Dual-energy computed tomography in acute ischemic stroke: state-of-the-art
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Dual-energy computed tomography in acute ischemic stroke: state-of-the-art Stephanie Mangesius 1 & Tanja Janjic 1 & Ruth Steiger 1,2 & Lukas Haider 3,4 & Rafael Rehwald 5,6,7 & Michael Knoflach 8 & Gerlig Widmann 7 & Elke Gizewski 1 & Astrid Grams 1 Received: 20 May 2020 / Revised: 31 October 2020 / Accepted: 18 November 2020 # The Author(s) 2020
Abstract Dual-energy computed tomography (DECT) allows distinguishing between tissues with similar X-ray attenuation but different atomic numbers. Recent studies demonstrated that this technique has several areas of application in patients with ischemic stroke and a potential impact on patient management. After endovascular stroke therapy (EST), hyperdense areas can represent either hemorrhage or contrast staining due to blood-brain barrier disruption, which can be differentiated reliably by DECT. Further applications are improved visualization of early infarctions, compared to single-energy computed tomography, and prediction of transformation into infarction or hemorrhage in contrast-enhancing areas. In addition, DECT allows detection and evaluation of the material composition of intra-arterial clots after EST. This review summarizes the clinical state-of-the-art of DECT in patients with stroke, and features some prospects for future developments. Key points • Dual-energy computed tomography (DECT) allows differentiation between tissues with similar X-ray attenuation but different atomic numbers. • DECT has several areas of application in patients with ischemic stroke and a potential impact on patient management. • Prospects for future developments in DECT may improve treatment decision-making. Keywords Stroke . Brain ischemia . Tomography, X-ray computed . Hemorrhage . Thrombosis
* Tanja Janjic [email protected] 1
Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
2
Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
3
NMR Research Unit, Queens Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Science, University College London, London, UK
4
Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
5
Institute of Neurology, University College London, London, UK
6
Department of Radiology, University of Cambridge, Cambridge, UK
7
Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
8
Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
Abbreviations AUC Area under the curve BBB Blood-brain barrier BE Brain edema BW Brain window CA Contrast agent CNR Contrast-to-noise ratio DECT Dual-energy computed tomography DLCT Dual-layer detector CT D W I - Diffusion-weighted magnetic resonance imaging MRI EID Energy-integrating detectors EST Endovascular stroke therapy FR Fibrin-rich GM Gray matter HU Hounsfield unit IM Iodine map series IPH Intraparenchymal hemorrhage
Eur Radiol
MCA MECT OR PCD RBC SECT TICI VMI VNC WM
Middle cer
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