Prediction Of Intracerebral Hemorrhage After Endovascular Treatment Of AIS:Combining Quantitative Parameters On Dual-energy CT And Clinical Related Factors

Objective: To evaluate the predictive value of dual-energy computed tomographic(DECT)quantitative parameters for intracerebral hemorrhage(ICH)complications in patients with parenchymal hyperdensity area(HDA)after endovascular treatment of acute ischemic stroke(AIS);and to explore the clinical influence factors of ICH complications in such patients.Methods: Seventy-two consecutive patients with parenchymal hyperdensity who underwent brain DECT immediately after endovascular treatment for AIS from November 2017 to October 2019 were included,and DECT data of all patients were retrospectively analyzed.Retrospectively,two radiologists blinded to any clinical information independently evaluated DECT images of all patients for the distribution of HDA and for the presence of Contrast staining(CS)and early hemorrhage.The volumes(ml)of parenchymal HDA in mixed image and the apparent maximum iodine concentration(mg/ml),maximum CT value(HU)in iodine overlap image were measured.All patients were divided into ICH group and non-ICH group according to whether ICH complications occurred in postoperative follow-up CT or magnetic resonance imaging(MRI)susceptibility weighed imaging series(SWI)imagings(24-72 h).Then ICH group was divided into early ICH group and delayed ICH group according to DECT imagings.The following variables were collected by the third radiologist: gender,age,preoperative NIHSS score,ASPECT score of based-line non-contrast CT(NCCT),previous intravenous thrombolytic therapy,site of vessel occlusion,time from symptom onset to vascular recanalization and interventional puncture to vascular recanalization.Chi-square test or Fisher's exact test and Mann-Whitney U test were used to analyze the differences of DECT parameters and other clinically relevant factors among each group.The receiver operating characteristic(ROC)curve was used to analyze the quantitative parameters of DECT and clinical counting data for obtaining the cut-off value of predicting ICH.Multifactor logistics regression analysis was used to analyze the clinical influencing factors of ICH in patients with cerebral parenchyma HDA after endovascular treatment of AIS.Results:1.Forty of 72 patients(55.6%)developed ICH on postoperative,while 32 patients(44.4%)did not.In the ICH group,18 patients(45%)showed early ICH immediately after endovascular treatment,and 22 patients(55%)developed delayed ICH as confirmed by CT/SWI.postoperative follow-up images showed that 100%(18/18)of patients with early ICH and 40.7%(22/54)of patients with early non-ICH showed increased intracerebral hemorrhage range and secondary intracerebral hemorrhage.2.There was no significant difference in DECT quantitative parameters between early ICH group and delayed ICH group(P>0.05).The volume of the parenchymal HDA,apparent maximum iodine concentration and maximum CT value between ICH group and non-ICH group were significantly different(P<0.001).The median values of them were 22.03 m L and 1.8 m L,3.8 mg/m L and 1.43 mg/m L,154 HU and 90 HU,respectively.Area under the curve(AUC)of ROC showed areas of 0.909,0.859 and 0.842,respectively,for identifying patients developing intracerebral hemorrhage.The HDA volume in the mixed map was greater than 9.12 ml(sensitivity is 82.5%,specificity is 90.6%),the apparent maximum iodine concentration in the IOM was greater than 1.93 mg/m L(sensitivity is 87.5%,specificity is 68.7%),and the maximum CT value was greater than 123 HU(sensitivity is 70%,specificity is 84.4%),respectively,were used as the cut-off values for postoperative ICH complications(P<0.001).3.There was a statistical difference in ASPECT scores of based-line NCCT between early ICH group and delayed ICH group(P<0.05);the rest of clinical datas were not statistically different(P>0.05).Comparison of clnical datas between ICH group and non-ICH group showed statistically significant differences in preoperative NIHSS score and ASPECT score,time from symptom onset to recanalization,and site of parenchymal hyperdensity(P<0.05);gender,age,previous intravenous thrombolytic therapy,site of vessel occlusion,time from interventional puncture to vascular recanalization were not statistically different(P>0.05).Logistic regression analysis showed that preoperative NIHSS score(OR=1.248;95% CI,0.941-0.977),ASPECT score of based-line NCCT(OR=0.156;95% CI,0.057-0.421)were independent influencing factors of ICH in HDA patients after endovascular treatment of AIS.Conclusions:1.Three quantitative parameters of DECT immediately after endovascular therapy for AIS,namely,HDA volume in mixed map,maximum iodine concentration and maximum CT value in IOM,maybe can help identify patients with high risk of ICH development,Which may contribute to better clinical decision-making and postoperative management and minimize hemorrhagic complications.2.Preoperative high NIHSS score and low ASPECT score were independent risk factors for ICH complications in AIS patients with HDA after endovascular therapy.Moreover,the time from symptom onset to vascular recanalization also played a role in ICH development.It is necessary to observe these patients in order to improve the prognosis.3.Compared with single-energy CT,DECT could provide additional diagnostic information to help radiologists identify patients at high risk of ICH after endovascular treatment of AIS,thereby preventing the occurrence of ICH and guiding clinical treatment.4.The combination of imaging and clinical data may help clinicians better predict ICH,so as to prevent the emergence of ICH and guide clinical treatment.