Early prediction of final infarct volume with material decomposition images of dual-energy CT after mechanical thrombect
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DIAGNOSTIC NEURORADIOLOGY
Early prediction of final infarct volume with material decomposition images of dual-energy CT after mechanical thrombectomy Silke Hopf-Jensen 1
&
Max Anraths 1 & Stephanie Lehrke 1 & Silke Szymczak 2 & Mario Hasler 3 & Stefan Müller-Hülsbeck 1
Received: 19 May 2020 / Accepted: 16 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Evaluation of water material density images (wMDIm) of dual-energy CT (DECT) for earlier prediction of final infarct volume (fiV) in follow-up single-energy CT (SECT) and correlation with clinical outcome. Methods Fifty patients (69 years, ± 12.1, 40–90, 50% female) with middle cerebral artery (MCA) occlusions were included. Early infarct volumes were analyzed in monoenergetic images (MonoIm) and wMDIm at 60 keV and compared with the fiV in SECT 4.9 days (± 4) after thrombectomy. Association between infarct volume and functional outcome was tested by linear regression analysis. Results wMDIm shows a prior visible infarct demarcation (60.7 ml, ± 74.9 ml) compared with the MonoIm (37.57 ml, ± 76.7 ml). Linear regression analysis, Bland–Altman plots and Pearson correlation coefficients show a close correlation of infarct volume in wMDIm to the fiV in SECT (r = 0.86; 95% CI 0.76–0.92), compared with MonoIm and SECT (r = 0.81; 95% CI 0.69– 0.89). The agreement with SECT is substantially higher in patients with infarct volumes < 70 ml (n = 33; 66%). Coefficients were smaller with r = 0.59 (95% CI 0.31; 0.78) for MonoIm and SECT compared with r = 0.77 (95% CI 0.57; 0.88) for wMDIm and SECT. At admission, the mean NIHSS score and mRS were 17.02 (± 4.7) and 4.9 (± 0.2). mRS ≤ 2 was achieved in 56% at 90 days with a mean mRS of 2.5 (± 0.8) at discharge. Conclusion Material decomposition allows earlier visibility of the final infarct volume. This promises an earlier evaluation of the dimension and severity of infarction and may lead to faster initiation of secondary stroke prophylaxis. Keywords Dual-energy CT . Material decomposition . Water material density image . Mechanical thrombectomy . Infarct volume
Abbreviations wMDIm Water material density images MonoIm Monoenergetic images DECT Dual-energy CT fiV Final infarct volume MCA Middle cerebral artery SECT Single-energy CT
IodMDIm NIHSS mRS ECASS mTICI AsiR ASPECTS
* Silke Hopf-Jensen [email protected]
Introduction
1
Department of Diagnostic and Interventional Radiology and Neuroradiology, Diakonissenhospital Flensburg, Knuthstraße 1, 24939 Flensburg, Germany
2
Institute of Medical Informatics and Statistics, Kiel University, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
3
Faculty of Agricultural and Nutritional Sciences, Kiel University, Kiel, Germany
Iodine material density image National Institutes of Health Stroke Scale Modified Rankin Scale European Cooperative Acute Stroke Study Modified treatment in cerebral infarction score Adaptive statistical iterative reconstruction Alberta stroke program early CT score
Although ischaemic stroke is sti
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