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Differentiation of Hemorrhage from Iodinated Contrast in Different Intracranial Compartments Using Dual-Energy Head CT.
MedLine Citation:
PMID:  22268092     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE:Identification of ICH, particularly after ischemic stroke therapy, is important for guiding subsequent antithrombotic management and is often confounded by contrast staining or extravasations within intracerebral or extra-axial compartments. This study evaluates the accuracy of DECT in distinguishing ICH from iodinated contrast in patients who received contrast via IA or IV delivery.MATERIALS AND METHODS:Forty patients who had received IA or IV contrast were evaluated using a DECT scanner at 80kV and 140kV to distinguish hyperdensities secondary to contrast staining or extravasation from those representing ICH. A 3-material decomposition algorithm was used to obtain virtual noncontrast images and iodine overlay images. Sensitivity, specificity, and accuracy of DECT in prospectively distinguishing intracranial contrast from hemorrhage within parenchymal, subarachnoid, extra-axial, intraventricular, and intra-arterial compartments were computed using routine clinical follow-up imaging as the standard of reference.RESULTS:A total of 148 foci of intracranial hyperattenuation were identified. Of these, 142 were correctly classified for the presence of hemorrhage by DECT. The sensitivity, specificity, and accuracy for identifying hemorrhage, depending on the compartment being considered, were 100%, 84.4%-100%, and 87.2%-100%, respectively. The only instances where DECT failed to correctly identify the source of hyperattenuation was in the presence of diffuse parenchymal calcification (n = 5) and a metallic streak artifact (n = 1).CONCLUSION:After IA and/or IV contrast administration, DECT can accurately differentiate all types of ICH from iodinated contrast without employing any additional radiation.
Authors:
C M Phan; A J Yoo; J A Hirsch; R G Nogueira; R Gupta
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-1-19
Journal Detail:
Title:  AJNR. American journal of neuroradiology     Volume:  -     ISSN:  1936-959X     ISO Abbreviation:  -     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-1-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8003708     Medline TA:  AJNR Am J Neuroradiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Departments of Neurology, Neurosurgery, and Radiology, Emory University School of Medicine, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Wang Ambulatory Care Center, Boston, Massachusetts.
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