The hematoma measurement accuracy of dual-energy computed tomography angiography in spontaneous intracerebral hemorrhage

PURPOSE: To investigate the accuracy of hematoma volume (V), surface area (S), and surface regularity (SR) measured on dual-energy computed tomography angiography (DECTA), using non-contrast computed tomography (NCCT) as the reference standard. METHODS: A total of 129 patients with spontaneous intracerebral hemorrhage (sICH) who underwent both NCCT and DECTA scans were retrospectively studied. Patients were stratified by V: Group 1 ( 60 mL); and by morphology: regular, irregular, and lobular. DECTA data were post-processed to generate conventional computed tomography angiography (CTA) and 60 keV virtual monoenergetic imaging (VMI). These, along with NCCT images, were imported into 3D Slicer software to obtain V and S; SR was subsequently calculated. Deviation percentages (ΔV, ΔS, ΔSR) of conventional CTA and 60 keV VMI relative to NCCT were calculated. We assessed correlations using simple linear regression, compared different modalities with unpaired t-tests or Mann-Whitney U tests, evaluated agreement via Bland-Altman analysis, and compared deviation percentages across groups using one-way analysis of variance or Kruskal-Wallis H tests. Inter-reader consistency was assessed using the intraclass correlation coefficient (ICC). RESULTS: values ≥ 0.085). CONCLUSION: Hematoma volume measurements from DECTA show good agreement with NCCT measurements, suggesting potential utility for follow-up assessment in certain clinical scenarios. However, DECTA-derived SR measurements are significantly lower than those from NCCT. Volume measurement accuracy of conventional CTA was higher for large hematomas (> 60 mL). CLINICAL SIGNIFICANCE: Accurate hematoma measurement is crucial for prognosis and management in sICH. This study indicates that V measurements from DECTA are comparable to those from NCCT in certain clinical scenarios, offering potential added value when CTA is clinically indicated.