Flat‐panel detector CT to assess intracranial hemorrhage immediately following mechanical thrombectomy

Author:

Inoa Violiza123ORCID,Dornbos David4,DiNitto Julie5,Martineau David67,Sullivan Joseph67,Angel Jacqueline89,Nolan Vikki G.10,Arthur Adam S.12,Hoit Daniel12,Nickele Christopher12,Goyal Nitin12,Elijovich Lucas123

Affiliation:

1. Semmes‐Murphey Clinic Memphis Tennessee USA

2. Department of Neurosurgery The University of Tennessee Health Science Center Memphis Tennessee USA

3. Department of Neurology The University of Tennessee Health Science Center Memphis Tennessee USA

4. Department of Neurosurgery University of Kentucky Lexington Kentucky USA

5. Siemens Medical Solutions Malvern Pennsylvania USA

6. Department of Radiology MidSouth Imaging Memphis Tennessee USA

7. Department of Radiology Baptist Memorial Hospital Memphis Tennessee USA

8. Department of Radiology The University of Tennessee Health Science Center Memphis Tennessee USA

9. Department of Radiology Methodist University Hospital Memphis Tennessee USA

10. Division of Epidemiology Biostatistics and Environmental Health University of Memphis School of Public Health Memphis Tennessee USA

Abstract

AbstractBackground and PurposeThe risk of symptomatic intracranial hemorrhage (ICH) approaches 5% despite mechanical thrombectomy (MT) efficacy for ischemic stroke secondary to large vessel occlusion. Flat‐panel detector CT (FDCT) imaging with Syngo Dyna CT imaging (Siemens Medical Solutions, Malvern, PA) can be used immediately following MT to detect ICH.PurposeTo evaluate the accuracy and reliability of FDCT imaging with Dyna CT compared to conventional post‐MT CT and MRI.MethodsHead FDCT (20 second, 70 kV) was performed immediately following MT on 26 consecutive patients; postprocedural CT or MRI was obtained ∼24 hours later. Two blinded, independent neuroradiologists evaluated all imaging, identifying ICH, stroke, and presence of subarachnoid contrast. Cohen's κ statistic was used to assess interrater agreement for each imaging outcome and compared the FDCT to conventional imaging.ResultsFDCT for ICH demonstrated a strong degree of interrater reliability (κ = 0.896; 95% confidence interval [CI], 0.734‐1.057). Negligible reliability was seen for ischemia determination on immediate post‐MT FDCT (κ = 0.149; 95% CI, –0.243 to 0.541). ICH evaluation between FDCT and post‐MT conventional CT revealed modest interrater reliability (κ = 0.432; 95% CI, –0.100 to 0.965), which did not reach statistical significance. There was no substantive reliability in the evaluation of ICH between FDCT and post‐MT MRI (κ = 0.118, 95% CI, –0.345 to 0.580).ConclusionFDCT, such as Dyna CT, immediately post‐MT is a promising tool that can expedite the detection of ICH with a high degree of reliability, although the detection of ischemic parenchymal changes is limited.

Publisher

Wiley

Subject

Neurology (clinical),Radiology, Nuclear Medicine and imaging

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