The Journal of Practical Medicine ›› 2025, Vol. 41 ›› Issue (21): 3449-3454.doi: 10.3969/j.issn.1006-5725.2025.21.022

• Medical Examination and Clinical Diagnosis • Previous Articles    

Diagnostic efficacy of spectral CT virtual non⁃contrast imaging combined with iodine mapping for differentiating early postoperative intracerebral hemorrhage from contrast extravasation after endovascular therapy

Yun TAN1,Zhongyi KONG2,Ximing CAO1,Zhenbang WANG1,Junhui ZHENG1,Wei. LUO1   

  1. *.Department of Radiology，Guangdong Provincial People's Hospital Affiliated to Southern Medical University （Guangdong Academy of Medical Sciences），Guangzhou 518000，Guangdong，China
  • Received:2025-07-09 Online:2025-11-10 Published:2025-11-13

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Abstract:

Objective To evaluate the diagnostic value of dual?layer spectral CT （DLCT） virtual non?contrast （VNC） imaging combined with iodine maps in differentiating early post?endovascular therapy （EVT） intracranial hemorrhage from contrast extravasation. Methods Retrospective analysis of 97 patients who underwent DLCT immediately after EVT was conducted. Taking 24?hour follow?up CT/MRI as the gold standard， patients were divided into hemorrhage and non?hemorrhage groups， and their clinical data were compared. VNC CT values and iodine concentration （IC） were measured. Spearman's rank correlation was used to analyze the relationship between VNC CT and IC values， and ROC curve analysis using R software to evaluate the diagnostic performance of VNC， iodine maps， and their combination. Results Among 97 patients， 51 （52.6%） showed no intracranial hyperdense lesions， while 46 （47.4%） with abnormal densities were analyzed. Using 24?hour postoperative CT/MRI as reference standard， among the 46 patients ultimately included in the analysis， 38 cases （82.6%） were non?hemorrhagic and 8 cases （17.4%） hemorrhagic. No significant differences existed in age， sex， or treatment methods （all P > 0.05）. VNC CT values and IC showed significantly negative correlation （r = -0.537， P < 0.01）. ROC analysis revealed AUCs of 0.917 （95%CI： 0.786 ~ 0.999） for VNC， 0.878 （95%CI： 0.719 ~ 0.999） for IC， and 0.919 （95%CI： 0.812 ~ 0.999） for the combination of the two （P < 0.05 for combined vs. individual methods）. Optimal thresholds were 53.6 HU for VNC and 0.605 mg/ml for IC. Based on the final analysis of 46 enrolled patients， the sensitivity of VNC， iodine map， and their combination in differentiating early cerebral hemorrhage from contrast extravasation was 88.9%， 94.3%， and 91.4%， respectively； the specificity 94.3%， 77.8%， and 88.9%， respectively； and the accuracy 90.9%， 90.9%， and 93.2%， respectively. Conclusion The DLCT VNC?iodine map combination significantly improves differentiation between post?EVT hemorrhage and contrast extravasation， and it is recommended for routine clinical application.

Key words: dual-layer spectral CT, endovascular therapy, virtual non-contrast, iodine density map

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