Abstract Background and Purpose Accurate differentiation between hemorrhage and iodinated contrast staining is critical for managing ischemic stroke patients following revascularization. While dual‐energy CT (DECT) has shown promise in this context, studies have predominantly focused on dual‐source or fast‐kV switching systems. This study evaluates the diagnostic accuracy of a sequential axial scanning DECT system for assessing hemorrhagic transformations of ischemic stroke patients after having received thrombolytic therapy and/or endovascular procedures using MRI as the gold standard. Materials and Methods A retrospective cohort of 97 ischemic stroke patients underwent DECT imaging within 24 h post‐revascularization, followed by MRI within 48 h. Patient hemorrhage types were classified based on the Heidelberg classification using MRI as a ground truth. DECT performance was assessed by calculating sensitivity, specificity, and predictive values for hemorrhage classes. Results Of the 97 DECT examinations, 25 (25.8%) showed a hyper density in the DECT images compared to 31 (32.0%) hyper densities identified by MRI. DECT achieved 100% sensitivity for larger hemorrhages that impact patient management (class 3) but lower sensitivity (61.0%) for smaller hemorrhages (class 1) with no false positives (100% specificity). Conclusion Sequential axial scanning DECT offers a reliable and accessible alternative to MRI for detecting clinically significant hemorrhages in acute stroke settings. Its ability to differentiate hemorrhage from contrast staining in a single session supports its integration into routine clinical workflows, enhancing timely decision‐making and improving patient care.
Pressram et al. (Thu,) studied this question.