title: Distinction between contrast staining and hemorrhage after endovascular stroke treatment: one CT is not enough.
abstract: BACKGROUND
  Postinterventional cerebral hyperdensities (PCHDs) are a common finding after endovascular stroke treatment. There is uncertainty about the extent to which PCHDs correspond to hemorrhage or contrast staining. Our aim was to evaluate the use of PCHD density on immediate postinterventional CT, and PCHD evolution on follow-up CT for differentiating contrast staining from hemorrhage after endovascular treatment.
  
  
  METHODS
  We retrospectively reviewed the imaging data of 84 patients who underwent endovascular treatment for acute arterial ischemic stroke in the anterior circulation and who received an immediate postinterventional CT, a follow-up CT within 36 h, and a follow-up MRI within 10 days.
  
  
  RESULTS
  PCHDs were seen in 62 of 84 patients in a total of 130 Alberta Stroke Program Early CT Score (ASPECTS) areas. A specificity of 100% to predict hemorrhage was only seen for PCHDs with densities <40 HU (for ruling hemorrhage out) and ≥140 HU (for ruling hemorrhage in), at the cost of a low sensitivity of 1.1% and 2.4%, respectively. Persisting PCHDs correlated with hemorrhage with a specificity of 93.3% and a sensitivity of 62.5%. When follow-up CT was performed at least 19 h after the first CT, persisting PCHDs correlated with hemorrhage with a specificity of 100% and a sensitivity of 62.5%.
  
  
  CONCLUSIONS
  There are no density thresholds for PCHDs that allow predicting the absence or presence of hemorrhage with 100% specificity and acceptable sensitivity. A CT scan performed at least 19-24 h after endovascular therapy is the only reliable method to differentiate contrast staining from hemorrhage.
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, RWTH University Hospital Aachen, Aachen, Germany.|Department of Vascular and Interventional Radiology, University Hospital (UZ) Ghent, Ghent, Belgium.
authors.forename: Sven
authors.identifier: http://orcid.org/0000-0002-7779-5740
authors.initials: S
authors.lastname: Dekeyzer
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, RWTH University Hospital Aachen, Aachen, Germany.|Institute for Neuroscience and Medicine 4, Forschungszentrum Jülich GmbH, Jülich, Germany.
authors.forename: Omid
authors.identifier: http://orcid.org/0000-0002-2055-4217
authors.initials: O
authors.lastname: Nikoubashman
authors.affiliation: Department of Vascular and Interventional Radiology, University Hospital (UZ) Ghent, Ghent, Belgium.
authors.forename: Bart
authors.identifier: http://orcid.org/0000-0001-9366-4532
authors.initials: B
authors.lastname: Lutin
authors.affiliation: Department of Vascular and Interventional Radiology, University Hospital (UZ) Ghent, Ghent, Belgium.
authors.forename: Jeroen
authors.identifier: http://orcid.org/0000-0002-2202-5829
authors.initials: J
authors.lastname: De Groote
authors.affiliation: Department of Neurology, AZ Groeninge, Courtray, Belgium.
authors.forename: Evelien
authors.identifier: http://orcid.org/0000-0002-1841-9315
authors.initials: E
authors.lastname: Vancaester
authors.affiliation: Department of Neurology, AZ Sint-Jan, Bruges, Belgium.
authors.forename: Sofie
authors.identifier: http://orcid.org/0000-0003-0076-9277
authors.initials: S
authors.lastname: De Blauwe
authors.affiliation: Department of Neurology, University Hospital (UZ) Ghent, Ghent, Belgium.
authors.forename: Dimitri
authors.identifier: http://orcid.org/0000-0001-5403-3092
authors.initials: D
authors.lastname: Hemelsoet
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, RWTH University Hospital Aachen, Aachen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Wiesmann
authors.affiliation: Department of Vascular and Interventional Radiology, University Hospital (UZ) Ghent, Ghent, Belgium.
authors.forename: Luc
authors.identifier: http://orcid.org/0000-0001-5814-2798
authors.initials: L
authors.lastname: Defreyne
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016477:Artifacts; D020520:Brain Infarction / Q000000981:diagnostic imaging* / Q000628:therapy*; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging*; D002648:Child; D003287:Contrast Media; D057510:Endovascular Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D017131:Thrombectomy; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult
chemical_list: D003287:Contrast Media
keywords: Stroke