Diagnostic accuracy of dual-energy CT in distinguishing intracerebral hemorrhage from contrast staining: a systematic review and meta-analysis with radiation dose assessment

PURPOSE: This systematic review and meta-analysis aimed to investigate the diagnostic accuracy of dual-energy CT (DECT) in distinguishing intracerebral hemorrhage (ICH) from contrast staining after procedures and to assess the associated radiation dose in comparison with conventional CT. METHODS: A systematic search was conducted up to December 2024. Eligible studies included those applying DECT for cerebrovascular conditions with retrievable technical and diagnostic performance data. Pooled estimates of sensitivity, specificity, and radiation dose parameters were calculated using a random-effects model. RESULTS: A total of 68 studies, including 5530 patients, met the inclusion criteria. Among them, 34/68 (50%) focused on lesion detection, 18/68 (26%) on technical aspects, and 16/68 (24%) on prediction. A meta-analysis of 10 studies demonstrated a pooled sensitivity of 96.1% (95% CI 83.8%-99.1%) and specificity of 97.8% (95% CI 91.4%-99.5%) for differentiating ICH from contrast staining. Additionally, a radiation dose meta-analysis of 13 studies provided pooled estimates of computed tomography dose index volume (CTDIvol) at 28.83 mGy (95% CI 20.60-37.07 mGy) and dose-length product (DLP) at 517.66 mGy × cm (95% CI 400.19-635.13 mGy × cm), comparable to conventional single-energy CT. CONCLUSION: DECT demonstrates excellent diagnostic accuracy in differentiating ICH from contrast staining, with radiation exposure comparable to conventional CT. The large variability in voltage and doses among different protocols reflects the relative immaturity of DECT and the need for multicentric harmonization and standardization. Given its high diagnostic accuracy and comparable radiation exposure to single-energy CT, where technically available, DECT should always be considered in the specific scenario of differentiating ICH from contrast staining. CLINICAL RELEVANCE STATEMENT: DECT provides high diagnostic accuracy without increasing radiation exposure, enabling confident post-treatment differentiation between hemorrhage and contrast staining to guide timely therapeutic decisions.