Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/33031
Title: Occult contrast retention post-thrombectomy on 24-hour follow-up Dual Energy CT: associations and impact on imaging analysis.
Austin Authors: Pham, Jenny;Gan, Calvin;Dabboucy, Jasmin;Stella, Damien;Dowling, Richard;Yan, Bernard;Bush, Stephen;Williams, Cameron;Mitchell, Peter;Desmond, Patricia;Thijs, Vincent N ;Asadi, Hamed ;Brooks, Mark;Maingard, Julian;Jhamb, Ash;Pavlin-Premrl, Davor;Campbell, Bruce;Ng, Felix Chun Fai
Affiliation: Department of Neurology, Royal Melbourne Hospital, Parkville, Australia
Department of Radiology, Royal Melbourne Hospital, Parkville, Australia.
Neurology
Radiology
University of Melbourne, Parkville, Australia.
The Florey Institute of Neuroscience and Mental Health
Melbourne Brain Centre, Department of Medicine at Royal Melbourne Hospital, University of Melbourne, Australia.
Issue Date: Dec-2023
Date: 2023
Publication information: International Journal of Stroke : official journal of the International Stroke Society 2023; 18(10)
Abstract: BackgroundFollowing reperfusion treatment in ischemic stroke, CT imaging at 24-hours is widely used to assess radiological outcomes. Even without visible hyperattenuation, occult angiographic contrast may persist in the brain and confound Hounsfield Unit-based imaging metrics such as Net Water Uptake (NWU).AimsWe aimed to assess the presence and factors associated with retained contrast post-thrombectomy on 24-hour imaging using Dual Energy CT (DECT), and its impact on the accuracy of NWU as a measure of cerebral edema.MethodsConsecutive patients with anterior circulation large vessel occlusion who had post-thrombectomy DECT performed 24-hours post-treatment from two thrombectomy stroke centers were retrospectively studied. NWU was calculated by interside comparison of Hounsfield Units of the infarct lesion and its mirror homolog. Retained contrast was quantified by the difference in NWU values with and without adjustment for iodine. Patients with visible hyperdensities from hemorrhagic transformation or visible contrast retention, and bilateral infarcts were excluded. Cerebral edema was measured by relative hemispheric volume (rHV) and midline shift (MLS).ResultsOf 125 patients analyzed (median age 71 [IQR 61-80], baseline NIHSS 16 [IQR 9.75-21]), reperfusion (defined as extended-Thrombolysis-In-Cerebral-Infarction 2b-3) was achieved in 113 patients (90.4%). Iodine-subtracted NWU was significantly higher than unadjusted NWU (17.1% vs 10.8%, p<0.001). In multivariable median regression analysis, increased age (p=0.024), number of passes (p=0.006), final infarct volume (p=0.023) and study site (p=0.021) were independently associated with amount of retained contrast. Iodine-subtracted NWU correlated with rHV (rho=0.154, p=0.043) and MLS (rho=0.165, p=0.033) but unadjusted NWU did not (rHV rho=-0.035, p=0.35; MLS rho=0.035, p=0.347).ConclusionsAngiographic iodine contrast is retained in brain parenchyma 24-hours post-thrombectomy, even without visually obvious hyperdensities on CT, and significantly affects NWU measurements. Adjustment for retained iodine using DECT is required for accurate NWU measurements post-thrombectomy. Future quantitative studies analyzing CT after thrombectomy should consider occult contrast retention.
URI: https://ahro.austin.org.au/austinjspui/handle/1/33031
DOI: 10.1177/17474930231182018
ORCID: 0000-0003-2943-8869
0000-0001-7219-7779
0000-0003-3632-9433
0000-0001-6973-8677
Journal: International Journal of Stroke : official journal of the International Stroke Society
Start page: 17474930231182018
PubMed URL: 37260232
ISSN: 1747-4949
Type: Journal Article
Subjects: Cerebral Infarction
Dual-Energy CT
Edema
Ischaemic stroke
Net Water Uptake
Thrombectomy
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