Highlights
- •DE-CTA-derived parameters could be associated with thrombus composition and allow for personalized thrombectomy strategies.
- •The RBC-dominant thrombi showed significantly higher VNC values and lower IC, λHU, and Zeff values than the F/P-dominant thrombi (p < 0.05).
- •The thrombus composition was associated with DE-CTA-derived parameters.
Objectives
We aimed to assess the value of dual-energy computed tomography angiography (DE-CTA)
derived parameters as a quantitative biomarker of thrombus composition in acute ischemic
stroke (AIS).
Methods
AIS patients who underwent DE-CTA before thrombectomy between August 2016 and September
2022 were included in this study. We assessed the relative proportion of red blood
cells (RBCs) and the fibrin/platelet ratio (F/P) of the retrieved clots and categorized
the clots as RBC-dominant (RBCs > F/P) or F/P-dominant (F/P > RBCs). The thrombus
based parameters were measured on polyenergetic images (PEI), virtual monoenergetic
(VM), virtual non-contrast (VNC), iodine concentration (IC), and effective atomic
number (Zeff) images respectively, and the slope of the spectral Hounsfield unit curve (λHU) was
calculated. These parameters were compared in the DE-CTA images of RBC- and F/P-dominant
thrombi. The diagnostic performance of the parameters was analyzed using the ROC curve.
Correlations between thrombus composition and DE-CTA-derived parameters were assessed.
Results
The retrieved clots in 54 of 88 patients (61.36%) were RBC-dominant. The RBC-dominant
thrombi showed significantly higher VNC values and lower IC, λHU, and Zeff values than the F/P-dominant thrombi (p < 0.05). The CT density measured on IC images showed the largest AUC value (AUC,
0.94; sensitivity, 77.78%; specificity, 100.00%). The Spearman rank-order correlation
coefficient values showed that CT density measured on IC images of the thrombus showed
the strongest association with the proportion of RBCs (r = -0.64, p < 0.001) and F/P (r = 0.65, p < 0.001).
Conclusions
DE-CTA-derived parameters, especially the CT density measured on IC images, could
be associated with thrombus composition and allow for personalized thrombectomy strategies.
Key Words
Abbreviations:
λHU (Slope of the spectral Hounsfield unit curve), AIS (Acute ischemic stroke), DE-CTA (Dual-energy computed tomography angiography), F/P (Fibrin/platelet), H&E (Hematoxylin & eosin), IC (Iodine concentration), ICA (Internal carotid artery), ICC (Intraclass correlation coefficient), LVO (Large vessel occlusion), MCA (Middle cerebral artery), PEI (Polyenergetic images), RBC (Red blood cell), VNC (Virtual non-contrast), VM (Virtual monoenergetic), Zeff (Effective atomic number), NCCT (Non-contrast computed tomography), DECT (Dual-energy computed tomography)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 30, 2022
Accepted:
December 13,
2022
Received in revised form:
December 6,
2022
Received:
October 11,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
