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PT  - JOURNAL ARTICLE
AU  - Byrne, D.
AU  - Walsh, J.P.
AU  - Schmiedeskamp, H.
AU  - Settecase, F.
AU  - Heran, M.K.S.
AU  - Niu, B.
AU  - Salmeen, A.K.
AU  - Rohr, B.
AU  - Field, T.S.
AU  - Murray, N.
AU  - Rohr, A.
TI  - Prediction of Hemorrhage after Successful Recanalization in Patients with Acute Ischemic Stroke: Improved Risk Stratification Using Dual-Energy CT Parenchymal Iodine Concentration Ratio Relative to the Superior Sagittal Sinus
AID  - 10.3174/ajnr.A6345
DP  - 2020 Jan 01
TA  - American Journal of Neuroradiology
PG  - 64--70
VI  - 41
IP  - 1
4099  - http://www.ajnr.org/content/41/1/64.short
4100  - http://www.ajnr.org/content/41/1/64.full
SO  - Am. J. Neuroradiol.2020 Jan 01; 41
AB  - BACKGROUND AND PURPOSE: Brain parenchymal hyperdensity on postthrombectomy CT in patients with acute stroke can be due to hemorrhage and/or contrast staining. We aimed to determine whether iodine concentration within contrast-stained parenchyma compared with an internal reference in the superior sagittal sinus on dual-energy CT could predict subsequent intracerebral hemorrhage.MATERIALS AND METHODS: Seventy-one patients with small infarct cores (ASPECTS ≥ 7) and good endovascular recanalization (modified TICI 2b or 3) for anterior circulation large-vessel occlusion were included. Brain parenchymal iodine concentration as per dual-energy CT and the percentage of contrast staining relative to the superior sagittal sinus were recorded and correlated with the development of intracerebral hemorrhage using Mann-Whitney U and Fisher exact tests.RESULTS: Forty-three of 71 patients had parenchymal hyperdensity on initial dual-energy CT. The median relative iodine concentration compared with the superior sagittal sinus was significantly higher in those with subsequent intracerebral hemorrhage (137.9% versus 109.2%, P = .007). By means of receiver operating characteristic analysis, a cutoff value of 100% (iodine concentration relative to the superior sagittal sinus) enabled identification of patients going on to develop intracerebral hemorrhage with 94.75% sensitivity, 43.4% specificity, and a likelihood ratio of 1.71.CONCLUSIONS: Within our cohort of patients, the relative percentage of iodine concentration at dual-energy CT compared with the superior sagittal sinus was a reliable predictor of intracerebral hemorrhage development and may be a useful imaging biomarker for risk stratification after endovascular treatment.DECTdual-energy CTICHintracerebral hemorrhageSSSsuperior sagittal sinus