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Yang Y, Li K. Letter to editor on the article "assessment of post-thrombectomy brain hemorrhage in acute ischemic stroke with dual-energy CT: how reliable is it in clinical practice?" by Pacielli et al. LA RADIOLOGIA MEDICA 2024; 129:1424-1425. [PMID: 38896310 DOI: 10.1007/s11547-024-01834-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 06/12/2024] [Indexed: 06/21/2024]
Affiliation(s)
- Yang Yang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical and Pharmaceutical College, Chongqing, China
| | - Kunhua Li
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Rd, Yuzhong District, Chongqing, 400010, China.
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Steffen P, Winkelmeier L, Kniep H, Geest V, Soltanipanah S, Fiehler J, Broocks G. Quantification of ischemic brain edema after mechanical thrombectomy using dual-energy computed tomography in patients with ischemic stroke. Sci Rep 2024; 14:4148. [PMID: 38378795 PMCID: PMC10879140 DOI: 10.1038/s41598-024-54600-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/14/2024] [Indexed: 02/22/2024] Open
Abstract
Net water uptake (NWU) is a quantitative imaging biomarker used to assess cerebral edema resulting from ischemia via Computed Tomography (CT)-densitometry. It serves as a strong predictor of clinical outcome. Nevertheless, NWU measurements on follow-up CT scans after mechanical thrombectomy (MT) can be affected by contrast staining. To improve the accuracy of edema estimation, virtual non-contrast images (VNC-I) from dual-energy CT scans (DECT) were compared to conventional polychromatic CT images (CP-I) in this study. We examined NWU measurements derived from VNC-I and CP-I to assess their agreement and predictive value in clinical outcome. 88 consecutive patients who received DECT as follow-up after MT were included. NWU was quantified on CP-I (cNWU) and VNC-I (vNWU). The clinical endpoint was functional independence at discharge. cNWU and vNWU were highly correlated (r = 0.71, p < 0.0001). The median difference between cNWU and vNWU was 8.7% (IQR: 4.5-14.1%), associated with successful vessel recanalization (mTICI2b-3) (ß: 11.6%, 95% CI 2.9-23.0%, p = 0.04), and age (ß: 4.2%, 95% CI 1.3-7.0%, p = 0.005). The diagnostic accuracy to classify outcome between cNWU and vNWU was similar (AUC:0.78 versus 0.77). Although there was an 8.7% median difference, indicating potential edema underestimation on CP-I, it did not have short-term clinical implications.
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Affiliation(s)
- Paul Steffen
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany.
| | - Laurens Winkelmeier
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
| | - Helge Kniep
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
| | - Vincent Geest
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
| | - Setareh Soltanipanah
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
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Ebaid NY, Mouffokes A, Yasen NS, Elrosasy AM, Philip KG, Assy MM, Alsowey AM. Diagnostic accuracy of dual-energy computed tomography in the diagnosis of neurological complications after endovascular treatment of acute ischaemic stroke: a systematic review and meta-analysis. Br J Radiol 2024; 97:73-92. [PMID: 38263833 PMCID: PMC11027317 DOI: 10.1093/bjr/tqad007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 09/28/2023] [Accepted: 10/22/2023] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVES To investigate dual-energy computed tomography's (DECT) diagnostic performance in detecting neurological complications following endovascular therapy (EVT) of acute ischaemic stroke (AIS). METHODS We performed the literature search using Web of Science, Scopus, PubMed, EBSCO, and Science Direct databases for published related studies. The selected studies estimated the validity of DECT in the detection of neurological complications after EVT for AIS. Study quality assessment was performed utilizing the Quality of Diagnostic Accuracy Studies-2 Tool. Our meta-analysis calculated the pooled sensitivity, negative likelihood ratio, specificity, and positive likelihood ratio for each detected complication. The summary receiver operating characteristics (sROC) curve was utilized to estimate the area under the curve (AUC). RESULTS Of 22 studies, 21 were included in the quantitative synthesis. In the detection of intracerebral haemorrhage (ICH), DECT pooled overall sensitivity and specificity were 69.9% (95% CI, 44.5%-86.8%) and 100% (95% CI, 92.1%-100%); whereas, in the detection of ischaemia, they were 85.9% (95% CI, 80.4%-90%) and 90.7% (95% CI, 87%-93.5%), respectively. On the sROC curve, AUC values of 0.954 and 0.952 were recorded for the detection of ICH and ischaemia, respectively. CONCLUSIONS DECT demonstrated high accuracy and specificity in the detection of neurological complications post-endovascular treatment of AIS. However, further prospective studies with a standardized reference test and a larger sample size are recommended to support these findings. ADVANCES IN KNOWLEDGE DECT is a rapid and valid imaging tool for the prediction of ICH and cerebral ischaemia after the EVT of AIS.
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Affiliation(s)
- Noha Yahia Ebaid
- Radiodiagnosis Department, Faculty of Medicine, Zagazig University, Zagazig 40511, Egypt
- Medical Research Group of Egypt, Cairo 11511, Egypt
| | - Adel Mouffokes
- Medical Research Group of Egypt, Cairo 11511, Egypt
- Faculty of Medicine, University of Oran 1 Ahmed Ben Bella, Oran 31020, Algeria
| | - Noha S Yasen
- Medical Research Group of Egypt, Cairo 11511, Egypt
- Faculty of Applied Medical Sciences, Misr University for Science and Technology, Cairo 11511, Egypt
| | - Amr M Elrosasy
- Medical Research Group of Egypt, Cairo 11511, Egypt
- Faculty of Medicine, Cairo University, Cairo 11511, Egypt
| | - Kerollos George Philip
- Medical Research Group of Egypt, Cairo 11511, Egypt
- Faculty of Medicine, Sohag University, Sohag 82511, Egypt
| | - Mostafa Mohamad Assy
- Radiodiagnosis Department, Faculty of Medicine, Zagazig University, Zagazig 40511, Egypt
| | - Ahmed Mohamed Alsowey
- Radiodiagnosis Department, Faculty of Medicine, Zagazig University, Zagazig 40511, Egypt
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Grkovski R, Acu L, Ahmadli U, Nakhostin D, Thurner P, Wacht L, Kulcsár Z, Alkadhi H, Winklhofer S. Dual-Energy Computed Tomography in Stroke Imaging : Value of a New Image Acquisition Technique for Ischemia Detection after Mechanical Thrombectomy. Clin Neuroradiol 2023; 33:747-754. [PMID: 36862231 PMCID: PMC10450017 DOI: 10.1007/s00062-023-01270-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/24/2023] [Indexed: 03/03/2023]
Abstract
OBJECTIVE To assess if a new dual-energy computed tomography (DECT) technique enables an improved visualization of ischemic brain tissue after mechanical thrombectomy in acute stroke patients. MATERIAL AND METHODS The DECT head scans with a new sequential technique (TwinSpiral DECT) were performed in 41 patients with ischemic stroke after endovascular thrombectomy and were retrospectively included. Standard mixed and virtual non-contrast (VNC) images were reconstructed. Infarct visibility and image noise were assessed qualitatively by two readers using a 4-point Likert scale. Quantitative Hounsfield units (HU) were used to assess density differences of ischemic brain tissue versus healthy tissue on the non-affected contralateral hemisphere. RESULTS Infarct visibility was significantly better in VNC compared to mixed images for both readers R1 (VNC: median 1 (range 1-3), mixed: median 2 (range 1-4), p < 0.05) and R2 (VNC: median 2 (range 1-3), mixed: 2 (range 1-4), p < 0.05). Qualitative image noise was significantly higher in VNC compared to mixed images for both readers R1 (VNC: median 3, mixed: 2) and R2 (VNC: median 2, mixed: 1, p < 0.05, each). Mean HU were significantly different between the infarcted tissue and the reference healthy brain tissue on the contralateral hemisphere in VNC (infarct 24 ± 3) and mixed images (infarct 33 ± 5, p < 0.05, each). The mean HU difference between ischemia and reference in VNC images (mean 8 ± 3) was significantly higher (p < 0.05) compared to the mean HU difference in mixed images (mean 5 ± 4). CONCLUSION TwinSpiral DECT allows an improved qualitative and quantitative visualization of ischemic brain tissue in ischemic stroke patients after endovascular treatment.
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Affiliation(s)
- Risto Grkovski
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
- Department of Radiology, University Medical Centre Maribor, Ljubljanska ulica 5, 2000, Maribor, Slovenia
| | - Leyla Acu
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Uzeyir Ahmadli
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Dominik Nakhostin
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Patrick Thurner
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Lorenz Wacht
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Zsolt Kulcsár
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Sebastian Winklhofer
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
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Abel F, Schubert T, Winklhofer S. Advanced Neuroimaging With Photon-Counting Detector CT. Invest Radiol 2023; 58:472-481. [PMID: 37158466 DOI: 10.1097/rli.0000000000000984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
ABSTRACT Photon-counting detector computed tomography (PCD-CT) is an emerging technology and promises the next step in CT evolution. Photon-counting detectors count the number of individual incoming photons and assess the energy level of each of them. These mechanisms differ substantially from conventional energy-integrating detectors. The new technique has several advantages, including lower radiation exposure, higher spatial resolution, reconstruction of images with less beam-hardening artifacts, and advanced opportunities for spectral imaging. Research PCD-CT systems have already demonstrated promising results, and recently, the first whole-body full field-of-view PCD-CT scanners became clinically available. Based on published studies of preclinical systems and the first experience with clinically approved scanners, the performance can be translated to valuable neuroimaging applications, including brain imaging, intracranial and extracranial CT angiographies, or head and neck imaging with detailed assessment of the temporal bone. In this review, we will provide an overview of the current status in neuroimaging with upcoming and potential clinical applications.
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Affiliation(s)
- Frederik Abel
- From the Department of Diagnostic and Interventional Radiology
| | - Tilman Schubert
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sebastian Winklhofer
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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