Differentiation between Cerebral Hemorrhage and Contrast Extravasation Using Dual Energy Computed Tomography after Intra-Arterial Neuro Interventional Procedures.

Abstract

Purpose:To evaluate the value of dual-energy computed tomography (DECT) in differentiating cerebral hemorrhage from blood brain barrier (BBB) disruption after neuro-interventional procedures with intra-arterial injection of iodinated contrast material.Material and methods:This prospective study was approved by the local ethics committee, and informed consent was obtained for all patients. Thirty five patients with acute ischemic stroke or un-ruptured brain aneurysm who had received intra-arterial administration of iodinated contrast material were evaluated using DECT at 80 and 150 kV immediately after the procedure.A three-material decomposition algorithm was used to obtain virtual non-contrast (VNC) images and iodine overlay maps (IOM). A follow-up examination (brain magnetic resonance imaging MRI or conventional CT) was used as the standard of reference for hemorrhage, defined as a persistant hyperdensity on a conventional CT or T2* hypo-intensity on brain MRI. The diagnostic values of DECT in differentiating hemorrhage and iodinated contrast material were obtained.Results:Mixed images obtained with DECT showed intra-parenchymal or subarachnoid hyperattenuation in 18/35 patients. Among these, 16 were classified (according to VNC images and IOM) as contrast extravasations and two with a mixture of hemorrhage and contrast material. On follow-up imaging, there were two patients with hemorrhage. The sensitivity, specificity, and accuracy of DECT in the identifying hemorrhage was calculated as 67% (2/3), 100% (32/32) and 97% (32/33) respectively.Conclusion:DECT allows an early and accurate differentiation between cerebral hemorrhage and BBB disruption after intra-arterial neuro-interventional procedures.