scholarly journals Imaging of Contrast Medium Extravasation in Anticoagulation-Associated Intracerebral Hemorrhage With Dual-Energy Computed Tomography

Stroke ◽  
2013 ◽  
Vol 44 (10) ◽  
pp. 2883-2890 ◽  
Author(s):  
Sae-Yeon Won ◽  
Frieder Schlunk ◽  
Julien Dinkel ◽  
Hulya Karatas ◽  
Wendy Leung ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Intracerebral Hemorrhage ◽  
Contrast Medium ◽  
Dual Energy ◽  
Hematoma Expansion ◽  
Prothrombin Complex Concentrates ◽  
Dual Energy Computed Tomography ◽  
Warfarin Group ◽  
Significant Difference ◽  
Contrast Medium Extravasation

Background and Purpose— Contrast medium extravasation (CE) in intracerebral hemorrhage (ICH) is a marker of ongoing bleeding and a predictor of hematoma expansion. The aims of the study were to establish an ICH model in which CE can be quantified, characterized in ICH during warfarin and dabigatran anticoagulation, and to evaluate effects of prothrombin complex concentrates on CE in warfarin-associated ICH. Methods— CD1-mice were pretreated orally with warfarin, dabigatran, or vehicle. Prothrombin complex concentrates were administered in a subgroup of warfarin-treated mice. ICH was induced by stereotactic injection of collagenase VIIs into the right striatum. Contrast agent (350 μL Isovue 370 mg/mL) was injected intravenously after ICH induction (2–3.5 hours). Thirty minutes later, mice were euthanized, and CE was measured by quantifying the iodine content in the hematoma using dual-energy computed tomography. Results— The optimal time point for contrast injection was found to be 3 hours after ICH induction, allowing detection of both an increase and a decrease of CE using dual-energy computed tomography. CE was higher in the warfarin group compared with the controls ( P =0.002). There was no significant difference in CE between dabigatran-treated mice and controls. CE was higher in the sham-treated warfarin group than in the prothrombin complex concentrates–treated warfarin group ( P <0.001). Conclusions— Dual-energy computed tomography allows quantifying CE, as a marker of ongoing bleeding, in a model of anticoagulation-associated ICH. Dabigatran induces less CE in ICH than warfarin and consequently reduces risks of hematoma expansion. This constitutes a potential safety advantage of dabigatran over warfarin. Nevertheless, in case of warfarin anticoagulation, prothrombin complex concentrates reduce this side effect.

scholarly journals Staging of pulmonary metastases using dual-energy computed tomography after anti-angiogenic therapy

2017 ◽  
Vol 4 (2) ◽  
pp. 74
Author(s):  
Jens-Christian Altenbernd ◽  
Axel Wetter ◽  
Lale Umutlu ◽  
Michael Forsting
Keyword(s):  
Computed Tomography ◽  
Contrast Medium ◽  
Pulmonary Metastases ◽  
Small Cell Lung Carcinoma ◽  
Therapy Response ◽  
Dual Energy ◽  
Rank Test ◽  
Time Interval ◽  
Cell Lung Carcinoma ◽  
Dual Energy Computed Tomography

Objective: The aim of this study was the evaluation of dual-energy computed tomography (DECT) for the assessment of pulmonary metastases (PM) after antiangiogentic therapy (AT).Material and methodology: A total of 82 patients with non-small cell lung carcinoma (NSCLC), colorectal cancer (CRC), gastrointestinal stromal tumors (GIST) and hepatocellular carcinoma (HCC) were examined before and after AT with  DECT of the lung. The number, size, CT densities (HU) of the PM were determined by 2 radiologists in consens in both DECT. The Wilcoxon sign rank test was applied (SPSS, version 21, SPSS, IBM, Chicago, USA).Results: The 82 patients (NSCLC: 32/82; CRC: 34/82; GIST: 10/82; HCC: 6/82) with a total of 201 PM were included. DECT were produced with a time interval of 4 $\pm$ 1 months. Size changes of the metastases: PM total 23 mm vs. 24 mm; p = .1/ NSCLC 22 mm vs. 23 mm; p = .2/ CRC 23 mm vs. 23 mm; p = .3/ GIST 24 mm vs. 25 mm; p = .1/ HCC 22 mm vs. 21 mm; p = .1. Contrast media in the course: PM total 45 HU vs. 25 HU; -44%; p < .05/ NSCLC 43 HU vs. 22 HU; -49%; p < .05/CRC 33 HU vs. 15 HU; -55%; p < .05/ GIST 45 HU vs. 24 HU; 47%; p < .05/HCC 62 HU vs. 43 HU; -31%, p < .05.Conclusions: The quantification of the contrast medium uptake of pulmonary metastases is valid by using dual-energy imaging. In this way, the therapy response according to antiangiogenetic therapy with regard to the contrast medium uptake can be assessed more precisely without native imaging in addition to changes in the size of the metastases.

scholarly journals Intra- and inter-observer agreement and reliability of bone mineral density measurements around acetabular cup: a porcine ex-vivo study using single- and dual-energy computed tomography

2017 ◽  
Vol 6 (7) ◽  
pp. 205846011771974 ◽  
Author(s):  
Bo Mussmann ◽  
Søren Overgaard ◽  
Trine Torfing ◽  
Morten Bøgehøj ◽  
Oke Gerke ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Bone Density ◽  
Dual Energy ◽  
Observer Agreement ◽  
Acetabular Cup ◽  
Mineral Density ◽  
Metal Artifacts ◽  
Dual Energy Computed Tomography ◽  
Observer Reliability ◽  
Significant Difference

Background Periprosthetic bone loss is considered to be a potentially contributing factor in aseptic loosening of acetabular hip components, but no studies have shown this association. The lack of association might be caused by insufficient image quality because of metal artifacts and challenges in measuring bone density (BMD) in complex anatomic structures which might be overcome using dual-energy computed tomography (DECT). Purpose To test inter- and intra-observer agreement and reliability of in-house segmentation software measuring BMD adjacent to acetabular cup and to compare measurements performed with single-energy CT (SECT) and DECT in cemented and cementless cups. Material and Methods Twenty-four acetabular cups inserted in porcine hip specimens were scanned with SECT and DECT. Bone density was measured in a three-dimensional volume adjacent to the cup. Double measurements were performed. Results BMD derived from SECT was approximately four times higher than that of DECT. In both scan modes, intraclass correlation coefficient (ICC) was >0.90 with no differences between repeated measurements, except for uncemented cups where a statistically significant difference of 11 mg/cm3 was found with DECT. DECT showed narrower limits of agreement than SECT. Inter-observer analysis showed small differences. Conclusion BMD can be estimated with high intra- and inter-observer reliability with SECT and DECT around acetabular cups using custom software. The intra- and inter-observer agreement of DECT is superior to that of SECT and better in the cementless concept. Good intra- and inter-observer reliability can be obtained in both cemented and cementless cups using the segmentation software. SECT and DECT cannot be used interchangeably.

scholarly journals Comparison of Black Hole Sign, Satellite Sign, and Iodine Sign to Predict Hematoma Expansion in Patients with Spontaneous Intracerebral Hemorrhage

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Milind Ratna Shakya ◽  
Fan Fu ◽  
Miao Zhang ◽  
Yi Shan ◽  
Fan Yu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Black Hole ◽  
Intracerebral Hemorrhage ◽  
Odds Ratio ◽  
Predictive Accuracy ◽  
Characteristic Curve ◽  
Receiver Operator Characteristic Curve ◽  
Hematoma Expansion ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Significant Difference

Purpose. To discretely and collectively compare black hole sign (BHS) and satellite sign (SS) with recently introduced gemstone spectral imaging-based iodine sign (IS) for predicting hematoma expansion (HE) in spontaneous intracerebral hemorrhage (SICH). Methods. This retrospective study includes 90 patients from 2017 to 2019 who underwent both spectral computed tomography angiography (CTA) as well as noncontrast computed tomography (NCCT) within 6 hours of SICH onset along with subsequent follow-up NCCT scanned within 24 hours. We named the presence of any of BHS or SS as any NCCT sign. Two independent reviewers analyzed all the HE predicting signs. Receiver-operator characteristic curve analysis and logistic regression were performed to compare the predictive performance of HE. Results. A total of 61 patients had HE, out of which IS was seen in 78.7% (48/61) while BHS and SS were seen in 47.5% (29/61) and 41% (25/61), respectively. The area under the curve for BHS, SS, and IS was 63.4%, 67%, and 82.4%, respectively, while for any NCCT sign was 71.5%. There was no significant difference between IS and any NCCT sign ( P = 0.108 ). Multivariate analysis showed IS (odds ratio 68.24; 95% CI 11.76-396.00; P < 0.001 ) and any NCCT sign (odds ratio 19.49; 95% CI 3.99-95.25; P < 0.001 ) were independent predictors of HE whereas BHS (odds ratio 0.34; 95% CI 0.01-38.50; P = 0.534 ) and SS (odds ratio 4.54; 95% CI 0.54-38.50; P = 0.165 ) had no significance. Conclusion. The predictive accuracy of any NCCT sign was better than that of sole BHS and SS. Both any NCCT sign and IS were independent predictors of HE. Although IS had higher predictive accuracy, any NCCT sign may still be regarded as a fair predictor of HE when CTA is not available.

scholarly journals Dual-Energy CT Angiography Improves Accuracy of Spot Sign for Predicting Hematoma Expansion in Intracerebral Hemorrhage

2021 ◽  
Vol 23 (1) ◽  
pp. 82-90
Author(s):  
Michaël T.J. Peeters ◽  
Kim J.D. de Kort ◽  
Rik Houben ◽  
Wouter J.P. Henneman ◽  
Robert J. van Oostenbrugge ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Intracerebral Hemorrhage ◽  
Diagnostic Accuracy ◽  
Dual Energy ◽  
Hematoma Expansion ◽  
Dual Energy Ct ◽  
Spot Sign ◽  
Poor Outcome ◽  
Fusion Images ◽  
Delayed Phase

Background and Purpose Spot sign (SS) on computed tomography angiography (CTA) is associated with hematoma expansion (HE) and poor outcome after intracerebral hemorrhage (ICH). However, its predictive performance varies across studies, possibly because differentiating hyperdense hemorrhage from contrast media is difficult. We investigated whether dual-energy-CTA (DE-CTA), which can separate hemorrhage from iodinated contrast, improves the diagnostic accuracy of SS for predicting HE.Methods Primary ICH patients undergoing DE-CTA (both arterial as well as delayed venous phase) and follow-up computed tomography were prospectively included between 2014 and 2019. SS was assessed on both arterial and delayed phase images of the different DE-CTA datasets, i.e., conventional-like mixed images, iodine images, and fusion images. Diagnostic accuracy of SS for prediction of HE was determined on all datasets. The association between SS and HE, and between SS and poor outcome (modified Rankin Scale at 3 months ≥3) was assessed with multivariable logistic regression, using the dataset with highest diagnostic accuracy.Results Of 139 included patients, 47 showed HE (33.8%). Sensitivity of SS for HE was 32% (accuracy 0.72) on conventional-like mixed arterial images which increased to 76% (accuracy 0.80) on delayed fusion images. Presence of SS on delayed fusion images was independently associated with HE (odds ratio [OR], 17.5; 95% confidence interval [CI], 6.14 to 49.82) and poor outcome (OR, 3.84; 95% CI, 1.16 to 12.73).Conclusions Presence of SS on DE-CTA, in particular on delayed phase fusion images, demonstrates higher diagnostic performance in predicting HE compared to conventional-like mixed imaging, and it is associated with poor outcome.

Single-Source Dual-Energy Computed Tomography Detects Disk Injury in Patients with Vertebral Fractures

2019 ◽  
Author(s):  
Torsten Diekhoff ◽  
Michael Fuchs ◽  
Nils Engelhard ◽  
Kay-Geert Hermann ◽  
Michael Putzier ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Vertebral Fractures ◽  
Dual Energy ◽  
Single Source ◽  
Dual Energy Computed Tomography

Dual energy computed tomography angiography of a pulmonary embolized port catheter fragment

2011 ◽  
Vol 12 (1) ◽  
pp. 62-63 ◽  
Author(s):  
Thomas Henzler ◽  
Steffen Diehl ◽  
Susanne Jochum ◽  
Tim Sueselbeck ◽  
Stefan O Schoenberg ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Computed Tomography Angiography ◽  
Dual Energy ◽  
Port Catheter ◽  
Dual Energy Computed Tomography
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