Purpose
The main complications of treatment of ischemic stroke is hemorrhagic transformation; large series have demonstrated its presence between 10-15% of strokes treated endovascularly,
this results in a worse prognosis.
Sometimes,
it is easy to recognize an intraparenchymal hematoma,
but,
considering the presence of contrast extravasation after intra-arterial recanalization occurs between 30-50% of cases,
it can be a challenge differential diagnosis.
In this situation Dual-energy CT takes an important role in patient management and prognosis.
Different studies have shown that the study with dual-energy CT is...
Methods and Materials
We performed a retrospective analysis of prospective screened patients admitted to our center over a period of 3 years (2010-2012) showing an acute ischemic stroke treated endovascularly; according to our protocol,
dual-energy CT was performed within the first 12 hours after endovascular treatment to rule out intracerebral bleeding in order to begin the antithrombotic treatment.
We included all dual-energy CT with intracranial hyperdensities.
Thirty-nine patients were included (mean age 67,
range 30 to 85 years),
16 men (mean age 66,
range 49 to 83 years)...
Results
The dichotomization of each observer is presented in the Table 3 .
The interobserver agreement obtained was excellent between experienced neuroradiologists in both conventional CT and dual-energy CT (k = 0,83 and k =1 respectively).
We obtain a poor correlation comparing the readings of conventional TC between the experienced neuroradiologists and the second-year resident; k = 0,41 (NR1 vs R2) and k = 0,31 (NR2 vs R2).
However,
we found a good correlation comparing dual-energy CT readings between the experienced neuroradiologists and the second-year resident;...
Conclusion
Inexperienced observers increase the agreement with experienced neuroradilogists with dual-energy CT comparing to nonenhanced CT in the detection of hemorrhage transformation in acute stroke patients after endovascular treatment.
Therefore,
dual-energy CT helps to inexperienced observers to perform a right diagnosis which has an important relevance in the management and outcome of the patients.
References
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del Zoppo GJ,
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PROACT: a phase II randomized trial of recombinant pro-urokinase by direct arterial delivery in acute middle...