Prediction of Intracerebral Hemorrhage After Endovascular Treatment of Acute Ischemic Stroke: Combining Quantitative Parameters on Dual-Energy CT with Clinical Related Factors

Abstract

ObjectivesTo evaluate the predictive value of dual-energy CT (DECT) quantitative parameters and clinical influence factors for intracerebral hemorrhage (ICH) complications after endovascular treatment in patients with acute ischemic stroke (AIS). MethodsSeventy-two consecutive patients who underwent brain DECT immediately after endovascular treatment for AIS from November 2017 to October 2019 were included. Retrospectively, the volume of brain parenchymal hyperdensity area (HDA), the maximum iodine concentration, and maximum CT value on DECT images was evaluated and measured by two radiologists blinded to any clinical information independently. Follow-up CT imaging (24–72 h) were used to assess the development of ICH complications. DECT parameters and clinical influence factors were analyzed by Chi-square test or Fisher's exact test and Mann-Whitney U test. Receiver operating characteristic curves were generated for continuous variables. ResultsFollow-up CT images confirmed that forty of 72 patients (55.6%) developed ICH. The volume of HDA, median maximum iodine concentration and maximum CT value between ICH group and non-ICH group were significantly different (P < 0.001). Combining the DECT quantitative parameters with clinical predictors, receiver operating characteristic analysis revealed an area under the curve of 0.985, for identifying patients developing ICH with sensitivity, specificity, positive predictive value and negative predictive value were 90%, 100%, 100% and 88.9%, respectively. ConclusionsThree quantitative parameters of DECT and clinical predictors showed great predictive performance in identifing ICH complications in patients with brain parenchyma HDA after endovascular therapy, which may contribute to better clinical decision-making.