Virtual monoenergetic dual-energy CT reconstructions at 80 keV are optimal non-contrast CT technique for early stroke detection

2021 ◽  
pp. 197140092110474
Author(s):  
Doris Dodig ◽  
Zrinka Matana Kaštelan ◽  
Nina Bartolović ◽  
Slaven Jurković ◽  
Damir Miletić ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Symptom Onset ◽  
Brain Oedema ◽  
Dual Energy ◽  
Characteristic Analysis ◽  
Stroke Incidence ◽  
Ct Technique ◽  
Contrast Ct ◽  
Early Stroke

Background Virtual monoenergetic (VM) dual-energy computed tomography (DE-CT) enables grey-to-white matter contrast-to-noise ratio optimization, potentially increasing ischaemic brain oedema visibility. The aim of this study was to compare the diagnostic accuracy of VM and standard DE-CT reconstructions for early stroke detection. Methods Consecutive patients with non-contrast DE-CT of the brain scanned within 12 h of stroke symptom onset were prospectively included in the study. Patients with other significant brain pathology were excluded. Two radiologists jointly evaluated standard and VM reconstructions (from 40 to 190 keV at increments of 10 keV) for early stroke signs on a four-point Likert scale: (a) stroke definitely present, (b) stroke probably present, (c) probably no stroke, and (d) definitely no stroke. Follow-up imaging and clinical data served as the standard of reference. Diagnostic accuracy was evaluated by receiver operating characteristic analysis. Results Stroke incidence among 184 patients was 76%. In 64 patients follow-up imaging served as the standard of reference: ischemic brain oedema detection was significantly more accurate on VM reconstructions at 80 keV compared with standard DE-CT reconstructions (area under the curve (AUC) = 0.821 vs. AUC = 0.672, p = 0.002). The difference was most prominent within the first 3 h after symptom onset (at 11%, AUC = 0.819 vs. AUC = 0.709, p = 0.17) and in patients with National Institutes of Health Stroke Scale above 16 (at 37.5%, AUC = 1 vs. AUC = 0.625, p = 0.14). Conclusion VM DE-CT reconstructions at 80 keV appear to be the optimal non-contrast CT technique for diagnosing early ischaemic stroke, particularly within the first 3 h after symptom onset and in severely ill patients.

scholarly journals Copeptin: Limited Usefulness in Early Stroke Differentiation?

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Johannes von Recum ◽  
Julia Searle ◽  
Anna Slagman ◽  
Jörn Ole Vollert ◽  
Matthias Endres ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Symptom Onset ◽  
Final Diagnosis ◽  
Emergency Setting ◽  
Stroke Mimics ◽  
Suspected Stroke ◽  
Ischemic Attack ◽  
Initial Blood ◽  
Range Of Values ◽  
Early Stroke

Background. Stroke can be a challenging diagnosis in an emergency-setting. We sought to determine whether copeptin may be a useful biomarker to differentiate between ischemic stroke (IS), transient ischemic attack (TIA), and stroke-mimics.Methods. In patients with suspected stroke arriving within 4.5 hours of symptom-onset, copeptin-levels were measured in initial blood-samples. The final diagnosis was adjudicated by vascular neurologists blinded to copeptin-values.Results. Of all 36 patients with available copeptin-values (median age 71 years, IQR: 54–76; 44% female), 20 patients (56%) were diagnosed with IS, no patient was diagnosed with hemorrhagic stroke, nine patients (25%) were diagnosed with TIA, and seven patients (19%) were stroke-mimics. Copeptin-levels (in pmol/L) tended to be higher in patients with IS [19.1 (11.2–48.5)] compared to TIA [9.4 (5.4–13.8)]. In stroke-mimics the range of values was extremely broad [33.3 (7.57–255.7)]. The diagnostic accuracy of copeptin for IS was 63% with a sensitivity of 80% and a positive predictive value of 64%.Conclusion. In this cohort of patients copeptin-levels within 4.5 hours of symptom onset were higher in patients with IS compared to TIA but the broad range of values in stroke-mimics limits diagnostic accuracy. This trial is registered with UTN: U1111-1119-7602.

scholarly journals Impact of contrast CT angiography and whole brain contrast CT perfusion study on the accuracy of cerebrovascular diagnosis in patients presenting with a major stroke-like syndrome

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 325-325
Author(s):  
Mustapha A Ezzeddine ◽  
Michael H Lev ◽  
Colin T McDonald ◽  
Guy A Rordorf ◽  
Jamary Oliveira-Filho ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Ct Perfusion ◽  
Accurate Diagnosis ◽  
Emergency Setting ◽  
Vascular Territory ◽  
Stroke Subtype ◽  
Whole Brain ◽  
Therapeutic Decisions ◽  
Contrast Ct

52 Objective: The diagnosis of ischemic stroke subtype is difficult in the emergency setting when based only upon a non-contrast CT scan and clinical findings. Accurate diagnosis may be important because prognosis depends upon the size and location of the infarct and emergency therapeutic decisions rest upon attempts to improve prognosis. Diffusion/perfusion weighted MR identifies acute ischemia and ischemic injury but is expensive, and not consistently accessible nationwide. We investigated the ability of a readily available CT contrast study (CT angiography, CTA; and whole brain CT perfusion, CTP) to enhance diagnostic accuracy of stroke subtype. Methods: All patients (1/97–12/98) who received a CTA within 24 hours of stroke onset (mean=4.6 hrs) and a follow-up CT or MRI within 2 weeks were analyzed (N=40). Stroke neurologists made stroke subtype diagnoses based upon: 1) non contrast CT and clinical vignette; 2) #1 and CTA; 2) #1, #2 and CTP. Diagnostic accuracy at each sequential step was measured against the gold standard based upon all available clinical, lab and follow-up imaging information. Results: The addition of the contrast CT study (CT+CTP)led to a statistically significant, relative improvement in accuracy of 1)infarct localization, 100%; 2) involved vascular territory, 69%; 3) occluded vessel, 94%; 4) TOAST stroke subtype, 44%; and 5) Oxfordshire stroke subtype, 81%. CTA led to significant improvement in diagnostic accuracy of vessel occlusion and TOAST subtype. CTP led to significant improvement in diagnostic accuracy of infarct localization, vascular territory and Oxfordshire classification. Conclusion: The addition of a contrast CT study to evaluate the intracranial vessels (CTA) and whole brain perfusion (CTP) enables highly accurate diagnosis of stroke subtype in the emergency setting. The ability of this widely accessible, emergency neuroimaging technique to predict functional outcome and guide therapeutic decisions can now be investigated.

Hematoma Expansion in Intracerebral Hemorrhage With Unclear Onset

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000011895
Author(s):  
Andrea Morotti ◽  
Gregoire Boulouis ◽  
Andreas Charidimou ◽  
Qi Li ◽  
Loris Poli ◽  
...  
Keyword(s):  
Symptom Onset ◽  
Hematoma Expansion ◽  
Prognostic Impact ◽  
Replication Cohort ◽  
Medical Treatments ◽  
Similar Frequency ◽  
Medical Centers ◽  
Academic Medical ◽  
Contrast Ct

ObjectiveTo investigatethe prevalence, predictors and prognostic impact of hematoma expansion (HE) inintracerebral hemorrhage (ICH) patients with unclear symptom onset (USO).MethodsRetrospective analysis of patients with primary spontaneous ICH admitted at 5 academic medical centers in USA and Italy.HE (volume increase >6 mL and/or >33% from baseline to follow-up non-contrast CT [NCCT]) and mortality at 30 days were the outcomes of interest. Baseline NCCT was also analyzed for presence of hypodensities (any hypodense region within the hematoma margins). Predictors of HE and mortality were explored with multivariable logistic regression.ResultsWe enrolled 2,165 subjects, 1,022 in the development cohort and 1,143 in the replication cohort, of whom 352 (34.4%) and 407 (35.6%) had ICH with USO respectively. When compared with subjects having a clear symptom onset, USO patients had a similar frequency of HE (25.0% vs 21.9%, p = 0.269 and 29.9% vs 31.5%, p = 0.423). Among USO patients, HE was independently associated with mortality after adjustment for confounders (odds ratio [OR] 2.64, 95% confidence interval [CI] 1.43–4.89, p = 0.002). This finding wassimilar in the replication cohort (OR 3.46, 95% CI 1.86–6.44, p < 0.001). The presence of NCCT hypodensities in USO subjects was an independent predictor of HE in the development (OR 2.59, 95% CI 1.27–5.28, p = 0.009) and replication (OR 2.43, 95% CI 1.42–4.17, p = 0.001) population.ConclusionHE is common in USO patients and independently associated with worse outcome. These findings suggest that USO patients may be enrolled in clinical trials on medical treatments targeting HE.

scholarly journals Improved Diagnostic Accuracy of Bone Metastasis Detection by Water-HAP Associated to Non-Contrast CT

Diagnostics ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. 853
Author(s):  
Yoshinobu Ishiwata ◽  
Yojiro Hieda ◽  
Soichiro Kaki ◽  
Shinjiro Aso ◽  
Keiichi Horie ◽  
...  
Keyword(s):  
Bone Metastasis ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Ct Images ◽  
Kappa Coefficient ◽  
Characteristic Analysis ◽  
Predictive Values ◽  
Contrast Ct ◽  
Sensitivity Specificity ◽  
Conventional Ct

We examined whether water-hydroxyapatite (HAP) images improve the diagnostic accuracy of bone metastasis compared with non-contrast CT alone. We retrospectively evaluated dual-energy computed tomography (DECT) images of 83 cancer patients (bone metastasis, 31; without bone metastasis, 52) from May 2018 to June 2019. Initially, two evaluators examined for bone metastasis on conventional CT images. In the second session, both CT and CT images plus water-HAP images on DECT. The confidence of bone metastasis was scored from 1 (benign) to 5 (malignant). The sensitivity, specificity, positive predictive values, and negative predictive values for both modalities were calculated based on true positive and negative findings. The intra-observer area under curve (AUC) for detecting bone metastasis was compared by receiver operating characteristic analysis. Kappa coefficient calculated the inter-observer agreement. In conventional CT images, sensitivity, specificity, positive predictive value, and negative predictive value of raters 1 and 2 for the identification of bone metastases were 0.742 and 0.710, 0.981 and 0.981, 0.958 and 0.957, and 0.864 and 0.850, respectively. In water-HAP, they were 1.00 and 1.00, 0.981 and 1.00, 0.969 and 1.00, and 1.00 and 1.00, respectively. In CT, AUCs were 0.861 and 0.845 in each observer. On water-HAP images, AUCs were 0.990 and 1.00. Kappa coefficient was 0.964 for CT and 0.976 for water-HAP images. The combination of CT and water-HAP images significantly increased diagnostic accuracy for detecting bone metastasis. Water-HAP images on DECT may enable accurate initial staging, reduced radiation exposure, and cost.

scholarly journals Non-contrast dual-energy CT virtual ischemia maps accurately estimate ischemic core size in large-vessel occlusive stroke

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Dylan N. Wolman ◽  
Fasco van Ommen ◽  
Elizabeth Tong ◽  
Frans Kauw ◽  
Jan Willem Dankbaar ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Ct Perfusion ◽  
Primary Outcome Measure ◽  
Dual Energy ◽  
Large Vessel ◽  
Dual Energy Ct ◽  
Vessel Occlusion ◽  
Ischemic Core ◽  
Contrast Ct

AbstractDual-energy CT (DECT) material decomposition techniques may better detect edema within cerebral infarcts than conventional non-contrast CT (NCCT). This study compared if Virtual Ischemia Maps (VIM) derived from non-contrast DECT of patients with acute ischemic stroke due to large-vessel occlusion (AIS-LVO) are superior to NCCT for ischemic core estimation, compared against reference-standard DWI-MRI. Only patients whose baseline ischemic core was most likely to remain stable on follow-up MRI were included, defined as those with excellent post-thrombectomy revascularization or no perfusion mismatch. Twenty-four consecutive AIS-LVO patients with baseline non-contrast DECT, CT perfusion (CTP), and DWI-MRI were analyzed. The primary outcome measure was agreement between volumetric manually segmented VIM, NCCT, and automatically segmented CTP estimates of the ischemic core relative to manually segmented DWI volumes. Volume agreement was assessed using Bland–Altman plots and comparison of CT to DWI volume ratios. DWI volumes were better approximated by VIM than NCCT (VIM/DWI ratio 0.68 ± 0.35 vs. NCCT/DWI ratio 0.34 ± 0.35; P < 0.001) or CTP (CTP/DWI ratio 0.45 ± 0.67; P < 0.001), and VIM best correlated with DWI (rVIM = 0.90; rNCCT = 0.75; rCTP = 0.77; P < 0.001). Bland–Altman analyses indicated significantly greater agreement between DWI and VIM than NCCT core volumes (mean bias 0.60 [95%AI 0.39–0.82] vs. 0.20 [95%AI 0.11–0.30]). We conclude that DECT VIM estimates the ischemic core in AIS-LVO patients more accurately than NCCT.

scholarly journals Vertebral Bone Marrow and Endplate Assessment on MR Imaging for the Differentiation of Modic Type 1 Endplate Changes and Infectious Spondylodiscitis

2020 ◽  
Vol 9 (3) ◽  
pp. 826 ◽  
Author(s):  
Ursula Schwarz-Nemec ◽  
Klaus M. Friedrich ◽  
Christoph Stihsen ◽  
Felix K. Schwarz ◽  
Siegfried Trattnig ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Mr Imaging ◽  
Diagnostic Accuracy ◽  
Characteristic Analysis ◽  
Vertebral Bone ◽  
Endplate Changes ◽  
Modic Type ◽  
Infectious Spondylodiscitis ◽  
Vertebral Bone Marrow

On magnetic resonance (MR) imaging, Modic type 1 (MT1) endplate changes and infectious spondylodiscitis share similar findings. Therefore, this study investigated vertebral bone marrow and endplate changes to enable their differentiation. The lumbar spine MR examinations of 91 adult patients were retrospectively included: 39 with MT1; 19 with early spondylodiscitis without abscess; and 33 with advanced spondylodiscitis with abscess. The assessment included percentage of bone marrow edema on sagittal short tau inversion recovery images, and the signal ratio of edema to unaffected bone and endplate contour (normal; irregular, yet intact; blurred; destructive) on sagittal unenhanced T1-weighted images. Differences were tested for statistical significance by Chi-square test and mixed model analysis of variance. The MR diagnostic accuracy in differentiating MT1 and spondylodiscitis was assessed by cross-tabulation and receiver-operating characteristic analysis. The endplate contours, edema extents, and T1-signal ratios of MT1 (extent, 31.96%; ratio, 0.83) were significantly different (p < 0.001) from early spondylodiscitis (56.42%; 0.60), and advanced spondylodiscitis (91.84%; 0.61). The highest diagnostic accuracy (sensitivity, 94.87%; specificity, 94.23%; accuracy, 94.51%) in identifying MT1 was provided by an irregular, yet intact endplate contour. This may be a useful MR feature for the differentiation between MT1 and spondylodiscitis, particularly in its early stage.

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