Contrast Extravasation versus Hemorrhage after Thrombectomy in Patients with Acute Stroke

Journal of Neuroimaging : Official Journal of the American Society of Neuroimaging
Vivek Yedavalli, Steffen Sammet

Abstract

Intra-arterial recanalization postprocedural imaging in stroke patients can result in diagnostic complications due to hyperdensities on noncontrast computed tomography (CT), which may represent either contrast extravasation or intracranial hemorrhage. If these lesions are hemorrhage, then they are risk factors becoming symptomatic, which, if not distinguished, can alter clinical management. We investigate the effects of iodinated contrast on postprocedural magnetic resonance imaging (MRI) and prevalence of equivocal imaging interpretations of postprocedural extravasated contrast versus hemorrhage while identifying protocol pitfalls. We identified 10 patients diagnosed with ischemic stroke who underwent intra-arterial recanalization in a 5-year period. These patients demonstrated a hyperdensity on a postprocedural CT within 24 hours, underwent an MRI within 48 hours, and an additional confirmatory noncontrast CT at least 72 hours postprocedure. Postprocedural MRI in all 10 stroke patients demonstrated T1 - and T2 -relaxation time changes due to residual iodine contrast agents. This lead to false positive postprocedural hemorrhage MRI interpretations in 2/10 patients, 3/10 false negative interpretations of contrast extravasation,...Continue Reading

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Citations

Nov 10, 2018·AJNR. American Journal of Neuroradiology·S Van HedentD Jordan
May 8, 2019·Stroke; a Journal of Cerebral Circulation·Julien PuntonetCatherine Oppenheim
Jul 7, 2019·Current Neurology and Neuroscience Reports·Felix C Ng, Bruce C V Campbell
Feb 29, 2020·Neurosurgery·Rima S RindlerDaniel L Barrow
Jun 9, 2020·Frontiers in Neurology·Håkan AlmqvistMichael V Mazya
May 18, 2017·Journal of Neuroimaging : Official Journal of the American Society of Neuroimaging·Vivek Yedavalli, Steffen Sammet
Sep 30, 2020·Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association·Justin De PreyAlexis N Simpkins
Jul 31, 2021·Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association·Ling LiYunfeng Bao

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