Content area
Full Text
Neuroradiology (2014) 56:737744 DOI 10.1007/s00234-014-1381-8
INTERVENTIONAL NEURORADIOLOGY
Differentiating intraparenchymal hemorrhage from contrast extravasation on post-procedural noncontrast CT scan in acute ischemic stroke patients undergoing endovascular treatment
Seyedmehdi Payabvash & Mushtaq H. Qureshi &
Shayaan M. Khan & Mahnoor Khan & Shahram Majidi &
Swaroop Pawar & Adnan I Qureshi
Received: 7 March 2014 /Accepted: 8 May 2014 /Published online: 13 June 2014 # Springer-Verlag Berlin Heidelberg 2014
AbstractIntroduction This study aimed to identify the imaging characteristics that can help differentiate intraparenchymal hemorrhage from benign contrast extravasation on post-procedural noncontrast CT scan in acute ischemic stroke patients after endovascular treatment.
Methods We reviewed the clinical and imaging records of all acute ischemic stroke patients who underwent endovascular treatment in two hospitals over a 3.5-year period. The immediate post-procedural CT scan was evaluated for the presence of hyperdense lesion(s). The average attenuation of the lesion(s) was measured. Intraparenchymal hemorrhage was defined as a persistent hyperdensity visualized on follow-up CT scan, 24 h or greater after the procedure.
Results Of the 135 patients studied, 74 (55 %) patients had hyperdense lesion(s) on immediate post-procedural CT scan. Follow-up scans confirmed the diagnosis of intraparenchymal hemorrhage in 20 of these 74 patients. A receiver operating characteristic analysis showed that the average attenuation of the most hyperdense lesion can differentiate intraparenchymal hemorrhage from contrast extravasation with an area under the curve of 0.78 (p=0.001). An average attenuation of <50 Hounsfield units
(HU) in the most visually hyperattenuating hyperdense lesion had 100 % specificity and 56 % sensitivity for identification of contrast extravasations. Petechial hyperdensity was seen in 46/54 (85 %) patients with contrast extravasation versus 9/20 (45 %) patients with intraparenchymal hemorrhage on the immediate post-procedural CT scan (p<0.001).
Conclusion An average attenuation <50 HU of the most hyperattenuating hyperdense parenchymal lesion on immediate post-procedural CT scan was very specific for differentiating contrast extravasation from intraparenchymal hemorrhage in acute ischemic stroke patients after endovascular treatment.
Keywords Contrast extravasation . Intraparenchymal hemorrhage . Intra-arterial treatment . Noncontrast CT . Ischemic stroke
AbbreviationsANOVA Analysis of varianceAUC Area under the curveECASS European Cooperative Acute Stroke Study HU Hounsfield unitIA Intra-arterialIV IntravenousmRs Modified Rankin scaleNIHSS National Institutes of Health Stroke Scale NINDS National Institute of Neurological Disorders and StrokePACS Picture archiving and communications system ROC...