Clinical utility of consecutive volume scanning dual-energy CT in differentiating hemorrhage from contrast staining in ischemic stroke patients

Abstract

Background and Purpose: Accurate differentiation between hemorrhage and iodinated contrast staining is critical for managing ischemic stroke patients following revascularization. While dual-energy CT (DECT) has shown promise in this context, studies have predominantly focused on dual-source or fast-kV switching systems. This study evaluates the diagnostic accuracy of a sequential axial scanning DECT system for assessing hemorrhagic transformations of ischemic stroke patients after having received thrombolytic therapy and/or endovascular procedures using MRI as the gold standard. Materials and Methods: A retrospective cohort of 97 ischemic stroke patients underwent DECT imaging within 24 h post-revascularization, followed by MRI within 48 h. Patient hemorrhage types were classified based on the Heidelberg classification using MRI as a ground truth. DECT performance was assessed by calculating sensitivity, specificity, and predictive values for hemorrhage classes. Results: Of the 97 DECT examinations, 25 (25.8%) showed a hyper density in the DECT images compared to 31 (32.0%) hyper densities identified by MRI. DECT achieved 100% sensitivity for larger hemorrhages that impact patient management (class 3) but lower sensitivity (61.0%) for smaller hemorrhages (class 1) with no false positives (100% specificity). Conclusion: Sequential axial scanning DECT offers a reliable and accessible alternative to MRI for detecting clinically significant hemorrhages in acute stroke settings. Its ability to differentiate hemorrhage from contrast staining in a single session supports its integration into routine clinical workflows, enhancing timely decision-making and improving patient care.