Background and Purpose: We aimed to determine whether dual-energy CT (DECT) follow-up can differentiate contrast staining (CS) from intracranial hemorrhage (ICH) in stroke patients treated with intravenous thrombolysis (IVT), who had undergone acute stroke imaging using CT angiography (CTA), and CT perfusion (CTP). Materials and Methods: Between November 2012 and January 2018, 168 patients at our comprehensive stroke center underwent DECT follow-up within 36 h after IVT and acute CTA with or without CTP but did not receive intra-arterial imaging or treatment. Two independent readers evaluated plain monochromatic CT (pCT) alone and compared this with a second reading of a combined DECT approach using pCT and water- and iodine-weighted images, establishing and grading the ICH diagnosis, per Heidelberg and Safe Implementation of Treatments in Stroke Monitoring Study (SITS-MOST) classifications. Results: On pCT alone within 36 h, 31/168 (18.5%) patients had findings diagnosed as ICH. Using combined DECT (cDECT) changed ICH diagnosis to "CS only" in 3/168 (1.8%) patients, constituting 3/31 (9.7%) of cases with initially pCT-diagnosed ICH. These three cases had pCT diagnoses of one SAH, one minor, and one more extensive petechial hemorrhage (hemorrhagic infarction types 1 and 2), respectively. pCT alone had a 100% sensitivity, 98% specificity, 90% positive predictive value (PPV), 100% negative predictive value (NPV), and 98% accuracy for any ICH, compared to the cDECT. Inter-reader agreement for ICH classification using pCT compared to DECT was weighted kappa 0.92 (95% CI 0.87-0.98) vs. 0.91 (0.85-0.95). Conclusion: Compared to pCT, DECT within 36 h after IV thrombolysis for acute ischemic stroke, changes the radiological diagnosis of post-treatment ICH to "CS only" in a small proportion of patients. Studies are warranted of whether the altered radiological reports have an impact on patient management, for example initiation timing of antithrombotic secondary prevention.

中文翻译：

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中风溶栓后的双能CT随访改变了出血并发症的评估。

背景与目的：我们旨在确定双能CT（DECT）随访能否将接受静脉溶栓治疗（IVT）的卒中患者进行对比造影（CS）与颅内出血（ICH）进行区分，这些患者已经接受了急性卒中显像CT血管造影（CTA）和CT灌注（CTP）。材料和方法：2012年11月至2018年1月，在IVT和有或没有CTP的急性CTA后36小时内，我们综合卒中中心的168例患者接受了DECT随访，但未接受动脉内成像或治疗。两名独立的读者单独评估了单色单色CT（pCT），并将其与使用pCT以及水和碘加权图像对DECT组合方法的二读进行比较，从而确定了ICH诊断并对其进行分级，根据Heidelberg和“在卒中监测研究（SITS-MOST）”分类中安全实施治疗。结果：仅在36 h内进行pCT检查，就有31/168（18.5％）的患者被诊断为ICH。在3/168（1.8％）的患者中，使用联合DECT（cDECT）将ICH诊断更改为“仅CS”，占最初经pCT诊断的ICH病例的3/31（9.7％）。这三例患者的pCT诊断分别为1例SAH，1例轻微和1例较广泛的瘀斑出血（1型和2型出血性梗塞）。与cDECT相比，仅pCT对任何ICH的敏感性为100％，特异性为98％，阳性预测值为90％（PPV），阴性预测值为100％（NPV），准确性为98％。与pECT相比，使用pCT进行ICH分类的阅读器间一致性为加权kappa 0.92（95％CI 0.87-0.98）对0.91（0.85-0.95）。结论：与pCT相比，静脉溶栓后36小时内DECT在急性缺血性卒中中的作用，将一小部分患者将治疗后ICH的放射学诊断改为“仅CS”。有必要对改变的放射学报告是否对患者管理产生影响进行研究，例如抗血栓形成二级预防的开始时间。