Does your competent hospital even know of this research? What do they plan on doing with it to get survivors recovered? NOTHING? Like usual?
Clinical Applications of Dual‐Energy Computed Tomography for Acute Ischemic Stroke
Abstract
Acute ischemic stroke is a leading cause for neurological disability worldwide, and treatment strategies are rapidly evolving. Patient selection for recanalization therapy and postintervention management relies heavily on diagnostic imaging. In this narrative review, we searched the existing literature for clinical applications of dual‐energy computed tomography for acute ischemic stroke. We summarized the current clinical evidence on the use of dual‐energy computed tomography for identifying early cerebral ischemia, detecting and predicting hemorrhagic transformations, and characterizing clots and stenotic plaques. We also highlight future opportunities for dual‐energy computed tomography to be used to address important diagnostic challenges during acute stroke triage and postintervention management. Dual‐energy computed tomography is a powerful tool that can be used to improve the diagnostic accuracy of ischemia, hemorrhage, and vascular lesions in the context of acute ischemic stroke.
Nonstandard Abbreviations and Acronyms
| AIS | acute ischemic stroke |
| ANGEL‐ASPECT | Endovascular Therapy in Acute Anterior Circulation Large Vessel Occlusive Patients With a Large Infarct Core |
| BBB | blood–brain barrier |
| DECT | dual‐energy computed tomography |
| DE‐CTA | dual‐energy computed tomography angiography |
| EVT | endovascular thrombectomy |
| ICH | intracranial hemorrhage |
| keV | kilo‐electron volts |
| VMI | virtual monoenergetic image |
| VNC | virtual noncontrast |
Clinical Perspective
Dual‐energy computed tomography is a powerful tool that allows for material decomposition and generation of virtual monoenergetic images.
Processed dual‐energy computed tomography images can improve identification of early stroke, detection and prediction of hemorrhage, and characterization of stenotic vascular lesions.
Acute ischemic stroke (AIS) is a leading cause of neurological disability worldwide, and its incidence is on the rise with the global population aging.1 Clinical care for AIS has evolved over the past 3 decades, and, recently, endovascular thrombectomy (EVT) has emerged as a powerful treatment for AIS due to large‐vessel occlusions and has become standard of care for select patients.2, 3 Currently, patient selection for acute stroke therapy relies heavily on diagnostic imaging to promptly rule out hemorrhage and identify infarcted or at‐risk tissue. Neuroimaging also plays a critical role after acute AIS treatment, particularly for prevention and management of hemorrhagic transformations. While much work has been done to leverage imaging techniques to better characterize ischemic tissue during acute stroke triage and manage hemorrhage following treatment, many patients still do poorly,4 signaling a need for better diagnostic and predictive tools to further optimize patient triage and management.
Dual‐energy computed tomography (DECT) is a unique tool that allows for material decomposition on the basis of their differences in the change of x‐ray attenuation from one energy level to another.5 In addition, DECT images can also be reconstructed into virtual monoenergetic images (VMIs), which may improve iodine attenuation and suppress artifacts.6 Clinical availability of DECT is rapidly expanding, with a survey of chest radiologists showing that DECT is available in up to 75% of academic institutions worldwide.7 In this review, we summarize the current clinical data on the use of DECT to identify and predict hemorrhage, assess blood–brain barrier (BBB) and endothelial damage, identify strokes, and characterize stroke clots and carotid plaques. We also highlight current knowledge gaps in stroke medicine that could be addressed by DECT in future research.
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