B., J.P.W., F.S., M.K.S.H., B.R., T.S.F., N.M., A.R.), Vancouver, British Columbia, Canada. 3. Department of Emergency Radiology (J.P.W., N.M.). 4. Siemens Medical Solutions USA (H.S.), Malvern, Pennsylvania. 5. From the Division of Neuroradiology (D.B., F.S., M.K.S.H., A.R.). 6. Vancouver Imaging (B.N.), Vancouver General Hospital, Vancouver, British Columbia, Canada. 7. Division of Neurology (A.K.S., T.S.F.), Department of Medicine, Vancouver Stroke Program, Brain Research Center, University of British Columbia, Vancouver, British Columbia, Canada.
Abstract
BACKGROUND AND PURPOSE: Brain parenchymal hyperdensity on postthrombectomy CT in patients with acute stroke can be due to hemorrhage and/or contrast staining. We aimed to determine whether iodine concentration within contrast-stained parenchyma compared with an internal reference in the superior sagittal sinus on dual-energy CT could predict subsequent intracerebral hemorrhage. MATERIALS AND METHODS: Seventy-one patients with small infarct cores (ASPECTS ≥ 7) and good endovascular recanalization (modified TICI 2b or 3) for anterior circulation large-vessel occlusion were included. Brain parenchymal iodine concentration as per dual-energy CT and the percentage of contrast staining relative to the superior sagittal sinus were recorded and correlated with the development of intracerebral hemorrhage using Mann-Whitney U and Fisher exact tests. RESULTS: Forty-three of 71 patients had parenchymal hyperdensity on initial dual-energy CT. The median relative iodine concentration compared with the superior sagittal sinus was significantly higher in those with subsequent intracerebral hemorrhage (137.9% versus 109.2%, P = .007). By means of receiver operating characteristic analysis, a cutoff value of 100% (iodine concentration relative to the superior sagittal sinus) enabled identification of patients going on to develop intracerebral hemorrhage with 94.75% sensitivity, 43.4% specificity, and a likelihood ratio of 1.71. CONCLUSIONS: Within our cohort of patients, the relative percentage of iodine concentration at dual-energy CT compared with the superior sagittal sinus was a reliable predictor of intracerebral hemorrhage development and may be a useful imaging biomarker for risk stratification after endovascular treatment.
BACKGROUND AND PURPOSE: Brain parenchymal hyperdensity on postthrombectomy CT in patients with acute stroke can be due to hemorrhage and/or contrast staining. We aimed to determine whether iodine concentration within contrast-stained parenchyma compared with an internal reference in the superior sagittal sinus on dual-energy CT could predict subsequent intracerebral hemorrhage. MATERIALS AND METHODS: Seventy-one patients with small infarct cores (ASPECTS ≥ 7) and good endovascular recanalization (modified TICI 2b or 3) for anterior circulation large-vessel occlusion were included. Brain parenchymal iodine concentration as per dual-energy CT and the percentage of contrast staining relative to the superior sagittal sinus were recorded and correlated with the development of intracerebral hemorrhage using Mann-Whitney U and Fisher exact tests. RESULTS: Forty-three of 71 patients had parenchymal hyperdensity on initial dual-energy CT. The median relative iodine concentration compared with the superior sagittal sinus was significantly higher in those with subsequent intracerebral hemorrhage (137.9% versus 109.2%, P = .007). By means of receiver operating characteristic analysis, a cutoff value of 100% (iodine concentration relative to the superior sagittal sinus) enabled identification of patients going on to develop intracerebral hemorrhage with 94.75% sensitivity, 43.4% specificity, and a likelihood ratio of 1.71. CONCLUSIONS: Within our cohort of patients, the relative percentage of iodine concentration at dual-energy CT compared with the superior sagittal sinus was a reliable predictor of intracerebral hemorrhage development and may be a useful imaging biomarker for risk stratification after endovascular treatment.
Authors: D G Romano; S Cioni; S L Vinci; G Pero; C Comelli; A Comai; S Peschillo; D Mardighian; L Castellan; F Resta; M G Piano; S Comelli; L Barletta; A Puliti; S Leonini; S Bracco Journal: J Neurointerv Surg Date: 2016-03-16 Impact factor: 5.836
Authors: Mayank Goyal; Bijoy K Menon; Wim H van Zwam; Diederik W J Dippel; Peter J Mitchell; Andrew M Demchuk; Antoni Dávalos; Charles B L M Majoie; Aad van der Lugt; Maria A de Miquel; Geoffrey A Donnan; Yvo B W E M Roos; Alain Bonafe; Reza Jahan; Hans-Christoph Diener; Lucie A van den Berg; Elad I Levy; Olvert A Berkhemer; Vitor M Pereira; Jeremy Rempel; Mònica Millán; Stephen M Davis; Daniel Roy; John Thornton; Luis San Román; Marc Ribó; Debbie Beumer; Bruce Stouch; Scott Brown; Bruce C V Campbell; Robert J van Oostenbrugge; Jeffrey L Saver; Michael D Hill; Tudor G Jovin Journal: Lancet Date: 2016-02-18 Impact factor: 79.321
Authors: Arturo Renú; Sergio Amaro; Carlos Laredo; Luis San Román; Laura Llull; Antonio Lopez; Xabier Urra; Jordi Blasco; Laura Oleaga; Ángel Chamorro Journal: Stroke Date: 2015-02-05 Impact factor: 7.914
Authors: Tanja Djurdjevic; Rafael Rehwald; Michael Knoflach; Benjamin Matosevic; Stefan Kiechl; Elke Ruth Gizewski; Bernhard Glodny; Astrid Ellen Grams Journal: Eur Radiol Date: 2016-06-02 Impact factor: 5.315