Maarten van den Broek1,2, Danielle Byrne3,4, Daniel Lyndon3,4, Bonnie Niu5, Shu Min Yu5, Axel Rohr3,4, Fabio Settecase3,4. 1. Division of Neuroradiology, Vancouver General Hospital, Room G861, Vancouver, BC, V5Z 1M9, Canada. maartenvandenbroek@gmail.com. 2. Department of Radiology, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada. maartenvandenbroek@gmail.com. 3. Division of Neuroradiology, Vancouver General Hospital, Room G861, Vancouver, BC, V5Z 1M9, Canada. 4. Department of Radiology, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada. 5. Vancouver Imaging, Vancouver General Hospital, Vancouver, BC, V5Z 1M9, Canada.
Abstract
PURPOSE: Recent studies have shown the feasibility of dual-energy CT (DECT) virtual non-contrast (VNC) for determining infarct extent. In this study, patients presenting with large-vessel occlusion (LVO) acute ischemic stroke (AIS), we assess whether ASPECTS on DECTA-VNC differs from non-contrast CT (NCCT). METHODS: After IRB approval, LVO-AIS patients undergoing NCCT and DECTA between October 2016 and September 2018 were retrospectively reviewed. DECTA-VNC images were derived using Syngo.via (Siemens, Erlangen, Germany). ASPECTS was scored by two blinded neuroradiologists. Square-weighted kappa statistic, diagnostic performance, Wilcoxon signed-rank tests between groups, and CT doses were calculated. RESULTS: Fifty-one patients met inclusion criteria, with median age of 76 (IQR 67-82); 26/51 (51%) were female. Median time between last-known-well and CT was 120 min (IQR 60-252). DECTA-VNC ASPECTS score differed by ≤ 1 from consensus NCCT in 49/51 (96%) patients for reader 1 and in 46/51 (90%) for reader 2. ASPECTS on DECTA-SI and consensus NCCT differed by ≤ 1 in 45/51 (88%) for both readers. On a per ASPECTS-region basis, DECTA-VNC had 87% sensitivity, 95% specificity, 0.82% PPV, and 0.96% NPV. ASPECTS inter-rater agreement was highest for DECTA-VNC (κ = 0.71), DECTA-SI (κ = 0.48), and NCCT (κ = 0.40). NCCT median CTDIvol was 63.7 mGy (IQR 60.7-67.2); DLP was 1060.0 mGy·cm (IQR 981.0-1151.5). DECTA-VNC dose was lower: median CTDIvol was 20.9 mGy (IQR 19.8-22.2); DLP was 804.1 (IQR 691.6-869.4), p < 0.0001. CONCLUSION: DECTA-derived VNC yielded similar ASPECTS scores as NCCT and is therefore non-inferior in early ischemia-related low attenuation edema/infarct detection in acute LVO-AIS patients. Further evaluation of the role of DECTA-VNC in AIS imaging is warranted.
PURPOSE: Recent studies have shown the feasibility of dual-energy CT (DECT) virtual non-contrast (VNC) for determining infarct extent. In this study, patients presenting with large-vessel occlusion (LVO) acute ischemic stroke (AIS), we assess whether ASPECTS on DECTA-VNC differs from non-contrast CT (NCCT). METHODS: After IRB approval, LVO-AIS patients undergoing NCCT and DECTA between October 2016 and September 2018 were retrospectively reviewed. DECTA-VNC images were derived using Syngo.via (Siemens, Erlangen, Germany). ASPECTS was scored by two blinded neuroradiologists. Square-weighted kappa statistic, diagnostic performance, Wilcoxon signed-rank tests between groups, and CT doses were calculated. RESULTS: Fifty-one patients met inclusion criteria, with median age of 76 (IQR 67-82); 26/51 (51%) were female. Median time between last-known-well and CT was 120 min (IQR 60-252). DECTA-VNC ASPECTS score differed by ≤ 1 from consensus NCCT in 49/51 (96%) patients for reader 1 and in 46/51 (90%) for reader 2. ASPECTS on DECTA-SI and consensus NCCT differed by ≤ 1 in 45/51 (88%) for both readers. On a per ASPECTS-region basis, DECTA-VNC had 87% sensitivity, 95% specificity, 0.82% PPV, and 0.96% NPV. ASPECTS inter-rater agreement was highest for DECTA-VNC (κ = 0.71), DECTA-SI (κ = 0.48), and NCCT (κ = 0.40). NCCT median CTDIvol was 63.7 mGy (IQR 60.7-67.2); DLP was 1060.0 mGy·cm (IQR 981.0-1151.5). DECTA-VNC dose was lower: median CTDIvol was 20.9 mGy (IQR 19.8-22.2); DLP was 804.1 (IQR 691.6-869.4), p < 0.0001. CONCLUSION: DECTA-derived VNC yielded similar ASPECTS scores as NCCT and is therefore non-inferior in early ischemia-related low attenuation edema/infarct detection in acute LVO-AIS patients. Further evaluation of the role of DECTA-VNC in AIS imaging is warranted.
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