Intracranial Hemorrhage Assessment Using Sequential Acquisition Dual-energy CT after Endovascular Thrombectomy

The usefulness of dual-source dual-energy computed tomography (DECT) in distinguishing contrast staining (CS) from intracranial hemorrhage (ICH) has been reported. In this study, we evaluated ICH after mechanical thrombectomy (MT) using sequential acquisition DECT (SADE) and examined its diagnostic accuracy. Of the 76 patients who underwent MT for acute ischemic stroke between August 2022 and August 2023, 56 were ultimately included in the study. Using virtual non-contrast images (VNC) and iodine map images obtained from DECT, high-attenuation (HA) areas on mixed images were classified into ICH and CS, and the accuracy of DECT was evaluated using follow-up images of CT or magnetic resonance imaging within 48 hours after DECT. A total of 129 foci of HA areas were identified on the mixed image. There were 20 HA regions that were judged to have both ICH and CS, 109 that were judged to have CS only, and no HA regions that were judged to have ICH only. The sensitivity, specificity, and accuracy for identifying hemorrhage were 20.9%, 91.9%, and 65.8%, respectively. Misregistration artifacts occurred in VNC (n=2, 3.6%). In the evaluation of ICH after MT, although the sensitivity of SADE for bleeding is low due to the influence of delayed hemorrhagic changes, it has high specificity and is highly reliable for distinguishing CS. In addition, SADE may cause misregistration artifacts due to slight body movement.