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Research ArticleAdult Brain

Prediction of Hemorrhage after Successful Recanalization in Patients with Acute Ischemic Stroke: Improved Risk Stratification Using Dual-Energy CT Parenchymal Iodine Concentration Ratio Relative to the Superior Sagittal Sinus

D. Byrne, J.P. Walsh, H. Schmiedeskamp, F. Settecase, M.K.S. Heran, B. Niu, A.K. Salmeen, B. Rohr, T.S. Field, N. Murray and A. Rohr
American Journal of Neuroradiology January 2020, 41 (1) 64-70; DOI: https://doi.org/10.3174/ajnr.A6345
D. Byrne
aFrom the Division of Neuroradiology (D.B., F.S., M.K.S.H., A.R.)
fUniversity of British Columbia (D.B., J.P.W., F.S., M.K.S.H., B.R., T.S.F., N.M., A.R.), Vancouver, British Columbia, Canada.
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J.P. Walsh
bDepartment of Emergency Radiology (J.P.W., N.M.)
fUniversity of British Columbia (D.B., J.P.W., F.S., M.K.S.H., B.R., T.S.F., N.M., A.R.), Vancouver, British Columbia, Canada.
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H. Schmiedeskamp
dSiemens Medical Solutions USA (H.S.), Malvern, Pennsylvania
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F. Settecase
aFrom the Division of Neuroradiology (D.B., F.S., M.K.S.H., A.R.)
fUniversity of British Columbia (D.B., J.P.W., F.S., M.K.S.H., B.R., T.S.F., N.M., A.R.), Vancouver, British Columbia, Canada.
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M.K.S. Heran
aFrom the Division of Neuroradiology (D.B., F.S., M.K.S.H., A.R.)
fUniversity of British Columbia (D.B., J.P.W., F.S., M.K.S.H., B.R., T.S.F., N.M., A.R.), Vancouver, British Columbia, Canada.
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B. Niu
cVancouver Imaging (B.N.), Vancouver General Hospital, Vancouver, British Columbia, Canada
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A.K. Salmeen
eDivision of Neurology (A.K.S., T.S.F.), Department of Medicine, Vancouver Stroke Program, Brain Research Center, University of British Columbia, Vancouver, British Columbia, Canada
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B. Rohr
fUniversity of British Columbia (D.B., J.P.W., F.S., M.K.S.H., B.R., T.S.F., N.M., A.R.), Vancouver, British Columbia, Canada.
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T.S. Field
eDivision of Neurology (A.K.S., T.S.F.), Department of Medicine, Vancouver Stroke Program, Brain Research Center, University of British Columbia, Vancouver, British Columbia, Canada
fUniversity of British Columbia (D.B., J.P.W., F.S., M.K.S.H., B.R., T.S.F., N.M., A.R.), Vancouver, British Columbia, Canada.
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N. Murray
bDepartment of Emergency Radiology (J.P.W., N.M.)
fUniversity of British Columbia (D.B., J.P.W., F.S., M.K.S.H., B.R., T.S.F., N.M., A.R.), Vancouver, British Columbia, Canada.
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A. Rohr
aFrom the Division of Neuroradiology (D.B., F.S., M.K.S.H., A.R.)
fUniversity of British Columbia (D.B., J.P.W., F.S., M.K.S.H., B.R., T.S.F., N.M., A.R.), Vancouver, British Columbia, Canada.
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Abstract

BACKGROUND AND PURPOSE: Brain parenchymal hyperdensity on postthrombectomy CT in patients with acute stroke can be due to hemorrhage and/or contrast staining. We aimed to determine whether iodine concentration within contrast-stained parenchyma compared with an internal reference in the superior sagittal sinus on dual-energy CT could predict subsequent intracerebral hemorrhage.

MATERIALS AND METHODS: Seventy-one patients with small infarct cores (ASPECTS ≥ 7) and good endovascular recanalization (modified TICI 2b or 3) for anterior circulation large-vessel occlusion were included. Brain parenchymal iodine concentration as per dual-energy CT and the percentage of contrast staining relative to the superior sagittal sinus were recorded and correlated with the development of intracerebral hemorrhage using Mann-Whitney U and Fisher exact tests.

RESULTS: Forty-three of 71 patients had parenchymal hyperdensity on initial dual-energy CT. The median relative iodine concentration compared with the superior sagittal sinus was significantly higher in those with subsequent intracerebral hemorrhage (137.9% versus 109.2%, P = .007). By means of receiver operating characteristic analysis, a cutoff value of 100% (iodine concentration relative to the superior sagittal sinus) enabled identification of patients going on to develop intracerebral hemorrhage with 94.75% sensitivity, 43.4% specificity, and a likelihood ratio of 1.71.

CONCLUSIONS: Within our cohort of patients, the relative percentage of iodine concentration at dual-energy CT compared with the superior sagittal sinus was a reliable predictor of intracerebral hemorrhage development and may be a useful imaging biomarker for risk stratification after endovascular treatment.

ABBREVIATIONS:

DECT
dual-energy CT
ICH
intracerebral hemorrhage
SSS
superior sagittal sinus
  • © 2020 by American Journal of Neuroradiology
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American Journal of Neuroradiology: 41 (1)
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D. Byrne, J.P. Walsh, H. Schmiedeskamp, F. Settecase, M.K.S. Heran, B. Niu, A.K. Salmeen, B. Rohr, T.S. Field, N. Murray, A. Rohr
Prediction of Hemorrhage after Successful Recanalization in Patients with Acute Ischemic Stroke: Improved Risk Stratification Using Dual-Energy CT Parenchymal Iodine Concentration Ratio Relative to the Superior Sagittal Sinus
American Journal of Neuroradiology Jan 2020, 41 (1) 64-70; DOI: 10.3174/ajnr.A6345

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Prediction of Hemorrhage after Successful Recanalization in Patients with Acute Ischemic Stroke: Improved Risk Stratification Using Dual-Energy CT Parenchymal Iodine Concentration Ratio Relative to the Superior Sagittal Sinus
D. Byrne, J.P. Walsh, H. Schmiedeskamp, F. Settecase, M.K.S. Heran, B. Niu, A.K. Salmeen, B. Rohr, T.S. Field, N. Murray, A. Rohr
American Journal of Neuroradiology Jan 2020, 41 (1) 64-70; DOI: 10.3174/ajnr.A6345
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Cited By...

  • Correspondence on 'Subarachnoid iodine leakage on dual-energy computed tomography after mechanical thrombectomy is associated with malignant brain edema' by Ogata et al
  • Correspondence on 'Subarachnoid iodine leakage on dual-energy computed tomography after mechanical thrombectomy is associated with malignant brain edema' by Ogata et al
  • Quantitative Intracerebral Iodine Extravasation in Risk Stratification for Intracranial Hemorrhage in Patients with Acute Ischemic Stroke
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