The clinical utility of dual-energy CT in post-thrombectomy care: Part 2, the predictive value of contrast density and volume for delayed hemorrhagic transformation

Seoiyoung Ahn; Steven G Roth; Nishit Mummareddy; Yeji Ko; Akshay Bhamidipati; Jacob Jo; Julie DiNitto; Matthew R Fusco; Rohan V Chitale; Michael T Froehler

doi:10.1016/j.jstrokecerebrovasdis.2023.107216

The clinical utility of dual-energy CT in post-thrombectomy care: Part 2, the predictive value of contrast density and volume for delayed hemorrhagic transformation

J Stroke Cerebrovasc Dis. 2023 Aug;32(8):107216. doi: 10.1016/j.jstrokecerebrovasdis.2023.107216. Epub 2023 Jun 29.

Authors

Affiliations

¹ Vanderbilt University School of Medicine, Nashville, TN. Electronic address: seoiyoungahn@gmail.com.
² Cerebrovascular Program, Vanderbilt University Medical Center, Nashville, TN.
³ Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN.
⁴ Vanderbilt University School of Medicine, Nashville, TN.
⁵ Siemens Medical Solutions, Malvern, PA; Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN.

PMID: 37392484
DOI: 10.1016/j.jstrokecerebrovasdis.2023.107216

Abstract

Objectives: Dual-energy CT allows differentiation between blood and iodinated contrast. This study aims to determine the predictive value of contrast density and volume on post-thrombectomy dual-energy CT for delayed hemorrhagic transformation and its impact on 90-day outcomes.

Materials and methods: A retrospective analysis was performed on patients who underwent thrombectomy for anterior circulation large-vessel occlusion at a comprehensive stroke center from 2018-2021. Per institutional protocol, all patients underwent dual-energy CT immediately post-thrombectomy and MRI or CT 24 hours afterward. The presence of hemorrhage and contrast staining was evaluated by dual-energy CT. Delayed hemorrhagic transformation was determined by 24-hour imaging and classified into petechial hemorrhage or parenchymal hematoma using ECASS III criteria. Univariable and multivariable analyses were performed to determine predictors and outcomes of delayed hemorrhagic transformation.

Results: Of 97 patients with contrast staining and without hemorrhage on dual-energy CT, 30 and 18 patients developed delayed petechial hemorrhage and delayed parenchymal hematoma, respectively. On multivariable analysis, delayed petechial hemorrhage was predicted by anticoagulant use (OR,3.53;p=0.021;95%CI,1.19-10.48) and maximum contrast density (OR,1.21;p=0.004;95%CI,1.06-1.37;per 10 HU increase), while delayed parenchymal hematoma was predicted by contrast volume (OR,1.37;p=0.023;95%CI,1.04-1.82;per 10 mL increase) and low-density lipoprotein (OR,0.97;p=0.043;95%CI,0.94-1.00;per 1 mg/dL increase). After adjusting for potential confounders, delayed parenchymal hematoma was associated with worse functional outcomes (OR,0.07;p=0.013;95%CI,0.01-0.58) and mortality (OR,7.83;p=0.008;95%CI,1.66-37.07), while delayed petechial hemorrhage was associated with neither.

Conclusion: Contrast volume predicted delayed parenchymal hematoma, which was associated with worse functional outcomes and mortality. Contrast volume can serve as a useful predictor of delayed parenchymal hematoma following thrombectomy and may have implications for patient management.

Keywords: Contrast staining; Delayed hemorrhagic transformation; Dual-energy computed tomography; Parenchymal hematoma; Petechial hemorrhage; Stroke; Thrombectomy.