Clinical Applications of Dual‐Energy Computed Tomography for Acute Ischemic Stroke

 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

Huanwen Chen,

Uttam K. Bodanapally,

Marco Colasurdo,

Ajay Malhotra and

Dheeraj Gandhi

Originally published19 Feb 2024https://doi.org/10.1161/SVIN.123.001193Stroke: Vascular and Interventional Neurology. 2024;4:e001193

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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.

Subarachnoid iodine leakage on dual-energy computed tomography after mechanical thrombectomy is associated with malignant brain edema

Sounds like your competent? doctor needs to create a testing protocol for this and then an intervention to prevent this edema from happening! At least leaders in stroke would do that. IS YOUR DOCTOR A LEADER?  Or a mouse?

Subarachnoid iodine leakage on dual-energy computed tomography after mechanical thrombectomy is associated with malignant brain edema

1. http://orcid.org/0000-0002-4478-0251Atsushi Ogata1,
2. Kuniaki Ogasawara2,
3. Masashi Nishihara3,
4. Ayako Takamori4,
5. Takashi Furukawa1,
6. Toshihiro Ide5,
7. Hiroshi Ito1,
8. Fumitaka Yoshioka1,
9. Yukiko Nakahara1,
10. Jun Masuoka1,
11. Haruki Koike5,
12. Hiroyuki Irie3,
13. Tatsuya Abe1

1. Correspondence to Dr Atsushi Ogata, Department of Neurosurgery, Saga University, Saga, 849-8501, Japan; ogata.a24@gmail.com

Abstract

Background Dual-energy computed tomography (DE-CT) can differentiate between hemorrhage and iodine contrast medium leakage following mechanical thrombectomy (MT) for acute ischemic stroke (AIS). We determined whether subarachnoid hemorrhage (SAH) and subarachnoid iodine leakage (SAIL) on DE-CT following MT were associated with malignant brain edema (MBE).

Methods We analyzed the medical records of 81 consecutive anterior circulation AIS patients who underwent MT. SAH or SAIL was diagnosed via DE-CT performed immediately after MT. We compared the procedural data, infarct volumes, MBE, and modified Rankin scale 0–2 at 90 days between patients with and without SAH and between patients with and without SAIL. Furthermore, we evaluated the association between patient characteristics and MBE.

Results A total of 20 (25%) patients had SAH and 51 (63%) had SAIL. No difference in diffusion-weighted imaging (DWI)-infarct volume before MT was observed between patients with and without SAH or patients with and without SAIL. However, patients with SAIL had larger DWI-infarct volumes 1 day following MT than patients without SAIL (95 mL vs 29 mL; p=0.003). MBE occurred in 12 of 81 patients (15%); more patients with SAIL had MBE than patients without SAIL (22% vs 3%; p=0.027). Severe SAIL was significantly associated with MBE (OR, 12.5; 95% CI, 1.20–131; p=0.006), whereas SAH was not associated with MBE.

Conclusion This study demonstrated that SAIL on DE-CT immediately after MT was associated with infarct volume expansion and MBE.

Data availability statement

Data sharing not applicable as no datasets generated and/or analyzed for this study.

https://doi.org/10.1136/jnis-2023-021413

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.

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