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

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.

Keywords: Brain ischemia; Hemorrhage; Stroke; Thrombosis; Tomography, X-ray computed.

Conflict of interest statement

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Figures

Fig. 1
Fig. 1
Brain window (a, d), virtual non-contrast (b, e), and iodine map (c, f) series. The upper row shows a hyperdense area in the left basal ganglia on the brain window and iodine map, but not in the virtual non-contrast series, representing contrast staining; the lower row shows a hyperdense area in the right insular cortex of the brain window and the iodine map series, which is only partly hyperdense in the virtual non-contrast series (arrow), representing both contrast staining and hemorrhage
Fig. 2
Fig. 2
Brain window (a, e), virtual non-contrast (b, f), edema map (c, g), and follow-up (d, h) brain window series. The upper row shows no infarction demarcation in the brain window or the virtual non-contrast series, but a clear demarcation on the edema map (arrows), corresponding to the follow-up series; the lower row shows only a slight infarction demarcation in the left basal ganglia on the brain window and the virtual non-contrast series, but a clear demarcation on the edema map (arrows), corresponding to the follow-up series
Fig. 3
Fig. 3
Brain window (a, d), iodine map (b, e), and diffusion-weighted follow-up MRI (c, f) series. The upper row shows a slight iodine staining in both thalami and the right occipital lobe on the brain window and the iodine map series, with no future infarction; the lower row shows more pronounced iodine staining in both thalami and the right upper cerebellum, with later infarction development
Fig. 4
Fig. 4
Conventional angiography (a), brain window (b), and virtual non-contrast (c). A residual clot of the M2 part of the right middle cerebral artery known from the final angiography series after thrombectomy, seen as hyperdense dots on the brain window and the virtual non-contrast series (circles)

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