Article Text

PDF

Original research
Distinction between contrast staining and hemorrhage after endovascular stroke treatment: one CT is not enough
  1. Sven Dekeyzer1,2,
  2. Omid Nikoubashman1,3,
  3. Bart Lutin2,
  4. Jeroen De Groote2,
  5. Evelien Vancaester4,
  6. Sofie De Blauwe5,
  7. Dimitri Hemelsoet6,
  8. Martin Wiesmann1,
  9. Luc Defreyne2
  1. 1Department of Diagnostic and Interventional Neuroradiology, RWTH University Hospital Aachen, Aachen, Germany
  2. 2Department of Vascular and Interventional Radiology, University Hospital (UZ) Ghent, Ghent, Belgium
  3. 3Institute for Neuroscience and Medicine 4, Forschungszentrum Jülich GmbH, Jülich, Germany
  4. 4Department of Neurology, AZ Groeninge, Courtray, Belgium
  5. 5Department of Neurology, AZ Sint-Jan, Bruges, Belgium
  6. 6Department of Neurology, University Hospital (UZ) Ghent, Ghent, Belgium
  1. Correspondence to Dr Sven Dekeyzer, Klinik für Neuroradiologie, Universitätsklinikum Aachen, Pauwelsstr. 30, Aachen 52074, Germany; sven.dekeyzer{at}gmail.com

Abstract

Background Postinterventional cerebral hyperdensities (PCHDs) are a common finding after endovascular stroke treatment. There is uncertainty about the extent to which PCHDs correspond to hemorrhage or contrast staining. Our aim was to evaluate the use of PCHD density on immediate postinterventional CT, and PCHD evolution on follow-up CT for differentiating contrast staining from hemorrhage after endovascular treatment.

Methods We retrospectively reviewed the imaging data of 84 patients who underwent endovascular treatment for acute arterial ischemic stroke in the anterior circulation and who received an immediate postinterventional CT, a follow-up CT within 36 h, and a follow-up MRI within 10 days.

Results PCHDs were seen in 62 of 84 patients in a total of 130 Alberta Stroke Program Early CT Score (ASPECTS) areas. A specificity of 100% to predict hemorrhage was only seen for PCHDs with densities <40 HU (for ruling hemorrhage out) and ≥140 HU (for ruling hemorrhage in), at the cost of a low sensitivity of 1.1% and 2.4%, respectively. Persisting PCHDs correlated with hemorrhage with a specificity of 93.3% and a sensitivity of 62.5%. When follow-up CT was performed at least 19 h after the first CT, persisting PCHDs correlated with hemorrhage with a specificity of 100% and a sensitivity of 62.5%.

Conclusions There are no density thresholds for PCHDs that allow predicting the absence or presence of hemorrhage with 100% specificity and acceptable sensitivity. A CT scan performed at least 19–24 h after endovascular therapy is the only reliable method to differentiate contrast staining from hemorrhage.

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.