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Distinction between contrast staining and hemorrhage after endovascular stroke treatment : one CT is not enough

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Abstract
Background: Postinterventional cerebral hyperdensities (PCHDs) are a common finding after endovascular stroke treatment. There is uncertainty about the extent to which PCHDs correspond to hemorrhage or contrast staining. Our aim was to evaluate the use of PCHD density on immediate postinterventional CT, and PCHD evolution on follow-up CT for differentiating contrast staining from hemorrhage after endovascular treatment. Methods: We retrospectively reviewed the imaging data of 84 patients who underwent endovascular treatment for acute arterial ischemic stroke in the anterior circulation and who received an immediate postinterventional CT, a follow-up CT within 36 h, and a follow-up MRI within 10 days. Results: PCHDs were seen in 62 of 84 patients in a total of 130 Alberta Stroke Program Early CT Score (ASPECTS) areas. A specificity of 100% to predict hemorrhage was only seen for PCHDs with densities < 40 HU (for ruling hemorrhage out) and >= 140 HU (for ruling hemorrhage in), at the cost of a low sensitivity of 1.1% and 2.4%, respectively. Persisting PCHDs correlated with hemorrhage with a specificity of 93.3% and a sensitivity of 62.5%. When follow-up CT was performed at least 19 h after the first CT, persisting PCHDs correlated with hemorrhage with a specificity of 100% and a sensitivity of 62.5%. Conclusions: There are no density thresholds for PCHDs that allow predicting the absence or presence of hemorrhage with 100% specificity and acceptable sensitivity. A CT scan performed at least 19-24 h after endovascular therapy is the only reliable method to differentiate contrast staining from hemorrhage.
Keywords
ACUTE ISCHEMIC-STROKE, TISSUE-PLASMINOGEN ACTIVATOR, CEREBRAL-ARTERY, OCCLUSION, DUAL-ENERGY CT, INTRAARTERIAL THROMBOLYSIS, INTRACRANIAL, HEMORRHAGE, CLINICAL-SIGNIFICANCE, COMPUTED-TOMOGRAPHY, THERAPY, EXTRAVASATION

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MLA
Dekeyzer, Sven, et al. “Distinction between Contrast Staining and Hemorrhage after Endovascular Stroke Treatment : One CT Is Not Enough.” JOURNAL OF NEUROINTERVENTIONAL SURGERY, vol. 9, no. 4, 2017, pp. 394–98, doi:10.1136/neurintsurg-2016-012290.
APA
Dekeyzer, S., Nikoubashman, O., Lutin, B., DE GROOTE, J., Vancaester, E., De Blauwe, S., … Defreyne, L. (2017). Distinction between contrast staining and hemorrhage after endovascular stroke treatment : one CT is not enough. JOURNAL OF NEUROINTERVENTIONAL SURGERY, 9(4), 394–398. https://doi.org/10.1136/neurintsurg-2016-012290
Chicago author-date
Dekeyzer, Sven, Omid Nikoubashman, Bart Lutin, JEROEN DE GROOTE, Evelien Vancaester, Sofie De Blauwe, Dimitri Hemelsoet, Martin Wiesmann, and Luc Defreyne. 2017. “Distinction between Contrast Staining and Hemorrhage after Endovascular Stroke Treatment : One CT Is Not Enough.” JOURNAL OF NEUROINTERVENTIONAL SURGERY 9 (4): 394–98. https://doi.org/10.1136/neurintsurg-2016-012290.
Chicago author-date (all authors)
Dekeyzer, Sven, Omid Nikoubashman, Bart Lutin, JEROEN DE GROOTE, Evelien Vancaester, Sofie De Blauwe, Dimitri Hemelsoet, Martin Wiesmann, and Luc Defreyne. 2017. “Distinction between Contrast Staining and Hemorrhage after Endovascular Stroke Treatment : One CT Is Not Enough.” JOURNAL OF NEUROINTERVENTIONAL SURGERY 9 (4): 394–398. doi:10.1136/neurintsurg-2016-012290.
Vancouver
1.
Dekeyzer S, Nikoubashman O, Lutin B, DE GROOTE J, Vancaester E, De Blauwe S, et al. Distinction between contrast staining and hemorrhage after endovascular stroke treatment : one CT is not enough. JOURNAL OF NEUROINTERVENTIONAL SURGERY. 2017;9(4):394–8.
IEEE
[1]
S. Dekeyzer et al., “Distinction between contrast staining and hemorrhage after endovascular stroke treatment : one CT is not enough,” JOURNAL OF NEUROINTERVENTIONAL SURGERY, vol. 9, no. 4, pp. 394–398, 2017.
@article{8559616,
  abstract     = {{Background: Postinterventional cerebral hyperdensities (PCHDs) are a common finding after endovascular stroke treatment. There is uncertainty about the extent to which PCHDs correspond to hemorrhage or contrast staining. Our aim was to evaluate the use of PCHD density on immediate postinterventional CT, and PCHD evolution on follow-up CT for differentiating contrast staining from hemorrhage after endovascular treatment. 
Methods: We retrospectively reviewed the imaging data of 84 patients who underwent endovascular treatment for acute arterial ischemic stroke in the anterior circulation and who received an immediate postinterventional CT, a follow-up CT within 36 h, and a follow-up MRI within 10 days. 
Results: PCHDs were seen in 62 of 84 patients in a total of 130 Alberta Stroke Program Early CT Score (ASPECTS) areas. A specificity of 100% to predict hemorrhage was only seen for PCHDs with densities < 40 HU (for ruling hemorrhage out) and >= 140 HU (for ruling hemorrhage in), at the cost of a low sensitivity of 1.1% and 2.4%, respectively. Persisting PCHDs correlated with hemorrhage with a specificity of 93.3% and a sensitivity of 62.5%. When follow-up CT was performed at least 19 h after the first CT, persisting PCHDs correlated with hemorrhage with a specificity of 100% and a sensitivity of 62.5%. 
Conclusions: There are no density thresholds for PCHDs that allow predicting the absence or presence of hemorrhage with 100% specificity and acceptable sensitivity. A CT scan performed at least 19-24 h after endovascular therapy is the only reliable method to differentiate contrast staining from hemorrhage.}},
  author       = {{Dekeyzer, Sven and Nikoubashman, Omid and Lutin, Bart and DE GROOTE, JEROEN and Vancaester, Evelien and De Blauwe, Sofie and Hemelsoet, Dimitri and Wiesmann, Martin and Defreyne, Luc}},
  issn         = {{1759-8478}},
  journal      = {{JOURNAL OF NEUROINTERVENTIONAL SURGERY}},
  keywords     = {{ACUTE ISCHEMIC-STROKE,TISSUE-PLASMINOGEN ACTIVATOR,CEREBRAL-ARTERY,OCCLUSION,DUAL-ENERGY CT,INTRAARTERIAL THROMBOLYSIS,INTRACRANIAL,HEMORRHAGE,CLINICAL-SIGNIFICANCE,COMPUTED-TOMOGRAPHY,THERAPY,EXTRAVASATION}},
  language     = {{eng}},
  number       = {{4}},
  pages        = {{394--398}},
  title        = {{Distinction between contrast staining and hemorrhage after endovascular stroke treatment : one CT is not enough}},
  url          = {{http://doi.org/10.1136/neurintsurg-2016-012290}},
  volume       = {{9}},
  year         = {{2017}},
}

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