Comparison of various reconstructions derived from dual-energy CT immediately after endovascular treatment of acute ischemic stroke in predicting hemorrhage.

Predicting 24-h hemorrhage immediately after endovascular treatment (EVT) of ischemic stroke is important but difficult for clinicians. We thus aimed to identify better image markers in predicting hemorrhage from different reconstructions derived from dual-energy CT. We reviewed our prospectively collected database for anterior circulation ischemic stroke patients who received EVT and analyzed patients who underwent dual-energy CT immediately after EVT. Parenchymal hyperdensities were assessed on non-contrast CT and virtual non-contrast (VNC) which was constructed from dual-energy CT, respectively. Metallic hyperdensity sign was defined when a maximum density > 90 Hounsfield units was identified within the nonpetechial intracerebral hyperdense lesion in the basal ganglia on non-contrast CT. A total of 147 patients were included. Hemorrhagic transformation (HT) was identified in 81 (55.1%) patients, and parenchymal hemorrhage (PH) in 35 (23.8%) patients. The rate of HT at 24 h was higher in patients with parenchymal hyperdensities on non-contrast CT or VNC or with metallic hyperdensity sign than those without (72.4% vs 11.9%, p < 0.001; 82.0% vs 41.2%, p < 0.001; 100.0% vs 44.5%, p < 0.001). Parenchymal hyperdensities on non-contrast CT had a higher accuracy in predicting HT than those on VNC (76.9% vs 66.7%). Metallic hyperdensity sign on non-contrast CT also had a higher accuracy in predicting PH than parenchymal hyperdensities on VNC (88.4% vs 69.4%). Image markers on non-contrast CT (parenchymal hyperdensities and metallic hyperdensity sign) performed immediately post-EVT of ischemic stroke might be not inferior to dual-energy CT (parenchymal hyperdensities) to predict follow-up hemorrhage. • Image markers (parenchymal hyperdensities and metallic hyperdensity sign) on NCCT performed immediately post-EVT of ischemic stroke can predict follow-up hemorrhage. • Metallic hyperdensity sign on NCCT can accurately predict parenchymal hemorrhage. • Parenchymal hyperdensities on NCCT can accurately predict hemorrhagic transformation.