Value of Dual-Energy Dual-Layer CT After Mechanical Recanalization for the Quantification of Ischemic Brain Edema
Background and Purpose: Ischemic brain edema can be measured in computed tomography (CT) using quantitative net water uptake (NWU), a recently established imaging biomarker. NWU determined in follow-up CT after mechanical thrombectomy (MT) has shown to be a strong predictor of functional outcome. Ho...
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2021-07-01
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doaj-fe2379fab71f40be8a36bf3c6062514e2021-07-19T04:49:22ZengFrontiers Media S.A.Frontiers in Neurology1664-22952021-07-011210.3389/fneur.2021.668030668030Value of Dual-Energy Dual-Layer CT After Mechanical Recanalization for the Quantification of Ischemic Brain EdemaPaul Steffen0Friederike Austein1Friederike Austein2Thomas Lindner3Lukas Meyer4Matthias Bechstein5Johanna Rümenapp6Tristan Klintz7Olav Jansen8Susanne Gellißen9Uta Hanning10Jens Fiehler11Gabriel Broocks12Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Kiel, GermanyDepartment of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Kiel, GermanyDepartment of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Kiel, GermanyDepartment of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Kiel, GermanyDepartment of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyBackground and Purpose: Ischemic brain edema can be measured in computed tomography (CT) using quantitative net water uptake (NWU), a recently established imaging biomarker. NWU determined in follow-up CT after mechanical thrombectomy (MT) has shown to be a strong predictor of functional outcome. However, disruption of the blood–brain barrier after MT may also lead to contrast staining, increasing the density on CT scans, and hence, directly impairing measurements of NWU. The purpose of this study was to determine whether dual-energy dual-layer CT (DDCT) after MT can improve the quantification of NWU by measuring NWU in conventional polychromatic CT images (CP-I) and virtual non-contrast images (VNC-I). We hypothesized that VNC-based NWU (vNWU) differs from NWU in conventional CT (cNWU).Methods: Ten patients with middle cerebral artery occlusion who received a DDCT follow-up scan after MT were included. NWU was quantified in conventional and VNC images as previously published and was compared using paired sample t-tests.Results: The mean cNWU was 3.3% (95%CI: 0–0.41%), and vNWU was 11% (95%CI: 1.3–23.4), which was not statistically different (p = 0.09). Two patients showed significant differences between cNWU and vNWU (Δ = 24% and Δ = 36%), while the agreement of cNWU/vNWU in 8/10 patients was high (difference 2.3%, p = 0.23).Conclusion: NWU may be quantified precisely on conventional CT images, as the underestimation of ischemic edema due to contrast staining was low. However, a proportion of patients after MT might show significant contrast leakage resulting in edema underestimation. Further research is needed to validate these findings and investigate clinical implications.https://www.frontiersin.org/articles/10.3389/fneur.2021.668030/fullnet water uptakemechanical recanalizationdual-energy computed tomographyvirtual non-contrast imagebrain edemaischemia |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Paul Steffen Friederike Austein Friederike Austein Thomas Lindner Lukas Meyer Matthias Bechstein Johanna Rümenapp Tristan Klintz Olav Jansen Susanne Gellißen Uta Hanning Jens Fiehler Gabriel Broocks |
spellingShingle |
Paul Steffen Friederike Austein Friederike Austein Thomas Lindner Lukas Meyer Matthias Bechstein Johanna Rümenapp Tristan Klintz Olav Jansen Susanne Gellißen Uta Hanning Jens Fiehler Gabriel Broocks Value of Dual-Energy Dual-Layer CT After Mechanical Recanalization for the Quantification of Ischemic Brain Edema Frontiers in Neurology net water uptake mechanical recanalization dual-energy computed tomography virtual non-contrast image brain edema ischemia |
author_facet |
Paul Steffen Friederike Austein Friederike Austein Thomas Lindner Lukas Meyer Matthias Bechstein Johanna Rümenapp Tristan Klintz Olav Jansen Susanne Gellißen Uta Hanning Jens Fiehler Gabriel Broocks |
author_sort |
Paul Steffen |
title |
Value of Dual-Energy Dual-Layer CT After Mechanical Recanalization for the Quantification of Ischemic Brain Edema |
title_short |
Value of Dual-Energy Dual-Layer CT After Mechanical Recanalization for the Quantification of Ischemic Brain Edema |
title_full |
Value of Dual-Energy Dual-Layer CT After Mechanical Recanalization for the Quantification of Ischemic Brain Edema |
title_fullStr |
Value of Dual-Energy Dual-Layer CT After Mechanical Recanalization for the Quantification of Ischemic Brain Edema |
title_full_unstemmed |
Value of Dual-Energy Dual-Layer CT After Mechanical Recanalization for the Quantification of Ischemic Brain Edema |
title_sort |
value of dual-energy dual-layer ct after mechanical recanalization for the quantification of ischemic brain edema |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Neurology |
issn |
1664-2295 |
publishDate |
2021-07-01 |
description |
Background and Purpose: Ischemic brain edema can be measured in computed tomography (CT) using quantitative net water uptake (NWU), a recently established imaging biomarker. NWU determined in follow-up CT after mechanical thrombectomy (MT) has shown to be a strong predictor of functional outcome. However, disruption of the blood–brain barrier after MT may also lead to contrast staining, increasing the density on CT scans, and hence, directly impairing measurements of NWU. The purpose of this study was to determine whether dual-energy dual-layer CT (DDCT) after MT can improve the quantification of NWU by measuring NWU in conventional polychromatic CT images (CP-I) and virtual non-contrast images (VNC-I). We hypothesized that VNC-based NWU (vNWU) differs from NWU in conventional CT (cNWU).Methods: Ten patients with middle cerebral artery occlusion who received a DDCT follow-up scan after MT were included. NWU was quantified in conventional and VNC images as previously published and was compared using paired sample t-tests.Results: The mean cNWU was 3.3% (95%CI: 0–0.41%), and vNWU was 11% (95%CI: 1.3–23.4), which was not statistically different (p = 0.09). Two patients showed significant differences between cNWU and vNWU (Δ = 24% and Δ = 36%), while the agreement of cNWU/vNWU in 8/10 patients was high (difference 2.3%, p = 0.23).Conclusion: NWU may be quantified precisely on conventional CT images, as the underestimation of ischemic edema due to contrast staining was low. However, a proportion of patients after MT might show significant contrast leakage resulting in edema underestimation. Further research is needed to validate these findings and investigate clinical implications. |
topic |
net water uptake mechanical recanalization dual-energy computed tomography virtual non-contrast image brain edema ischemia |
url |
https://www.frontiersin.org/articles/10.3389/fneur.2021.668030/full |
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