Dual-Energy CT in Acute Stroke: Could Non-Contrast CT Be Replaced by Virtual Non-Contrast CT? A Feasibility Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. CT Protocol
2.2. VNCCT Reconstruction
2.3. Image Analysis
- Parenchymal hypodensities are characteristic of an acute ischemic event in the anterior and posterior circulation. These were defined according to the Alberta Stroke Program Early CT Score (ASPECTS) [3,10], which rates ischemia in the middle and posterior cerebral artery territories on a scale of 0 to 10, 10, indicating that no signs of ischemia are visible [5,11,12,13]. The examination was considered positive for early ischemic changes if the ASPECTS was under 10 [12].
- Intra-arterial thrombus is defined as a hyperdense artery in the anterior or posterior cerebral circulation;
- Intra- or extra-axial hemorrhages are defined as hyperattenuating areas of at least 60 HU [6].
2.4. Reference Standard
2.5. Statistical Analysis
3. Results
- -
- Acute ischemia: found in 46 patients (30.5%).
- -
- Anterior circulation: found in 39 patients (85.5%); detected in 16 patients on virtual non-contrast CT (VNCCT) and 12 on non-contrast CT (NCCT).
- -
- Posterior circulation: found in 8 patients (15.5%); detected in 6 patients on VNCCT and 6 on NCCT. Note: One patient exhibited both anterior and posterior ischemic signs.
- -
- Intraparenchymal hemorrhage: found in 6 patients (4%), all detected on both VNCCT and NCCT.
- -
- Alternative diagnoses: found in 11 patients (11%); 5 detected on VNCCT and 5 on NCCT.
- -
- Normal findings: present in 85 patients (89%), confirmed by both VNCCT and NCCT.
3.1. Agreement between VNCCT and NCCT
3.1.1. Anterior Circulation
3.1.2. Posterior Circulation
3.2. Performance of VNCCT and NCCT to Detect Acute Ischemia
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
ASPECTS | Alberta Stroke Program Early CT Score |
CT | computed tomography |
DECT | dual-energy CT |
IV | intravenous |
MRI | magnetic resonance imaging |
NCCT | true non-contrast CT |
VNCCT | virtual non-contrast CT |
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ASPECTS | Anterior Circulation (n = 148) | Posterior Circulation (n = 148) | ||
---|---|---|---|---|
VNCCT | NCCT | VNCCT | NCCT | |
4 | n = 3 | n = 3 | n = 0 | n = 0 |
5 | n = 1 | n = 1 | n = 0 | n = 0 |
6 | n = 2 | n = 1 | n = 3 | n = 2 |
7 | n = 1 | n = 2 | n = 0 | n = 0 |
8 | n = 3 | n = 2 | n = 1 | n = 2 |
9 | n = 6 | n = 3 | n = 4 | n = 2 |
10 | n = 132 | n = 136 | n = 140 | n = 142 |
Alternative Diagnoses n = 11 | Diagnosis Suspected at VNCCT n = 5 | Diagnosis Suspected at NCCT n = 5 |
---|---|---|
Tumor n = 4 | 4 | 4 |
Idiopathic seizures n = 2 | 0 | 0 |
Posterior reversible encephalopathy syndrome n = 1 | 0 | 0 |
Multiple sclerosis n = 1 | 0 | 0 |
Meniere’s disease n = 1 | 0 | 0 |
Abscess n = 1 | 1 | 1 |
Acute psychotic disorder n = 1 | 0 | 0 |
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Herpe, G.; Platon, A.; Poletti, P.-A.; Lövblad, K.O.; Machi, P.; Becker, M.; Muster, M.; Perneger, T.; Guillevin, R. Dual-Energy CT in Acute Stroke: Could Non-Contrast CT Be Replaced by Virtual Non-Contrast CT? A Feasibility Study. J. Clin. Med. 2024, 13, 3647. https://doi.org/10.3390/jcm13133647
Herpe G, Platon A, Poletti P-A, Lövblad KO, Machi P, Becker M, Muster M, Perneger T, Guillevin R. Dual-Energy CT in Acute Stroke: Could Non-Contrast CT Be Replaced by Virtual Non-Contrast CT? A Feasibility Study. Journal of Clinical Medicine. 2024; 13(13):3647. https://doi.org/10.3390/jcm13133647
Chicago/Turabian StyleHerpe, Guillaume, Alexandra Platon, Pierre-Alexandre Poletti, Karl O. Lövblad, Paolo Machi, Minerva Becker, Michel Muster, Thomas Perneger, and Rémy Guillevin. 2024. "Dual-Energy CT in Acute Stroke: Could Non-Contrast CT Be Replaced by Virtual Non-Contrast CT? A Feasibility Study" Journal of Clinical Medicine 13, no. 13: 3647. https://doi.org/10.3390/jcm13133647
APA StyleHerpe, G., Platon, A., Poletti, P.-A., Lövblad, K. O., Machi, P., Becker, M., Muster, M., Perneger, T., & Guillevin, R. (2024). Dual-Energy CT in Acute Stroke: Could Non-Contrast CT Be Replaced by Virtual Non-Contrast CT? A Feasibility Study. Journal of Clinical Medicine, 13(13), 3647. https://doi.org/10.3390/jcm13133647