Deans' stroke musings: Dual-energy computed tomography in acute ischemic stroke: state-of-the-art

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, December 15, 2020

Dual-energy computed tomography in acute ischemic stroke: state-of-the-art

Lots of big words and gobbledegook but I see nothing that even remotely suggests that anything here will get survivors better recovery. THAT IS THE WHOLE POINT OF STROKE RESEARCH, ISN'T IT? 100% RECOVERY?

Dual-energy computed tomography in acute ischemic stroke: state-of-the-art

Stephanie Mangesius,
Tanja Janjic,
Ruth Steiger,
Lukas Haider,
Rafael Rehwald,
Michael Knoflach,
Gerlig Widmann,
Elke Gizewski &
Astrid Grams

European Radiology (2020)Cite this article

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Abstract

Dual-energy computed tomography (DECT) allows distinguishing between tissues with similar X-ray attenuation but different atomic numbers. Recent studies demonstrated that this technique has several areas of application in patients with ischemic stroke and a potential impact on patient management. After endovascular stroke therapy (EST), hyperdense areas can represent either hemorrhage or contrast staining due to blood-brain barrier disruption, which can be differentiated reliably by DECT. Further applications are improved visualization of early infarctions, compared to single-energy computed tomography, and prediction of transformation into infarction or hemorrhage in contrast-enhancing areas. In addition, DECT allows detection and evaluation of the material composition of intra-arterial clots after EST. This review summarizes the clinical state-of-the-art of DECT in patients with stroke, and features some prospects for future developments.

Key points

• Dual-energy computed tomography (DECT) allows differentiation between tissues with similar X-ray attenuation but differentatomic numbers.

• DECT has several areas of application in patients with ischemic stroke and a potential impact on patient management.

• Prospects for future developments in DECT may improve treatment decision-making.

Introduction

The benefit of dual-energy computed tomography (DECT) compared to single-energy computed tomography (SECT) in acute ischemic stroke has been documented in several studies [1,2,3,4,5]. DECT reliably differentiates between tissues with similar X-ray attenuation but different compositions, with regard to atomic numbers [6], and further extrapolates virtual monochromatic series of a certain tube voltage [7].

Initially, DECT was designed for coronary imaging, as it provides not only visualization of stenosis but also high accuracy for the detection and characterization of coronary plaques [8,9,10].

For neuroradiological applications [6, 7, 11,12,13,14,15,16,17], four major different DECT techniques are available: (1) dual-source X-ray tubes with different tube voltages, 80–100 kV and 140 kV, performing simultaneously (Siemens); (2) single-source rapid voltage switching between two tube voltages (GE); (3) a single-source split beam, where the X-ray beam is split into two different energy spectra that differ in table feel direction (Siemens); and (4) a dual-layer detector with simultaneous data acquisition of the low- and high-energy dataset (Phillips) [6, 18, 19].

To date, there are only two published review articles that describe the application of DECT in cerebral or cerebrovascular diseases from 2015 and 2016 [18, 20] and one on emergency neuroimaging from 2016 [21]. Recently published studies on the application of DECT in acute ischemic stroke have not yet been recapitulated. The aim of this literature review is to provide an overview of the clinical state-of-the-art of this rapidly evolving technology.