Hemorrhagic Transformation Assessment Based on Dual Energy CT of Immediately and Twenty-Four Hours after Endovascular Thrombectomy for Acute Ischemic Stroke
Background: Dual-energy CT (DECT) shows good performance in differentiating hemorrhage from contrast staining (CS). However, no guidelines have standardized the post-endovascular thrombectomy (EVT) examination time. We evaluated the value of performing DECT immediately and 24 h post-EVT in the diagn...
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| Format: | Article |
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MDPI AG
2023-07-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/13/15/2493 |
| _version_ | 1797586900789231616 |
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| author | Tianyu Wang Weili Ding Qing Chen Zhongxiang Ding |
| author_facet | Tianyu Wang Weili Ding Qing Chen Zhongxiang Ding |
| author_sort | Tianyu Wang |
| collection | DOAJ |
| description | Background: Dual-energy CT (DECT) shows good performance in differentiating hemorrhage from contrast staining (CS). However, no guidelines have standardized the post-endovascular thrombectomy (EVT) examination time. We evaluated the value of performing DECT immediately and 24 h post-EVT in the diagnosis and prediction of hemorrhagic transformation (HT). Methods: Two readers evaluated simulated conventional CT (sCCT) images compared with a second reading with DECT, establishing the diagnosis of HT immediately and 24 h post-EVT. Another reader’s diagnosis 2–7 days post-EVT using non-contrast CT was identified as the final diagnostic criteria. Results: DECT performed immediately and 24 h post-EVT changed 22.4% (52/232) and 12.5% (29/232) of sCCT-based HT diagnoses, respectively (χ<sup>2</sup> = 10.7, <i>p</i> < 0.05). The sensitivity, negative predictive value (NPV), and accuracy of DECT performed immediately post-EVT for predicting the final diagnosis of HT were 33.6%, 58.9%, and 65.9%, respectively, whereas those for DECT performed 24 h post-EVT were 82.4%, 84.3%, and 90.9%, respectively (χ<sup>2</sup> = 58.0, χ<sup>2</sup> = 42.9, χ<sup>2</sup> = 13.6; <i>p</i> < 0.05). The specificity and positive predictive value were both 100.0%. Delayed HT occurred in 50.0% (78/156) and 42.2% (19/45) of patients with CS diagnosed immediately and 24 h post-EVT, respectively. Conclusions: DECT performed immediately post-EVT changed a greater proportion of real-time HT diagnoses, whereas that performed 24 h post-EVT had higher sensitivity, NPV, and accuracy in predicting the final diagnosis of HT. A substantial proportion of patients with CS diagnosed at these two post-EVT timepoints subsequently developed delayed HT. |
| first_indexed | 2024-03-11T00:29:44Z |
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| language | English |
| last_indexed | 2024-03-11T00:29:44Z |
| publishDate | 2023-07-01 |
| publisher | MDPI AG |
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| series | Diagnostics |
| spelling | doaj.art-bdefc11ae1644dd5999e6123187b1bfd2023-11-18T22:46:16ZengMDPI AGDiagnostics2075-44182023-07-011315249310.3390/diagnostics13152493Hemorrhagic Transformation Assessment Based on Dual Energy CT of Immediately and Twenty-Four Hours after Endovascular Thrombectomy for Acute Ischemic StrokeTianyu Wang0Weili Ding1Qing Chen2Zhongxiang Ding3Department of Radiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, ChinaGraduate School of Zhejiang Chinese Medical University, Hangzhou 310053, ChinaGraduate School of Zhejiang Chinese Medical University, Hangzhou 310053, ChinaDepartment of Radiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, ChinaBackground: Dual-energy CT (DECT) shows good performance in differentiating hemorrhage from contrast staining (CS). However, no guidelines have standardized the post-endovascular thrombectomy (EVT) examination time. We evaluated the value of performing DECT immediately and 24 h post-EVT in the diagnosis and prediction of hemorrhagic transformation (HT). Methods: Two readers evaluated simulated conventional CT (sCCT) images compared with a second reading with DECT, establishing the diagnosis of HT immediately and 24 h post-EVT. Another reader’s diagnosis 2–7 days post-EVT using non-contrast CT was identified as the final diagnostic criteria. Results: DECT performed immediately and 24 h post-EVT changed 22.4% (52/232) and 12.5% (29/232) of sCCT-based HT diagnoses, respectively (χ<sup>2</sup> = 10.7, <i>p</i> < 0.05). The sensitivity, negative predictive value (NPV), and accuracy of DECT performed immediately post-EVT for predicting the final diagnosis of HT were 33.6%, 58.9%, and 65.9%, respectively, whereas those for DECT performed 24 h post-EVT were 82.4%, 84.3%, and 90.9%, respectively (χ<sup>2</sup> = 58.0, χ<sup>2</sup> = 42.9, χ<sup>2</sup> = 13.6; <i>p</i> < 0.05). The specificity and positive predictive value were both 100.0%. Delayed HT occurred in 50.0% (78/156) and 42.2% (19/45) of patients with CS diagnosed immediately and 24 h post-EVT, respectively. Conclusions: DECT performed immediately post-EVT changed a greater proportion of real-time HT diagnoses, whereas that performed 24 h post-EVT had higher sensitivity, NPV, and accuracy in predicting the final diagnosis of HT. A substantial proportion of patients with CS diagnosed at these two post-EVT timepoints subsequently developed delayed HT.https://www.mdpi.com/2075-4418/13/15/2493dual-energy CTischemic strokeendovascular thrombectomyhemorrhagic transformation |
| spellingShingle | Tianyu Wang Weili Ding Qing Chen Zhongxiang Ding Hemorrhagic Transformation Assessment Based on Dual Energy CT of Immediately and Twenty-Four Hours after Endovascular Thrombectomy for Acute Ischemic Stroke Diagnostics dual-energy CT ischemic stroke endovascular thrombectomy hemorrhagic transformation |
| title | Hemorrhagic Transformation Assessment Based on Dual Energy CT of Immediately and Twenty-Four Hours after Endovascular Thrombectomy for Acute Ischemic Stroke |
| title_full | Hemorrhagic Transformation Assessment Based on Dual Energy CT of Immediately and Twenty-Four Hours after Endovascular Thrombectomy for Acute Ischemic Stroke |
| title_fullStr | Hemorrhagic Transformation Assessment Based on Dual Energy CT of Immediately and Twenty-Four Hours after Endovascular Thrombectomy for Acute Ischemic Stroke |
| title_full_unstemmed | Hemorrhagic Transformation Assessment Based on Dual Energy CT of Immediately and Twenty-Four Hours after Endovascular Thrombectomy for Acute Ischemic Stroke |
| title_short | Hemorrhagic Transformation Assessment Based on Dual Energy CT of Immediately and Twenty-Four Hours after Endovascular Thrombectomy for Acute Ischemic Stroke |
| title_sort | hemorrhagic transformation assessment based on dual energy ct of immediately and twenty four hours after endovascular thrombectomy for acute ischemic stroke |
| topic | dual-energy CT ischemic stroke endovascular thrombectomy hemorrhagic transformation |
| url | https://www.mdpi.com/2075-4418/13/15/2493 |
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