title: Intraparenchymal Hyperattenuations on Flat-Panel CT Directly After Mechanical Thrombectomy are Restricted to the Initial Infarct Core on Diffusion-Weighted Imaging.
abstract: OBJECTIVE
  The presence of intraparenchymal hyperattenuations (IPH) on flat-panel computed tomography (FP-CT) after endovascular recanalization in stroke patients is a common phenomenon. They are thought to occur in ischemic areas with breakdown of the blood-brain barrier but previous studies that investigated a mutual interaction are scarce. We aimed to assess the relationship of IPH localization with prethrombectomy diffusion-weighted imaging (DWI) lesions.
  
  
  METHODS
  This retrospective multicenter study included 27 acute stroke patients who underwent DWI prior to FP-CT following mechanical thrombectomy. After software-based coregistration of DWI and FP-CT, lesion volumetry was conducted and overlapping was analyzed.
  
  
  RESULTS
  Two different patterns were observed: IPH corresponding to the DWI lesion and IPH exceeding the DWI lesion. The latter showed demarcated infarction of DWI exceeding IPH at 24 h. No major hemorrhage following IPH was observed. Most IPH were manifested within the basal ganglia and insular cortex.
  
  
  CONCLUSIONS
  The IPH primarily appeared within the initial ischemic core and secondarily within the penumbral tissue that progressed to infarction. The IPH represent the minimum final infarct volume, which may help in periinterventional decision making.
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Haus O22, 20246, Hamburg, Germany. tan.schneider@uke.de.
authors.forename: Tanja
authors.identifier: http://orcid.org/0000-0002-3767-5963
authors.initials: T
authors.lastname: Schneider
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Haus O22, 20246, Hamburg, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Mahraun
authors.affiliation: Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Julian
authors.initials: J
authors.lastname: Schroeder
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Haus O22, 20246, Hamburg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Frölich
authors.affiliation: Department of Neuroradiology, University Clinic Erlangen, Erlangen, Germany.
authors.forename: Philip
authors.initials: P
authors.lastname: Hoelter
authors.affiliation: Institute of Neuroradiology, Goethe University Hospital, Frankfurt, Germany.
authors.forename: Marlies
authors.initials: M
authors.lastname: Wagner
authors.affiliation: Départment de Neuroradiologie diagnostique et thérapeutique, University Hospital of Purpan, Toulouse, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Darcourt
authors.affiliation: Départment de Neuroradiologie diagnostique et thérapeutique, University Hospital of Purpan, Toulouse, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Cognard
authors.affiliation: Départment de Neuroradiologie, Hospitalier Universitaire Gui de Chauliac, Montpellier, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Bonafé
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Haus O22, 20246, Hamburg, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Fiehler
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Haus O22, 20246, Hamburg, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Siemonsen
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Haus O22, 20246, Hamburg, Germany.
authors.forename: Jan-Hendrik
authors.initials: JH
authors.lastname: Buhk
mesh_terms: D002545:Brain Ischemia / Q000000981:diagnostic imaging; D038524:Diffusion Magnetic Resonance Imaging; D006801:Humans; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis / Q000628:therapy*; D017131:Thrombectomy; D014057:Tomography, X-Ray Computed
keywords: Computed tomography angiography; Contrast media; Diffusion weighted imaging; Extravasation; Stroke; Thrombectomy