Application value of dual-source CT dual-energy scanning mode in early endovascular interventional treatment of acute ischemic stroke_West China Medical Journal

Authors：

ZHANG Ping ,  LI Jie

Department of Neurology, People’s Hospital of Deyang City, Deyang, Sichuan 618000, P. R. China;

Corresponding author：

LI Jie, Email: lijie860114@163.com

Keywords：

Acute ischemic stroke; Endovascular interventional therapy; Dual-source CT dual-energy scan

DOI：

10.7507/1002-0179.202005085

Video：

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Early endovascular interventional therapy can effectively improve the prognosis of patients with acute ischemic stroke. Dual-source CT dual-energy scanning, as a new CT imaging technology developed rapidly in recent years, with its unique technical characteristics and advantages, shows potential and application prospects in early endovascular interventional therapy of acute ischemic stroke. This article discusses the value of dual-source CT dual-energy scanning in the early screening and evaluation, the identification of postoperative iodine contrast agent extravasation and secondary cerebral hemorrhage, and the prediction of prognosis of patients with early endovascular interventional treatment of acute ischemic stroke. The purpose is to provide a theoretical basis for better application of dual-source CT dual-energy scanning in early endovascular interventional treatment of acute ischemic stroke.

Citation： ZHANG Ping, LI Jie. Application value of dual-source CT dual-energy scanning mode in early endovascular interventional treatment of acute ischemic stroke. West China Medical Journal, 2020, 35(6): 719-723. doi: 10.7507/1002-0179.202005085 Copy

1.	Wang W, Jiang B, Sun H, et al. Prevalence, incidence and mortality of stroke in china: results from a nationwide population-based survey of 480, 687 adults. Circulation, 2017, 135(8): 759-771.
2.	Wardlaw JM, Murray V, Berge E, et al. Thrombolysis for acute ischaemic stroke. Cochrane Database Syst Rev, 2014, 29(7): CD000213.
3.	de Los Ríos la Rosa F, Khoury J, Kissela BM, et al. Eligibility for intravenous recombinant tissue-type plasminogen activator within a population: the effect of the European cooperative acute stroke (ECASS) Ⅲ trial. Stroke, 2012, 43(6): 1591-1595.
4.	Zhou M, Wang H, Zhu J, et al. Cause-specific mortality for 240 causes in China during 1990-2013: a systematic subnational analysis for the Global Burden of Disease Study 2013. Lancet, 2016, 387(10015): 251-272.
5.	Heiss WD. Malignant MCA infarction: pathophysiology and imaging for early diagnosis and management decisions. Cerebrovasc Dis, 2016, 41(1/2): 1-7.
6.	Alexandrov AV. Current and future recanalization strategies for acute ischemic stroke. J Intern Med, 2010, 267(2): 209-219.
7.	Nikoubashman O, Jungbluth M, Schürmann K, et al. Neurothrombectomy in acute ischemic stroke: a prospective single-centre study and comparison with a randomized controlled trials. Eur J Neurol, 2016, 23(4): 807-816.
8.	Albers GW, Lansberg MG, Kemp S, et al. A multicenter randomized controlled trial of endovascular therapy following imaging evaluation for ischemic stroke (DEFFUSE 3). Int J Stroke, 2017, 12(8): 896-905.
9.	Goyal M, Demchuk AM, Menon BK, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med, 2015, 372(11): 1019-1030.
10.	郑玲, 顾海峰, 杨刚, 等. 双源 CT 成像技术及其临床应用的新进展. 医学研究生学报, 2008, 21(4): 404-407, 411.
11.	林晓珠, 沈云, 陈克敏. CT 能谱成像的基本原理与临床应用研究进展. 中华放射学杂志, 2011, 45(8): 798-800.
12.	Lenga L, Leithner D, Peterke JL, et al. Comparison of radiation dose and image quality of contrast-enhanced dual-source CT of the chest: single-versus dual-energy and second-versus third generation technology. AJR Am J Roentgenol, 2019, 212(4): 741-747.
13.	沈宓, 王晨, 刘光锐, 等. 国家卒中策略的实施—影像指南. 中国卒中杂志, 2008, 3(11): 845-854.
14.	Rennert RC, Wali AR, Steinberg JA, et al. Epidemiology, nature history, and clinical presentation of large vessel ischemic stroke. Neurosurgery, 2019, 85(suppl_1): S4-S8.
15.	中华医学会神经病学分会, 中华医学会神经病学分会神经血管介入协作组. 急性缺血性脑卒中早期血管内介入治疗流程与规范专家共识. 中华神经科杂志, 2017, 50(3): 172-177.
16.	郭元星, 欧陕兴. 双源 CT 在头颈部血管成像中的应用. 华南国防医学杂志, 2011, 25(2): 173-175.
17.	Postma AA, Hofman PA, Stadler AA, et al. Dual-energy CT of the brain and intracranial vessels. AJR Am J Roentgenol, 2012, 199(5 suppl): S26-S33.
18.	白爱国, 马光慧, 滑炎卿. 双能量 CT 血管造影的应用进展. 中华临床医师杂志 (电子版), 2013, 7(22): 10325-10328.
19.	Chai Y, Xing J, Gao J, et al. Feasibility of virtual nonenhanced images derived from single-source fast kVp-switching dual-energy CT in evaluating gastric tumors. Eur J Radiol, 2016, 85(2): 366-372.
20.	雷智鑫, 邓晓凤. 双源 CT 双能量去骨技术用于头颈部血管成像中的临床价值. 影像研究与医学应用, 2019, 3(2): 228-229.
21.	Uotani K, Watanabe Y, Higashi M, et al. Dual-energy CT head bone and hard plaque removal for quantification of calcified carotid stenosis: utility and comparison with digital subtraction angiography. Eur Radiol, 2009, 19(8): 2060-2065.
22.	Boxerman JL, Jayaraman MV, Mehan WA, et al. Clinical stroke penumbra: use of National Institutes of Health stroke scale as a surrogate for CT perfusion in patient triage for intra-arterial middle cerebral artery stroke therapy. AJNR Am J Neuroradiol, 2012, 33(10): 1893-1900.
23.	Albers GW, Goyal M, Jahan R, et al. Ischemic core and hypoperfusion volumes predict infarct size in SWIFT PRIME. Ann Neurol, 2016, 79(1): 76-89.
24.	Li Z, Li H, Zhang K, et al. Improvement of image quality and radiation dose of CT perfusion of the brain by means of low-tube voltage (70 KV). Eur Radiol, 2014, 24(8): 1906-1913.
25.	Jang YM, Lee DH, Kim HS, et al. The fate of high-density lesions on the non-contrast CT obtained immediately after intra-arterial thrombolysis in ischemic stroke patients. Korean J Radiol, 2006, 7(4): 221-228.
26.	Mokin M, Kan P, Kass-Hout T, et al. Intracerebral hemorrhage secondary to intravenous and endovascular intraarterial revascularization therapies in acute ischemic stroke: an update on risk factors, predictors, and management. Neurosurg Focus, 2012, 32(4): E2.
27.	王震汕, 陈婉琪, 黄伟鹏. 双源 CT 双能量物质分离技术应用现状. 实用放射学杂志, 2019, 35(1): 146-149, 153.
28.	李清, 吴芳, 刘佳宾, 等. 双能 CT 表现及临床相关因素与急性缺血性脑卒中血管内介入治疗后继发脑出血关系的初步研究. 中国急救复苏与灾害医学杂志, 2018, 13(5): 437-441.
29.	Gupta R, Phan C M, Leidecker C, et al. Evaluation of dual-energy CT for differentiating intracerebral hemorrhage from iodinated contrast material staining. Radiology, 2010, 257(1): 205-211.
30.	Tijssen MP, Hofman PA, Stadler AA, et al. The role of dual energy CT in differentiating between brain haemorrhage and contrast medium after mechanical revascularisation in acute ischaemic stroke. Eur Radiol, 2014, 24(4): 834-840.
31.	刘美洲, 刘辉佳, 富彦, 等. 双源双能量 CT 在鉴别急性缺血性脑梗死血运重建术后碘造影剂外渗和继发脑出血中的价值. 实用医学杂志, 2017, 33(15): 2569-2572.
32.	Shi ZS, Duckwiler GR, Jahan R, et al. Early Blood-brain barrier disruption after mechanical thrombectomy in acute ischemic stroke. J Neuroimaging, 2018, 28(3): 283-288.
33.	Renú A, Laredo C, Tudela R, et al. Brain hemorrhage after endovascular reperfusion therapy of ischemic stroke: a threshold-finding whole-brain perfusion CT study. J Cereb Blood Flow Meab, 2017, 37(1): 153-165.
34.	Renú A, Amaro S, Laredo C, et al. Relevance of blood–brain barrier disruption after endovascular treatment of ischemic stroke: dual-energy computed tomographic study. Stroke. Stroke, 2015, 46(3): 673-679.
35.	Chen Z, Zhang Y, Su Y, et al. Contrast extravasation is predictive of poor clinical outcomes in patients undergoing endovascular therapy for acute ischemic stroke in the anterior circulation. J Stroke Cerebrovasc Dis, 2020, 29(1): 104494.
36.	Djurdjevic T, Rehwald R, Knoflach M, et al. Prediction of infarction development after endovascular stroke therapy with dual-energy computed tomography. Eur Radiol, 2017, 27(3): 907-917.

1. Wang W, Jiang B, Sun H, et al. Prevalence, incidence and mortality of stroke in china: results from a nationwide population-based survey of 480, 687 adults. Circulation, 2017, 135(8): 759-771.
2. Wardlaw JM, Murray V, Berge E, et al. Thrombolysis for acute ischaemic stroke. Cochrane Database Syst Rev, 2014, 29(7): CD000213.
3. de Los Ríos la Rosa F, Khoury J, Kissela BM, et al. Eligibility for intravenous recombinant tissue-type plasminogen activator within a population: the effect of the European cooperative acute stroke (ECASS) Ⅲ trial. Stroke, 2012, 43(6): 1591-1595.
4. Zhou M, Wang H, Zhu J, et al. Cause-specific mortality for 240 causes in China during 1990-2013: a systematic subnational analysis for the Global Burden of Disease Study 2013. Lancet, 2016, 387(10015): 251-272.
5. Heiss WD. Malignant MCA infarction: pathophysiology and imaging for early diagnosis and management decisions. Cerebrovasc Dis, 2016, 41(1/2): 1-7.
6. Alexandrov AV. Current and future recanalization strategies for acute ischemic stroke. J Intern Med, 2010, 267(2): 209-219.
7. Nikoubashman O, Jungbluth M, Schürmann K, et al. Neurothrombectomy in acute ischemic stroke: a prospective single-centre study and comparison with a randomized controlled trials. Eur J Neurol, 2016, 23(4): 807-816.
8. Albers GW, Lansberg MG, Kemp S, et al. A multicenter randomized controlled trial of endovascular therapy following imaging evaluation for ischemic stroke (DEFFUSE 3). Int J Stroke, 2017, 12(8): 896-905.
9. Goyal M, Demchuk AM, Menon BK, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med, 2015, 372(11): 1019-1030.
10. 郑玲, 顾海峰, 杨刚, 等. 双源 CT 成像技术及其临床应用的新进展. 医学研究生学报, 2008, 21(4): 404-407, 411.
11. 林晓珠, 沈云, 陈克敏. CT 能谱成像的基本原理与临床应用研究进展. 中华放射学杂志, 2011, 45(8): 798-800.
12. Lenga L, Leithner D, Peterke JL, et al. Comparison of radiation dose and image quality of contrast-enhanced dual-source CT of the chest: single-versus dual-energy and second-versus third generation technology. AJR Am J Roentgenol, 2019, 212(4): 741-747.
13. 沈宓, 王晨, 刘光锐, 等. 国家卒中策略的实施—影像指南. 中国卒中杂志, 2008, 3(11): 845-854.
14. Rennert RC, Wali AR, Steinberg JA, et al. Epidemiology, nature history, and clinical presentation of large vessel ischemic stroke. Neurosurgery, 2019, 85(suppl_1): S4-S8.
15. 中华医学会神经病学分会, 中华医学会神经病学分会神经血管介入协作组. 急性缺血性脑卒中早期血管内介入治疗流程与规范专家共识. 中华神经科杂志, 2017, 50(3): 172-177.
16. 郭元星, 欧陕兴. 双源 CT 在头颈部血管成像中的应用. 华南国防医学杂志, 2011, 25(2): 173-175.
17. Postma AA, Hofman PA, Stadler AA, et al. Dual-energy CT of the brain and intracranial vessels. AJR Am J Roentgenol, 2012, 199(5 suppl): S26-S33.
18. 白爱国, 马光慧, 滑炎卿. 双能量 CT 血管造影的应用进展. 中华临床医师杂志 (电子版), 2013, 7(22): 10325-10328.
19. Chai Y, Xing J, Gao J, et al. Feasibility of virtual nonenhanced images derived from single-source fast kVp-switching dual-energy CT in evaluating gastric tumors. Eur J Radiol, 2016, 85(2): 366-372.
20. 雷智鑫, 邓晓凤. 双源 CT 双能量去骨技术用于头颈部血管成像中的临床价值. 影像研究与医学应用, 2019, 3(2): 228-229.
21. Uotani K, Watanabe Y, Higashi M, et al. Dual-energy CT head bone and hard plaque removal for quantification of calcified carotid stenosis: utility and comparison with digital subtraction angiography. Eur Radiol, 2009, 19(8): 2060-2065.
22. Boxerman JL, Jayaraman MV, Mehan WA, et al. Clinical stroke penumbra: use of National Institutes of Health stroke scale as a surrogate for CT perfusion in patient triage for intra-arterial middle cerebral artery stroke therapy. AJNR Am J Neuroradiol, 2012, 33(10): 1893-1900.
23. Albers GW, Goyal M, Jahan R, et al. Ischemic core and hypoperfusion volumes predict infarct size in SWIFT PRIME. Ann Neurol, 2016, 79(1): 76-89.
24. Li Z, Li H, Zhang K, et al. Improvement of image quality and radiation dose of CT perfusion of the brain by means of low-tube voltage (70 KV). Eur Radiol, 2014, 24(8): 1906-1913.
25. Jang YM, Lee DH, Kim HS, et al. The fate of high-density lesions on the non-contrast CT obtained immediately after intra-arterial thrombolysis in ischemic stroke patients. Korean J Radiol, 2006, 7(4): 221-228.
26. Mokin M, Kan P, Kass-Hout T, et al. Intracerebral hemorrhage secondary to intravenous and endovascular intraarterial revascularization therapies in acute ischemic stroke: an update on risk factors, predictors, and management. Neurosurg Focus, 2012, 32(4): E2.
27. 王震汕, 陈婉琪, 黄伟鹏. 双源 CT 双能量物质分离技术应用现状. 实用放射学杂志, 2019, 35(1): 146-149, 153.
28. 李清, 吴芳, 刘佳宾, 等. 双能 CT 表现及临床相关因素与急性缺血性脑卒中血管内介入治疗后继发脑出血关系的初步研究. 中国急救复苏与灾害医学杂志, 2018, 13(5): 437-441.
29. Gupta R, Phan C M, Leidecker C, et al. Evaluation of dual-energy CT for differentiating intracerebral hemorrhage from iodinated contrast material staining. Radiology, 2010, 257(1): 205-211.
30. Tijssen MP, Hofman PA, Stadler AA, et al. The role of dual energy CT in differentiating between brain haemorrhage and contrast medium after mechanical revascularisation in acute ischaemic stroke. Eur Radiol, 2014, 24(4): 834-840.
31. 刘美洲, 刘辉佳, 富彦, 等. 双源双能量 CT 在鉴别急性缺血性脑梗死血运重建术后碘造影剂外渗和继发脑出血中的价值. 实用医学杂志, 2017, 33(15): 2569-2572.
32. Shi ZS, Duckwiler GR, Jahan R, et al. Early Blood-brain barrier disruption after mechanical thrombectomy in acute ischemic stroke. J Neuroimaging, 2018, 28(3): 283-288.
33. Renú A, Laredo C, Tudela R, et al. Brain hemorrhage after endovascular reperfusion therapy of ischemic stroke: a threshold-finding whole-brain perfusion CT study. J Cereb Blood Flow Meab, 2017, 37(1): 153-165.
34. Renú A, Amaro S, Laredo C, et al. Relevance of blood–brain barrier disruption after endovascular treatment of ischemic stroke: dual-energy computed tomographic study. Stroke. Stroke, 2015, 46(3): 673-679.
35. Chen Z, Zhang Y, Su Y, et al. Contrast extravasation is predictive of poor clinical outcomes in patients undergoing endovascular therapy for acute ischemic stroke in the anterior circulation. J Stroke Cerebrovasc Dis, 2020, 29(1): 104494.
36. Djurdjevic T, Rehwald R, Knoflach M, et al. Prediction of infarction development after endovascular stroke therapy with dual-energy computed tomography. Eur Radiol, 2017, 27(3): 907-917.

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