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Diagnostic accuracy of dual-energy computed tomography to differentiate intracerebral hemorrhage from contrast extravasation after endovascular thrombectomy for acute ischemic stroke: systematic review and meta-analysis

  • Computed Tomography
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To assess whether dual-energy computed tomography (DECT), using conventional computed tomography or magnetic resonance imaging as a reference standard, is sufficiently accurate to differentiate intracerebral hemorrhage from contrast extravasation after endovascular thrombectomy for acute ischemic stroke.

Methods

On January 20, 2021, we searched the PubMed Medline, Embase, Web of Science, and Cochrane Library databases. QUADAS-2 was used to assess the risk of bias and applicability. Meta-analyses were performed using a bivariate random-effects model. To explore sources of heterogeneity, meta-regression analyses were performed. Deeks’ funnel plot asymmetry test was used to assess publication bias.

Results

A total of 7 studies (269 patients, 269 focal areas) were included. The pooled mean sensitivity, specificity, and accuracy of DECT in identifying intracerebral hemorrhage from contrast extravasation after mechanical thrombectomy for acute ischemic stroke were 0.77 (95% confidence interval (CI) 0.29 to 0.96), 1 (95% CI 0.86 to 1), and 0.99 (95% CI 0.98 to 1), respectively. This evidence was of moderate certainty due to the risk of bias. Higgin’s I-squared for study heterogeneity was observed for the pooled sensitivity (I2 = 78.88%) and pooled specificity (I2 = 82.12%). Moreover, Deeks’ funnel plot asymmetry test revealed no publication bias (p = 0.38).

Conclusion

DECT shows excellent accuracy and specificity in differentiating intracerebral hemorrhage from contrast extravasation after endovascular thrombectomy for acute ischemic stroke. Nevertheless, there was substantial and moderate heterogeneity among the studies. Future large-scale, prospective cohort studies are warranted to validate our findings.

Key Points

• Dual-energy computed tomography shows excellent accuracy and specificity in differentiating intracerebral hemorrhage from contrast extravasation after endovascular thrombectomy for acute ischemic stroke.

• Via meta-regression analysis, we found various possible covariates, including the publication date, image analysis, index test time, time of follow-up imaging, and reference standard judgment, that had an important effect on the heterogeneity.

• There were no concerns regarding applicability in any of the included studies.

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Abbreviations

95% CI:

95% confidence interval

AIS:

Acute ischemic stroke

AUROC:

Area under receiver operating characteristic

BBB:

Blood–brain barrier

CENTRAL:

Cochrane Central Register of Controlled Trials

DECT:

Dual-energy computed tomography

EVT:

Endovascular thrombectomy

Higgin’s I 2 :

Higgins I-squared

HSROC:

Hierarchical summary receiver operating curve

ICH:

Intracranial hemorrhage

QUADAS-2:

Quality assessment for diagnostic studies-2

ROC:

Receiver operating characteristic

VNC:

Virtual non-contrast

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Acknowledgements

We would like to thank Dr. Liao for her guidance on statistical methods. We are grateful for the advice and discussions with our colleagues Shan Deng and HaiPing Huang as well as the anonymous reviewers.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Author notes

  1. Shijian Chen and Jian Zhang contributed equally to this study and share first authorship.

Authors and Affiliations

  1. Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China

    Shijian Chen, Jian Zhang, Xuemei Quan, Yiju Xie, Xuhui Deng & Zhijian Liang

  2. Department of Neurology, Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China

    Yueling Zhang & Shengliang Shi

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  1. Shijian Chen
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Correspondence to Zhijian Liang.

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The scientific guarantor of this publication is Zhijian Liang.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Dr. Liao kindly provided statistical advice for this manuscript. Two of the authors have significant statistical expertise (Dr. Chen and Dr. Zhang).

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was not required because this is a systematic review of published literature.

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• prospective and retrospective

• multicenter study

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Chen, S., Zhang, J., Quan, X. et al. Diagnostic accuracy of dual-energy computed tomography to differentiate intracerebral hemorrhage from contrast extravasation after endovascular thrombectomy for acute ischemic stroke: systematic review and meta-analysis. Eur Radiol 32, 432–441 (2022). https://doi.org/10.1007/s00330-021-08212-1

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  • DOI: https://doi.org/10.1007/s00330-021-08212-1

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