Article Figures & Data
Figures
- FIG 1.
Flow chart of the steps involved in patient inclusion and exclusion.
- FIG 2.
Examples of ROIs drawn on axial, coronal, and sagittal iodine overlay maps.
- FIG 3.
A 75-year-old woman with an ASPECTS of 7 on preprocedural CT (A). B, C, and D, Left M2 middle trunk occlusion with modified TICI 3 recanalization. E, Simulated conventional 120 kV(peak) images show hyperattenuation involving the left basal ganglia and temporal, frontal, and parietal lobes. F, Iodine overlay maps show contrast staining, with the AIIC (2.4 mg I/mL) and NICR (151.9%), respectively. G, Virtual noncontrast CT reveals no hemorrhage signs. H, Contrast staining resolved on 36-hour follow-up CT. Her 90-day mRS score was 4.
- FIG 4.
An 80-year-old man with an ASPECTS of 7 on admission CT (A). B, C, and D, Left M1 occlusion with modified TICI 3 recanalization. E, Simulated conventional 120 kV(p) images show contrast staining involving the left basal ganglia and temporal lobe. F, Iodine overlay maps show contrast staining, with the AIIC (4.9 mg I/mL) and the NICR (317.3%), respectively. G, Virtual noncontrast CT shows no hemorrhage signs in the area with hyperattenuation in simulated conventional 120 kV(p) images. H, Parenchymal hematoma type 2 develops with a marked midline shift on 24-hour follow-up CT. The patient died 6 days after recanalization (mRS score of 6).
- FIG 5.
The NICR shows a strong correlation with the absolute intracerebral iodine concentration.
Tables
Single-Source CT Dual-Energy CT Scanner Somatom Emotion 16 Somatom FORCE Manufacturer Siemens Siemens Scanning mode Spiral Spiral Scanning direction Caudal-cranial Caudal-cranial kV(p) (kV) 110 80/Sn 150 Reference mAs 240 310/207 Collimation (mm) 16 × 0.6 192 × 0.6 Section thickness (mm) 5 1 Rotation time (sec) 0.6 1 Pitch 0.65 0.7 CARE Dose 4Da On On Reconstruction (A + B) Kernel H41s medium+ Hr40 Iterative algorithm NA ADMIRE 2 Note:—ADMIRE indicates advanced modeled iterative reconstruction; NA, not applicable.
↵a Siemens.
- Table 2:
Univariate analysis of patients’ baseline characteristics in cohorts with iodine staining without and with ICH (n = 95)
Patient Characteristics No Hemorrhage (n = 58) Hemorrhage (n = 37) P Value Age (mean) (SD) (yr) 68 (12.1) 67.7 (11.6) .897a Male sex (No.) (%) 28 (48.3%) 19 (51.3%) .770b History of hypertension (No.) (%) 28 (48.3%) 18 (48.6%) .972b History of diabetes mellitus (No.) (%) 13 (22.4%) 17 (45.9%) .016b History of atrial fibrillation (No.) (%) 28 (48.3%) 12 (32.4%) .105b MT duration (median) (IQR) (min) 70 (55–95) 60 (46–90) .310c Time of symptom onset to puncture (median) (IQR) (min) 200 (144–313) 230 (178–343) .169c ASPECTS (median) (IQR) 8 (7–9) 8 (7–9) .348c Baseline NIHSS (mean) (SD) 16 (6) 19 (7) .067a rLMC (mean) (SD) 11.8 (4.3) 9.4 (4.6) .01a Platelet count (median) (IQR) (109/L) 133.8 (96.7–175.4) 130 (100.3–167.9) .694c hs-CRP (median) (IQR) (mg I/L) 8.4 (1.2–45.3) 6.9 (0.5–41.2) .904c Occlusion site ICA occlusion (No.) (%) 15 (25%) 13 (31.5% .334b M1 trunk occlusion (No.) (%) 30 (51.7%) 18 (48.6%) .770b M2 trunk occlusion (No.) (%) 13 (22.4%) 6 (16.2%) .461b Thrombectomy devices Solitaired 13 (22.4%) 8 (21.6%) .983b Sofiae+Aperiof 13 (22.4%) 10 (27%) .609b Aperio 20 (34.5%) 14 (37.8%) .739b Sofia 12 (20.7%) 5 (13.5%) .374b Attempts of aspiration or stent retriever (median) (IQR) 1 (1–1) 1 (1-1) .840c Antiplatelet therapy (No.) (%) 39 (67.2) 25 (67.6) .974b Thrombolytic therapy (No.) (%) 12 (20.7) 7 (18.9) .833b Anticoagulant therapy (No.) (%) 12 (20.7) 6 (16.2) .587b Statin treatment (No.) (%) 29 (50) 24 (64.9) .155b DECT Parameters Follow-up CT No ICH ICH P Value AIIC (median) (IQR) (mg I/mL) 2.0 (1.7–4.5) 5.9 (2.7–11.4) <.001 NICR (median) (IQR) (%), 144.5 (105.8–221.0) 330.6 (181.8–703.3) <.001 90-Day mRS (4–6) (%) 30.2 (29/96) 57.1 (24/42) .003 - Table 4:
AIIC and NICR parameters in terms of the hemorrhage classification on the follow-up CT
AIIC (Median) (IQR) (mg I/mL) P Value NICR (Median) (IQR) (%) P Value HI (HI1+HI2) 4.2 (2.3–9.9) .258 252.8 (186.8–611.2) .465 PH (PH1+PH2) 8.3 (2.8–11.4) 429.8 (182.1–716.9) HI +PH1 3.7 (2.1–8.9) .024 248.2 (164.6–468.7) .08 PH2 9.3 (4.9–13.3) 455.3 (218.4–801.3) Note:—HI indicates hemorrhagic infarction; PH, parenchymal hematoma.
