Figure 2 - uploaded by Tianyu Wang
Content may be subject to copyright.
Diagnosis flowchart of delayed hemorrhagic transformation (HT) immediately and 24 h after endovascular thrombectomy (EVT). a: Delayed HT was diagnosed with reexamination in patients with no HT. CS, contrast staining; PCHDs, post-interventional cerebral hyperdensities.
Source publication
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...
Contexts in source publication
Context 1
... addition, whether immediately or 24 h after EVT, the inter-reader agreement of DECT Using NCCT 2-7 days after EVT, 113 HT and 119 non-HT cases were diagnosed ( Table 2). The diagnosis of HT based on DECT both immediately and 24 h after EVT was correct, whereas delayed HT occurred in 73 (71 CS and 2 non-PCHD) and 15 (14 CS and 1 non-PCHD) non-HT cases diagnosed using DECT immediately and 24 h post-EVT, respectively ( Figure 2). Combined with these results, the sensitivity, specificity, PPV, NPV, and accuracy of DECT performed immediately after EVT in predicting the final diagnosis of HT at 2-7 days were 33.6% (25.4-42.9%), ...
Context 2
... addition, whether immediately or 24 h after EVT, the inter-reader agreement of DECT Using NCCT 2-7 days after EVT, 113 HT and 119 non-HT cases were diagnosed ( Table 2). The diagnosis of HT based on DECT both immediately and 24 h after EVT was correct, whereas delayed HT occurred in 73 (71 CS and 2 non-PCHD) and 15 (14 CS and 1 non-PCHD) non-HT cases diagnosed using DECT immediately and 24 h post-EVT, respectively ( Figure 2). Combined with these results, the sensitivity, specificity, PPV, NPV, and accuracy of DECT performed immediately after EVT in predicting the final diagnosis of HT at 2-7 days were 33.6% (25.4-42.9%), ...
Similar publications
Since the publication of the landmark thrombectomy trials in 2015, the field of endovascular therapy for ischemic stroke has been rapidly growing. The very low number needed to treat to provide functional benefits shown by the initial randomized trials has led clinicians and investigators to seek to translate the benefits of endovascular therapy to...
Citations
Blood-brain barrier (BBB) disruption is an important pathological change after cerebral infarction that exacerbates brain injury. We aimed to investigate and compare the predictive utility of pre-treatment BBB permeability (BBBP) and BBBP within 1 h after endovascular treatment (EVT) for hemorrhagic transformation (HT) and 90-day prognosis.
Patients underwent preoperative computed tomography perfusion (CTP) and non-contrast CT (NCCT) within 1 h after EVT. Preoperative BBBP was determined by the relative permeability surface area product (rPS) in the hypoperfusion area. Postoperative BBBP was determined by the post-EVT Alberta Stroke Program Early CT Score (Post-ASPECTS), which is based on brain parenchymal hyperdensity on the postoperative NCCT.
We included 100 patients. Univariate logistic regression analysis revealed correlations of preoperative rPS with HT, poor outcomes, and death. However, these correlations were not observed in multivariate logistic regression. A Post-ASPECTS ≤7 and could independently predict poor outcomes, while Post-ASPECTS ≤6 could independently predict death and HT. The baseline National Institutes of Health Stroke Scale (NIHSS) score could independently predict poor outcomes and death but not HT. A combined model using the baseline NIHSS and Post-ASPECTS scores had better predictive performance for poor outcomes and death than baseline NIHSS score alone; however, it was not superior to the predictive performance of the Post-ASPECTS score.
The preoperative rPS cannot independently predict clinical outcomes in EVT-treated patients; contrastingly, the Post-ASPECTS score could independently predict poor outcomes, death, and HT. This parameter could inform prompt postoperative treatment decisions.
Acute ischemic stroke is a leading cause for neurological disability worldwide, and treatment strategies are rapidly evolving. Patient selection for recanalization therapy and postintervention management relies heavily on diagnostic imaging. In this narrative review, we searched the existing literature for clinical applications of dual‐energy computed tomography for acute ischemic stroke. We summarized the current clinical evidence on the use of dual‐energy computed tomography for identifying early cerebral ischemia, detecting and predicting hemorrhagic transformations, and characterizing clots and stenotic plaques. We also highlight future opportunities for dual‐energy computed tomography to be used to address important diagnostic challenges during acute stroke triage and postintervention management. Dual‐energy computed tomography is a powerful tool that can be used to improve the diagnostic accuracy of ischemia, hemorrhage, and vascular lesions in the context of acute ischemic stroke.
