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.
ABBREVIATIONS:
- DECT
- dual-energy CT
- ICH
- intracerebral hemorrhage
- SSS
- superior sagittal sinus
Footnotes
Disclosures: Heiko Schmiedeskamp—UNRELATED: Employment: Siemens. Thalia Field—UNRELATED: Grants/Grants Pending: Canadian Institutes of Health Research, Bayer Canada, Comments: site payments for recruitment (Canadian Institutes of Health Research) and in-kind study medication (Bayer Canada)*; Payment for Lectures Including Service on Speakers Bureaus: Servier Canada; Other: Michael Smith Foundation for Health Research, Vancouver Coastal Health Research Institute, Heart and Stroke Foundation of Canada, Comments: salary support awards.* * Money paid to the institution.
- © 2020 by American Journal of Neuroradiology