Background CT is the most commonly used imaging modality for acute ischemic stroke evaluation. There is growing interest to use pre-operative imaging to characterize clot composition in stroke. We performed an in-vitro study examining the ability of various CT techniques in differentiation between different clot types.
Methods Five clot types with varying fibrin and red blood cells (RBCs) densities (5% RBC and 95% fibrin; 25% RBC and 75% fibrin; 50% RBC and 50% fibrin; 75% RBC and 25% fibrin; 95% RBC and 5% fibrin) were prepared and scanned using various CT scanning protocols (single-energy, dual-energy, photon-counting detector CT, mixed images, and virtual monoenergetic images). Martius Scarlett Blue trichrome staining was performed to confirm the composition of each clot. Mean CT values of each type of clot under different scanning protocol were calculated and compared.
Results Mean CT values of the CT numbers in the five clot specimens for 5%, 25%, and 50% RBC clot were similar across modalities, and increased significantly for 75% and 95% RBC clots (P<0.0001). Mean CT values are highest in the Mono +50 keV images in each type of clot, and they were also significantly higher than all other imaging protocols (P<0.001). Dual-energy CT with Mono +50 keV images showed the greatest difference between attenuation in each type of clot.
Conclusion Mono +50 keV dual-energy CT scan may be helpful for differentiating between RBC-rich and fibrin-rich thrombi seen in large-vessel occlusion patients.
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
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Y-HD and MA contributed equally.
Contributors Y-HD, MA, GM, SL, and WB designed the model and the computational framework and analyzed the data. Y-HD, MA, and GM performed the experiments. Y-HD, MA, and GM wrote the manuscript with input from the other authors (WB, SF, DD, RK, and DFK). Y-HD and GM performed the calculations. All authors discussed the results and contributed to the final manuscript.
Funding This work was supported by NIH grant NS105853 (Brinjikji).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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