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August 22, 2026American Journal of Neuroradiology

Association between Edema and Contrast Extravasation on Immediate Post-Endovascular Treatment Dual-Energy CT and Final Brain Infarction

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Authors

FPFlorentina M.E. PinckaersMMMax M.G. MentinkMTMaud P.M. Tijssen

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Overview

Cohort study reveals that virtual non-contrast hypodensities best predict brain infarction after endovascular treatment, highlighting the value of dual-energy CT in post-stroke care.

Key Points

  • To determine whether contrast extravasation on iodine overlay maps or hypodensities on virtual non-contrast dual-energy CT reconstructions correlate better with final infarction on follow-up imaging compared to standard mixed-energy CT.
  • Retrospective single-center study screening anterior circulation stroke patients treated with endovascular treatment (EVT) between 2010 and 2019.
  • Included patients who underwent dual-energy CT (DECT) within three hours post-EVT and subsequent follow-up imaging during hospitalization.
  • Assessed ASPECTS for hyperdense contrast extravasation on iodine overlay maps (CE-ASPECTS), hypodensities on virtual non-contrast (VNC-ASPECTS), mixed-energy CT (NCCT-ASPECTS), and follow-up scans (FU-ASPECTS).
  • VNC-ASPECTS hypodensities demonstrated an average sensitivity of 67%, specificity of 85%, positive predictive value of 86%, negative predictive value of 74%, and diagnostic accuracy of 81% (p < .001).
  • Hypodensities on virtual non-contrast reconstructions correlated most strongly with final follow-up brain infarction, whereas contrast extravasation demonstrated only a weak correlation.

Cite This Study

Pinckaers et al. (2026) studied this question.

synapsesocial.com/papers/6a895ec3ca7ade938187cea6https://doi.org/10.3174/ajnr.a9598
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Also Consider

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  1. 1The correlation between CT perfusion deficits and immediate post-endovascular treatment contrast extravasation on dual energy CT in acute ischemic stroke patients2024 · 2 citations
  2. 2Location of the contrast extravasation is important in predicting outcome of anterior circulation stroke patients2024
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  4. 4Post-endovascular therapy contrast extravasation in the mesial temporal region on dual-energy CT is associated with outcome in acute ischemic stroke patients2024 · 1 citations
  5. 5AI-Assisted Edema Map Optimization Improves Infarction Detection in Twin-Spiral Dual-Energy CT2025 · 1 citations