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Gassenhuber M, Lochschmidt ME, Hammel J, Boeckh-Behrens T, Ikenberg B, Wunderlich S, Liesche-Starnecker F, Schlegel J, Pfeiffer F, Makowski MR, Zimmer C, Riederer I, Pfeiffer D. Multimaterial decomposition in dual-energy CT for characterization of clots from acute ischemic stroke patients. Eur Radiol Exp 2024; 8:52. [PMID: 38575701 PMCID: PMC10994882 DOI: 10.1186/s41747-024-00443-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/22/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Nowadays, there is no method to quantitatively characterize the material composition of acute ischemic stroke thrombi prior to intervention, but dual-energy CT (DE-CT) offers imaging-based multimaterial decomposition. We retrospectively investigated the material composition of thrombi ex vivo using DE-CT with histological analysis as a reference. METHODS Clots of 70 patients with acute ischemic stroke were extracted by mechanical thrombectomy and scanned ex vivo in formalin-filled tubes with DE-CT. Multimaterial decomposition in the three components, i.e., red blood cells (RBC), white blood cells (WBC), and fibrin/platelets (F/P), was performed and compared to histology (hematoxylin/eosin staining) as reference. Attenuation and effective Z values were assessed, and histological composition was compared to stroke etiology according to the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria. RESULTS Histological and imaging analysis showed the following correlation coefficients for RBC (r = 0.527, p < 0.001), WBC (r = 0.305, p = 0.020), and F/P (r = 0.525, p < 0.001). RBC-rich thrombi presented higher clot attenuation in Hounsfield units than F/P-rich thrombi (51 HU versus 42 HU, p < 0.01). In histological analysis, cardioembolic clots showed less RBC (40% versus 56%, p = 0.053) and more F/P (53% versus 36%, p = 0.024), similar to cryptogenic clots containing less RBC (34% versus 56%, p = 0.006) and more F/P (58% versus 36%, p = 0.003) than non-cardioembolic strokes. No difference was assessed for the mean WBC portions in all TOAST groups. CONCLUSIONS DE-CT has the potential to quantitatively characterize the material composition of ischemic stroke thrombi. RELEVANCE STATEMENT Using DE-CT, the composition of ischemic stroke thrombi can be determined. Knowledge of histological composition prior to intervention offers the opportunity to define personalized treatment strategies for each patient to accomplish faster recanalization and better clinical outcomes. KEY POINTS • Acute ischemic stroke clots present different recanalization success according to histological composition. • Currently, no method can determine clot composition prior to intervention. • DE-CT allows quantitative material decomposition of thrombi ex vivo in red blood cells, white blood cells, and fibrin/platelets. • Histological clot composition differs between stroke etiology. • Insights into the histological composition in situ offer personalized treatment strategies.
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Affiliation(s)
- Melina Gassenhuber
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, 81675, Germany
| | - Maximilian E Lochschmidt
- Chair of Biomedical Physics, Department of Physics, School of Natural Sciences, Technical University of Munich, 85748, Garching, Germany
| | - Johannes Hammel
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, 81675, Germany
- Chair of Biomedical Physics, Department of Physics, School of Natural Sciences, Technical University of Munich, 85748, Garching, Germany
- Munich Institute of Biomedical Engineering, Technical University of Munich, 85748, Garching, Germany
| | - Tobias Boeckh-Behrens
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, 81675, Germany
| | - Benno Ikenberg
- Department of Neurology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, 81675, Germany
| | - Silke Wunderlich
- Department of Neurology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, 81675, Germany
| | | | - Jürgen Schlegel
- Department of Neuropathology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, 81675, Germany
| | - Franz Pfeiffer
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, 81675, Germany
- Chair of Biomedical Physics, Department of Physics, School of Natural Sciences, Technical University of Munich, 85748, Garching, Germany
- Munich Institute of Biomedical Engineering, Technical University of Munich, 85748, Garching, Germany
- Institute for Advanced Study, Technical University of Munich, 85748, Garching, Germany
| | - Marcus R Makowski
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, 81675, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, 81675, Germany
| | - Isabelle Riederer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, 81675, Germany
| | - Daniela Pfeiffer
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, 81675, Germany.
- Institute for Advanced Study, Technical University of Munich, 85748, Garching, Germany.
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