Value of Dual-Energy Dual-Layer CT After Mechanical Recanalization for the Quantification of Ischemic Brain Edema
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Value of Dual-Energy Dual-Layer CT After Mechanical Recanalization for the Quantification of Ischemic Brain Edema. / Steffen, Paul; Austein, Friederike; Lindner, Thomas; Meyer, Lukas; Bechstein, Matthias; Rümenapp, Johanna; Klintz, Tristan; Jansen, Olav; Gellißen, Susanne; Hanning, Uta; Fiehler, Jens; Broocks, Gabriel.
In: FRONT NEUROL, Vol. 12, 668030, 2021.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Value of Dual-Energy Dual-Layer CT After Mechanical Recanalization for the Quantification of Ischemic Brain Edema
AU - Steffen, Paul
AU - Austein, Friederike
AU - Lindner, Thomas
AU - Meyer, Lukas
AU - Bechstein, Matthias
AU - Rümenapp, Johanna
AU - Klintz, Tristan
AU - Jansen, Olav
AU - Gellißen, Susanne
AU - Hanning, Uta
AU - Fiehler, Jens
AU - Broocks, Gabriel
N1 - Copyright © 2021 Steffen, Austein, Lindner, Meyer, Bechstein, Rümenapp, Klintz, Jansen, Gellißen, Hanning, Fiehler and Broocks.
PY - 2021
Y1 - 2021
N2 - Background and Purpose: Ischemic brain edema can be measured in computed tomography (CT) using quantitative net water uptake (NWU), a recently established imaging biomarker. NWU determined in follow-up CT after mechanical thrombectomy (MT) has shown to be a strong predictor of functional outcome. However, disruption of the blood-brain barrier after MT may also lead to contrast staining, increasing the density on CT scans, and hence, directly impairing measurements of NWU. The purpose of this study was to determine whether dual-energy dual-layer CT (DDCT) after MT can improve the quantification of NWU by measuring NWU in conventional polychromatic CT images (CP-I) and virtual non-contrast images (VNC-I). We hypothesized that VNC-based NWU (vNWU) differs from NWU in conventional CT (cNWU). Methods: Ten patients with middle cerebral artery occlusion who received a DDCT follow-up scan after MT were included. NWU was quantified in conventional and VNC images as previously published and was compared using paired sample t-tests. Results: The mean cNWU was 3.3% (95%CI: 0-0.41%), and vNWU was 11% (95%CI: 1.3-23.4), which was not statistically different (p = 0.09). Two patients showed significant differences between cNWU and vNWU (Δ = 24% and Δ = 36%), while the agreement of cNWU/vNWU in 8/10 patients was high (difference 2.3%, p = 0.23). Conclusion: NWU may be quantified precisely on conventional CT images, as the underestimation of ischemic edema due to contrast staining was low. However, a proportion of patients after MT might show significant contrast leakage resulting in edema underestimation. Further research is needed to validate these findings and investigate clinical implications.
AB - Background and Purpose: Ischemic brain edema can be measured in computed tomography (CT) using quantitative net water uptake (NWU), a recently established imaging biomarker. NWU determined in follow-up CT after mechanical thrombectomy (MT) has shown to be a strong predictor of functional outcome. However, disruption of the blood-brain barrier after MT may also lead to contrast staining, increasing the density on CT scans, and hence, directly impairing measurements of NWU. The purpose of this study was to determine whether dual-energy dual-layer CT (DDCT) after MT can improve the quantification of NWU by measuring NWU in conventional polychromatic CT images (CP-I) and virtual non-contrast images (VNC-I). We hypothesized that VNC-based NWU (vNWU) differs from NWU in conventional CT (cNWU). Methods: Ten patients with middle cerebral artery occlusion who received a DDCT follow-up scan after MT were included. NWU was quantified in conventional and VNC images as previously published and was compared using paired sample t-tests. Results: The mean cNWU was 3.3% (95%CI: 0-0.41%), and vNWU was 11% (95%CI: 1.3-23.4), which was not statistically different (p = 0.09). Two patients showed significant differences between cNWU and vNWU (Δ = 24% and Δ = 36%), while the agreement of cNWU/vNWU in 8/10 patients was high (difference 2.3%, p = 0.23). Conclusion: NWU may be quantified precisely on conventional CT images, as the underestimation of ischemic edema due to contrast staining was low. However, a proportion of patients after MT might show significant contrast leakage resulting in edema underestimation. Further research is needed to validate these findings and investigate clinical implications.
U2 - 10.3389/fneur.2021.668030
DO - 10.3389/fneur.2021.668030
M3 - SCORING: Journal article
C2 - 34349718
VL - 12
JO - FRONT NEUROL
JF - FRONT NEUROL
SN - 1664-2295
M1 - 668030
ER -