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Dual-Energy CT in the Evaluation of Intracerebral Hemorrhage of Unknown Origin: Differentiation between Tumor Bleeding and Pure Hemorrhage

Dual-Energy CT in the Evaluation of Intracerebral Hemorrhage of Unknown Origin: Differentiation... BACKGROUND AND PURPOSE: Detection of underlying tumor in patients with unknown-origin acute ICH may be difficult because acute hematoma may mask enhancement of tumor on postcontrast CT. We intended to investigate the clinical utility of DECT in differentiating tumor bleeding from pure ICH. MATERIALS AND METHODS: Using a dual-source CT scanner, we obtained TNC single-energy and postcontrast DECT scans for 56 patients with unknown-origin spontaneous ICH. From the 2 sets of postcontrast DECT images obtained with different tube energy, EA (equivalent to conventional postcontrast CT), VNC, color-coded iodine overlay, fusion images of iodine overlay and VNC images were produced. The diagnostic performances of fusion, EA, and combined EA and TNC images for detecting underlying tumors were compared. RESULTS: Of the 56 patients, 17 had primary or metastatic tumors (18 lesions) and 39 had nontumorous ICH. The sensitivities of fusion, EA, and combined EA and TNC images for detecting brain tumors were 94.4%, 61.1%, and 66.7%, respectively, and their specificities were 97.4%, 92.3%, and 89.7%, respectively. The areas under the ROC curves were 0.964, 0.786, and 0.842, respectively. Overall, the diagnostic performance of fusion images was significantly superior to EA ( P = .006) and combined EA and TNC ( P = .011) images. CONCLUSIONS: DECT may be useful in detecting underlying tumors in patients with unknown-origin ICH. ABBREVIATIONS: AUC area under curve AVM arteriovenous malformation CNR contrast-to-noise ratio DECT dual-energy CT EA enhanced average HU Hounsfield unit ICH intracerebral hemorrhage MPR multiplanar reformation ROC receiver operating characteristic analysis sd standard deviation TNC true noncontrast VNC virtual noncontrast http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

Dual-Energy CT in the Evaluation of Intracerebral Hemorrhage of Unknown Origin: Differentiation between Tumor Bleeding and Pure Hemorrhage

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Publisher
American Journal of Neuroradiology
Copyright
Copyright © 2012 by the American Society of Neuroradiology.
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A2890
pmid
22241388
Publisher site
See Article on Publisher Site

Abstract

BACKGROUND AND PURPOSE: Detection of underlying tumor in patients with unknown-origin acute ICH may be difficult because acute hematoma may mask enhancement of tumor on postcontrast CT. We intended to investigate the clinical utility of DECT in differentiating tumor bleeding from pure ICH. MATERIALS AND METHODS: Using a dual-source CT scanner, we obtained TNC single-energy and postcontrast DECT scans for 56 patients with unknown-origin spontaneous ICH. From the 2 sets of postcontrast DECT images obtained with different tube energy, EA (equivalent to conventional postcontrast CT), VNC, color-coded iodine overlay, fusion images of iodine overlay and VNC images were produced. The diagnostic performances of fusion, EA, and combined EA and TNC images for detecting underlying tumors were compared. RESULTS: Of the 56 patients, 17 had primary or metastatic tumors (18 lesions) and 39 had nontumorous ICH. The sensitivities of fusion, EA, and combined EA and TNC images for detecting brain tumors were 94.4%, 61.1%, and 66.7%, respectively, and their specificities were 97.4%, 92.3%, and 89.7%, respectively. The areas under the ROC curves were 0.964, 0.786, and 0.842, respectively. Overall, the diagnostic performance of fusion images was significantly superior to EA ( P = .006) and combined EA and TNC ( P = .011) images. CONCLUSIONS: DECT may be useful in detecting underlying tumors in patients with unknown-origin ICH. ABBREVIATIONS: AUC area under curve AVM arteriovenous malformation CNR contrast-to-noise ratio DECT dual-energy CT EA enhanced average HU Hounsfield unit ICH intracerebral hemorrhage MPR multiplanar reformation ROC receiver operating characteristic analysis sd standard deviation TNC true noncontrast VNC virtual noncontrast

Journal

American Journal of NeuroradiologyAmerican Journal of Neuroradiology

Published: May 1, 2012

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