Dual-energy CT in assessment of thrombus perviousness and its application in predicting outcomes after intravenous thrombolysis in acute ischemic stroke

Yao Dai; Haimin Xu; Xiang Fang; Xing Xiong; Ziyang Song; Su Hu; Yixing Yu; Chunhong Hu; Yu Zhang

doi:10.1016/j.ejrad.2023.110861

Dual-energy CT in assessment of thrombus perviousness and its application in predicting outcomes after intravenous thrombolysis in acute ischemic stroke

Eur J Radiol. 2023 Jul:164:110861. doi: 10.1016/j.ejrad.2023.110861. Epub 2023 May 5.

Authors

Yao Dai¹, Haimin Xu², Xiang Fang³, Xing Xiong³, Ziyang Song³, Su Hu³, Yixing Yu³, Chunhong Hu⁴, Yu Zhang⁵

Affiliations

¹ Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China; Department of Radiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou 215124, China.
² Department of Radiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou 215124, China.
³ Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China.
⁴ Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China. Electronic address: sudahuchunhong@163.com.
⁵ Department of Radiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou 215124, China. Electronic address: zhangyusdfyy@163.com.

PMID: 37167682
DOI: 10.1016/j.ejrad.2023.110861

Abstract

Purpose: To evaluate the feasibility of using iodine overlay maps reconstructed from dual-energy CT (DECT) to assess thrombus perviousness and investigate its value in predicting outcomes after intravenous thrombolysis in patients with acute ischemic stroke.

Method: 86 patients with proximal intracranial occlusions of the anterior circulation who underwent intravenous thrombolysis were included in this study. Thrombus iodine concentrations (IC_thrombus) and normalized iodine concentrations (NIC_thrombus) were compared to conventional perviousness parameters (thrombus attenuation increase, TAI; void fraction, ε and CTA-index). The associations between perviousness parameters and outcomes were analyzed by Spearman's correlation and regression analysis.

Results: IC_thrombus and NIC_thrombus were significantly correlated with conventional perviousness parameters (P < 0.001). The median IC_thrombus was 6.81 (interquartile range [IQR], 4.76-8.73) mg/ml in the favorable functional outcome group, which was higher than 3.52 (IQR, 2.08-6.86) mg/ml in the unfavorable outcome group (P = 0.001). The median NIC_thrombus was 0.095 (IQR, 0.068-0.116) and 0.054 (IQR, 0.031-0.083) in the favorable and unfavorable outcome groups, respectively (P < 0.001). NIC_thrombus predicted favorable outcome with a higher area under the curve (AUC) of 0.755 than any conventional perviousness parameter (P < 0.05). In the multivariable regression model, IC_thrombus was independently associated with favorable outcome (odds ratio [OR] = 1.472, 95 % CI: 1.154-1.877, P = 0.002) and successful recanalization (OR = 1.356, 95 % CI: 1.093-1.681, P = 0.006). IC_thrombus was negatively correlated with the final infarct volume (FIV) (r = -0.262, P = 0.020). Results for NIC_thrombus were similar.

Conclusions: DECT is of great value in assessing thrombus perviousness. NIC_thrombus is a meaningful predictor of stroke prognosis and recanalization after intravenous thrombolysis in acute ischemic stroke.

Keywords: CT angiography; Dual-energy X-ray absorptiometry scan; Ischemic stroke; Thrombus.

MeSH terms

Brain Ischemia* / diagnostic imaging
Brain Ischemia* / drug therapy
Computed Tomography Angiography / methods
Humans
Ischemic Stroke* / diagnostic imaging
Ischemic Stroke* / drug therapy
Stroke* / diagnostic imaging
Stroke* / drug therapy
Thrombolytic Therapy
Thrombosis* / diagnostic imaging
Thrombosis* / drug therapy
Treatment Outcome