Prediction of infarction development after endovascular stroke therapy with dual-energy computed tomography

After intraarterial recanalisation (IAR), the haemorrhage and the blood-brain barrier (BBB) disruption can be distinguished using dual-energy computed tomography (DECT). The aim of the present study was to investigate whether future infarction development can be predicted from DECT. DECT scans of 20 patients showing 45 BBB disrupted areas after IAR were assessed and compared with follow-up examinations. Receiver operator characteristic (ROC) analyses using densities from the iodine map (IM) and virtual non-contrast (VNC) were performed. Future infarction areas are denser than future non-infarction areas on IM series (23.44 +/- 24.86 vs. 5.77 +/- 2.77; p < 0.0001) and more hypodense on VNC series (29.71 +/- 3.33 vs. 35.33 +/- 3.50; p < 0.0001). ROC analyses for the IM series showed an area under the curve (AUC) of 0.99 (cut-off: < 9.97 HU; p < 0.05; sensitivity 91.18 %; specificity 100.00 %; accuracy 0.93) for the prediction of future infarctions. The AUC for the prediction of haemorrhagic infarctions was 0.78 (cut-off > 17.13 HU; p < 0.05; sensitivity 90.00 %; specificity 62.86 %; accuracy 0.69). The VNC series allowed prediction of infarction volume. Future infarction development after IAR can be reliably predicted with the IM series. The prediction of haemorrhages and of infarction size is less reliable. The IM series (DECT) can predict future infarction development after IAR. Later haemorrhages can be predicted using the IM and the BW series. The volume of definable hypodense areas in VNC correlates with infarction volume.