The Journal of Practical Medicine >

2025 , Vol. 41 >Issue 21: 3449 - 3454

DOI: https://doi.org/10.3969/j.issn.1006-5725.2025.21.022

Medical Examination and Clinical Diagnosis

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 TAN ,
  • Zhongyi KONG ,
  • Ximing CAO ,
  • Zhenbang WANG ,
  • Junhui ZHENG ,
  • Wei. LUO
Expand
  • *.Department of Radiology，Guangdong Provincial People's Hospital Affiliated to Southern Medical University （Guangdong Academy of Medical Sciences），Guangzhou 518000，Guangdong，China

Received date: 2025-07-09

  Online published: 2025-11-13

Fold

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

Cite this article

Yun TAN , Zhongyi KONG , Ximing CAO , Zhenbang WANG , Junhui ZHENG , Wei. LUO . 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[J]. The Journal of Practical Medicine, 2025 , 41(21) : 3449 -3454 . DOI: 10.3969/j.issn.1006-5725.2025.21.022

References

[1] WANG R， WANG M， YE J， et al. Mechanism overview and target mining of atherosclerosis： Endothelial cell injury in atherosclerosis is regulated by glycolysis （Review）［J］. Int J Mol Med， 2020， 47（1）：65-76. doi:10.3892/ijmm.2020.4798
[2] GBD 2019 Stroke Collaborators. Global， regional， and national burden of stroke and its risk factors， 1990-2019： A systematic analysis for the Global Burden of Disease Study 2019［J］. Lancet Neurol， 2021， 20（10）：795-820.
[3] 中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组，中华医学会神经病学分会神经血管介入协作组. 中国急性缺血性卒中早期血管内介入诊疗指南2022 ［J］. 中华神经科杂志， 2022， 55（6）：565-580.
[4] OZDEMIR G， EREN F， AYGUL R，et al. Endovascular treatment for anterior cerebral artery occlusions［J］. Interv Neuroradiol， 2024， 30（4）：571-578. doi:10.1177/15910199231162669
[5] FRANSEN P S， BEUMER D， BERKHEMER O A， et al. MR CLEAN， a multicenter randomized clinical trial of endovascular treatment for acute ischemic stroke in the Netherlands： Study protocol for a randomized controlled trial［J］. Trials， 2014， 15（1）： 343. doi:10.1186/1745-6215-15-343
[6] ZAOUAK Y， SADEGHI N， SARBU N， et al. Differentiation between cerebral hemorrhage and contrast extravasation using dual energy computed tomography after intra-arterial neurointerventional procedures［J］. J Biomed Sci Res， 2020， 3（1）： 1-8. doi:10.5334/jbsr.2083
[7] 梁百晖，杨文，刘岘，等. 双层探测器光谱CT对直肠腺癌转移淋巴结的诊断价值［J］. 实用医学杂志， 2023， 39（3）：374-380. doi:10.3969/j.issn.1006-5725.2023.03.020
[8] 贾萍，王晓明. 双层探测器光谱CT在头颈部血管相关疾病中的研究进展［J］. 中国医学影像学杂志， 2021，29（10）：1052-1055.
[9] 赵宝连，涂文婷，范丽，等. 双层探测器光谱CT在头颈部疾病中的研究进展［J］. 国际医学放射学杂志， 2023， 46（1）： 90-94 .
[10] 丁伟莉，王天宇，陈青，等. 急性缺血性卒中血管内介入治疗术后即刻及24 h双能CT检查对脑出血转化评估的作用［J］. 中国脑血管病杂志， 2023， 20（4）：223-229.
[11] 牛剑飞，王灵杰，石彩云，等. 双能CT定量参数鉴别颈动脉自发性壁内血肿及动脉粥样硬化的价值［J］. 实用放射学杂志， 2023，39（2）：195-198.
[12] LLOYD M. A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke［J］. J Emerg Med， 2015， 48（4）：521. doi:10.1016/j.jemermed.2015.02.026
[13] VENEMA E， BOODT N， BERKHEMER O A， et al. Workflow and factors associated with delay in the delivery of intra-arterial treatment for acute ischemic stroke in the MR CLEAN trial［J］. J Neuro Interl Surg， 2017， 10（5）： 424-428. doi:10.1136/neurintsurg-2017-013198
[14] MENG X， LI F， WU W， et al. Diagnostic value of carotid plaque assessment with AIS based on quantitative parameters of dual-layer detector spectral CT［J］. Int J General Med， 2024， 17： 1263-1272. doi:10.2147/ijgm.s448852
[15] 郭爽，李清，吴芳，等. 双能CT在急性缺血性卒中血管内治疗术后早期脑出血与碘对比剂外渗鉴别诊断中的应用［J］. 首都医科大学学报， 2018， 39（2）：173-177.
[16] ALUDIN S， SCHMILL L P， LANGGUTH P， et al. Spectral imaging and analysis of monophasic CT angiography to assess infarct core and penumbra in acute stroke［J］. Sci Rep， 2024， 14（1） ：28397. doi:10.1038/s41598-024-78789-2
[17] 杨志安，闵小红，徐俏宇，等. 能谱CT虚拟平扫及水基图定量参数在诊断颅脑血管内治疗术后颅内出血的研究 ［J］. 临床放射学杂志， 2024， 43（6）： 872-877.
[18] GULKO E， ALI S， GOMES W， et al. Differentiation of hemorrhage from contrast enhancement using dual-layer spectral CT in patients transferred for acute stroke［J］. Clin Imag， 2020， 69： 75-78. doi:10.1016/j.clinimag.2020.06.046
[19] BERNSEN M L E， VEENDRICK P B， MARTENS J M， et al. Initial experience with dual-layer detector spectral CT for diagnosis of blood or contrast after endovascular treatment for ischemic stroke［J］. Neuroradiol， 2022， 64（1）： 69-76. doi:10.1007/s00234-021-02736-5
[20] 郑思捷，向佳，陈茜彤，等. 宽体能谱CT参数在鉴别诊断肺癌纵隔转移，非转移淋巴结与反应性增生淋巴结中的价值［J］.实用医学杂志， 2024， 40（14）：2003-2008.
[21] RIEDERER I， FINGERLE A A， ZIMMER C， et al. Potential of dual-layer spectral CT for the differentiation between hemorrhage and iodinated contrast medium in the brain after endovascular treatment of ischemic stroke patients［J］. Clin Imaging， 2021， 79： 158-164. doi:10.1016/j.clinimag.2021.04.020
Options
Outlines

/

〈 〉