title: Dual-energy CT in the evaluation of intracerebral hemorrhage of unknown origin: differentiation between tumor bleeding and pure hemorrhage.
abstract: OBJECTIVE
  Detection of underlying tumor in patients with unknown-origin acute ICH may be difficult because acute hematoma may mask enhancement of tumor on postcontrast CT. We intended to investigate the clinical utility of DECT in differentiating tumor bleeding from pure ICH.
  
  
  METHODS
  Using a dual-source CT scanner, we obtained TNC single-energy and postcontrast DECT scans for 56 patients with unknown-origin spontaneous ICH. From the 2 sets of postcontrast DECT images obtained with different tube energy, EA (equivalent to conventional postcontrast CT), VNC, color-coded iodine overlay, fusion images of iodine overlay and VNC images were produced. The diagnostic performances of fusion, EA, and combined EA and TNC images for detecting underlying tumors were compared.
  
  
  RESULTS
  Of the 56 patients, 17 had primary or metastatic tumors (18 lesions) and 39 had nontumorous ICH. The sensitivities of fusion, EA, and combined EA and TNC images for detecting brain tumors were 94.4%, 61.1%, and 66.7%, respectively, and their specificities were 97.4%, 92.3%, and 89.7%, respectively. The areas under the ROC curves were 0.964, 0.786, and 0.842, respectively. Overall, the diagnostic performance of fusion images was significantly superior to EA (P = .006) and combined EA and TNC (P = .011) images.
  
  
  CONCLUSIONS
  DECT may be useful in detecting underlying tumors in patients with unknown-origin ICH.
authors.affiliation: Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. sjkimjb@amc.seoul.kr
authors.forename: S J
authors.initials: SJ
authors.lastname: Kim
authors.forename: H K
authors.initials: HK
authors.lastname: Lim
authors.forename: H Y
authors.initials: HY
authors.lastname: Lee
authors.forename: C G
authors.initials: CG
authors.lastname: Choi
authors.forename: D H
authors.initials: DH
authors.lastname: Lee
authors.forename: D C
authors.initials: DC
authors.lastname: Suh
authors.forename: S M
authors.initials: SM
authors.lastname: Kim
authors.forename: J K
authors.initials: JK
authors.lastname: Kim
authors.forename: B
authors.initials: B
authors.lastname: Krauss
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging*; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015900:Radiography, Dual-Energy Scanned Projection / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult