ASPECTS estimation using dual-energy CTA-derived virtual non-contrast in large vessel occlusion acute ischemic stroke: a dose reduction opportunity for patients undergoing repeat CT?,Neuroradiology

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ASPECTS estimation using dual-energy CTA-derived virtual non-contrast in large vessel occlusion acute ischemic stroke: a dose reduction opportunity for patients undergoing repeat CT?
Neuroradiology ( IF 2.8 ) Pub Date : 2021-08-11 , DOI: 10.1007/s00234-021-02773-0
Maarten van den Broek _{1,

2} , Danielle Byrne _{1,

2} , Daniel Lyndon _{1,

2} , Bonnie Niu ₃ , Shu Min Yu ₃ , Axel Rohr _{1,

2} , Fabio Settecase _{1,

2}

Affiliation

Purpose

Recent studies have shown the feasibility of dual-energy CT (DECT) virtual non-contrast (VNC) for determining infarct extent. In this study, patients presenting with large-vessel occlusion (LVO) acute ischemic stroke (AIS), we assess whether ASPECTS on DECTA-VNC differs from non-contrast CT (NCCT).

Methods

After IRB approval, LVO-AIS patients undergoing NCCT and DECTA between October 2016 and September 2018 were retrospectively reviewed. DECTA-VNC images were derived using Syngo.via (Siemens, Erlangen, Germany). ASPECTS was scored by two blinded neuroradiologists. Square-weighted kappa statistic, diagnostic performance, Wilcoxon signed-rank tests between groups, and CT doses were calculated.

Results

Fifty-one patients met inclusion criteria, with median age of 76 (IQR 67–82); 26/51 (51%) were female. Median time between last-known-well and CT was 120 min (IQR 60–252). DECTA-VNC ASPECTS score differed by ≤ 1 from consensus NCCT in 49/51 (96%) patients for reader 1 and in 46/51 (90%) for reader 2. ASPECTS on DECTA-SI and consensus NCCT differed by ≤ 1 in 45/51 (88%) for both readers. On a per ASPECTS-region basis, DECTA-VNC had 87% sensitivity, 95% specificity, 0.82% PPV, and 0.96% NPV. ASPECTS inter-rater agreement was highest for DECTA-VNC (κ = 0.71), DECTA-SI (κ = 0.48), and NCCT (κ = 0.40). NCCT median CTDIvol was 63.7 mGy (IQR 60.7–67.2); DLP was 1060.0 mGy·cm (IQR 981.0–1151.5). DECTA-VNC dose was lower: median CTDIvol was 20.9 mGy (IQR 19.8–22.2); DLP was 804.1 (IQR 691.6–869.4), p < 0.0001.

Conclusion

DECTA-derived VNC yielded similar ASPECTS scores as NCCT and is therefore non-inferior in early ischemia-related low attenuation edema/infarct detection in acute LVO-AIS patients. Further evaluation of the role of DECTA-VNC in AIS imaging is warranted.

中文翻译：

在大血管闭塞性急性缺血性卒中中使用双能 CTA 衍生的虚拟非对比进行 ASPECTS 估计：对接受重复 CT 的患者减少剂量的机会？

目的

最近的研究表明双能 CT (DECT) 虚拟平扫 (VNC) 用于确定梗死范围的可行性。在这项研究中，我们对出现大血管闭塞 (LVO) 急性缺血性卒中 (AIS) 的患者进行评估，评估 DECTA-VNC 上的 ASPECTS 是否与平扫 CT (NCCT) 不同。

方法

在 IRB 批准后，对 2016 年 10 月至 2018 年 9 月期间接受 NCCT 和 DECTA 的 LVO-AIS 患者进行了回顾性审查。DECTA-VNC 图像是使用 Syngo.via (Siemens, Erlangen, Germany) 获得的。ASPECTS 由两名不知情的神经放射科医师评分。计算平方加权 kappa 统计量、诊断性能、组间 Wilcoxon 符号秩检验和 CT 剂量。

结果

51 名患者符合纳入标准，中位年龄为 76 岁（IQR 67-82）；26/51 (51%) 是女性。上次已知井和 CT 之间的中位时间为 120 分钟 (IQR 60–252)。DECTA-VNC ASPECTS 评分与共识 NCCT 得分相差 ≤ 1，读者 1 为 49/51 (96%)，读者 2 为 46/51 (90%)。DECTA-SI 和共识 NCCT 的 ASPECTS 差异≤1两位读者的 45/51 (88%)。在每个 ASPECTS 区域的基础上，DECTA-VNC 的敏感性为 87%，特异性为 95%，PPV 为 0.82%，NPV 为 0.96%。DECTA-VNC (κ = 0.71)、DECTA-SI (κ = 0.48) 和 NCCT (κ = 0.40) 的 ASPECTS 评分者间一致性最高。NCCT 中位 CTDIvol 为 63.7 mGy (IQR 60.7–67.2)；DLP 为 1060.0 mGy·cm (IQR 981.0–1151.5)。DECTA-VNC 剂量较低：CTDIvol 中位数为 20.9 mGy (IQR 19.8–22.2)；DLP 为 804.1 (IQR 691.6–869.4)，p < 0.0001。