title: Dual-energy CT immediately after endovascular stroke intervention: prognostic implications.
abstract: OBJECTIVE
  Posttreatment intracerebral hemorrhage (ICH) after recanalization therapy of acute ischemic stroke increases morbidity and mortality. Dual-energy (DE) computed tomography (CT) allows differentiation of blood-brain barrier disruption (BBBD) and ICH. We evaluated the incidence of ICH and BBBD immediately after endovascular recanalization therapy, the correlation between BBBD and final infarction or ICH size, and the prognostic value of postinterventional BBBD.
  
  
  METHODS
  Imaging data sets (pretreatment CT, posttreatment DE-CT, and follow-up imaging by CT and/or magnetic resonance imaging) of 60 consecutive patients after endovascular recanalization therapy of acute ischemic stroke were retrospectively analyzed. After material differentiation, areas of increase attenuation in posttreatment DE-CT were correlated to ICH and infarction in follow-up imaging.
  
  
  RESULTS
  Areas of hyperattenuation were observed in 80.0 % (48 of 60) of all posttreatment CT. In 10.4 % (5 of 48) of these, hyperattenuating areas matched the hyperdensities on virtual nonenhanced CT and were rated as hemorrhage. The remaining 89.6 % (43 of 48) of scans with hyperattenuating areas demonstrated hyperdensities exclusively on iodine-only images and were rated as BBBD. All suspected ICH on DE-CT were proven in follow-up imaging. There were no false-positive or false-negative findings of ICH in DE-CT. In 98.3 % (59 of 60) of cases, at least small ischemic infarctions were identified in follow-up imaging. No correlation between the extent of BBBD and the final infarct size and/or early ICH size was found.
  
  
  CONCLUSIONS
  BBBD is a frequent finding after endovascular revascularization therapy. DE-CT allows for a reliable differentiation between frequent BBBD and rare ICH immediately after endovascular recanalization therapy.
authors: Institute of Diagnostic and Interventional Radiology, Neuroradiology and Nuclear Medicine, Klinikum Muenchen-Harlaching, Sanatoriumsplatz 2, 81545, Munich, Germany, morhard@nrad.de.
authors: D
authors: D
authors: Morhard
authors: L
authors: L
authors: Ertl
authors: W
authors: W
authors: Gerdsmeier-Petz
authors: B
authors: B
authors: Ertl-Wagner
authors: G
authors: G
authors: Schulte-Altedorneburg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001812:Blood-Brain Barrier / Q000000981:diagnostic imaging; D002543:Cerebral Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods*