Increased Multispectral CT Iodine Concentrations in Patients With Transient Neurological Deterioration Following Endovascular Neurointerventional Procedures: an Argument in Favor of the Elusive Contrast-Induced Encephalopathy?
Complication
Contrast-induced encephalopathy (CIE)
Dual-energy computed tomography (DECT)
Neuroendovascular procedures
Vascular territories
Journal
Clinical neuroradiology
ISSN: 1869-1447
Titre abrégé: Clin Neuroradiol
Pays: Germany
ID NLM: 101526693
Informations de publication
Date de publication:
12 Aug 2024
12 Aug 2024
Historique:
received:
01
12
2023
accepted:
26
06
2024
medline:
13
8
2024
pubmed:
13
8
2024
entrez:
12
8
2024
Statut:
aheadofprint
Résumé
So-called contrast-induced encephalopathy (CIE) is a rare but worrying condition occurring after cerebral angiography or neuroendovascular interventions using iodine contrast media. This study aimed to compare cerebral iodine concentrations in patients suspected of having CIE after endovascular procedures to those in matched controls. This is a retrospective monocentric study of 25 suspected CIE patients in a tertiary care teaching hospital diagnosed from June 2017 to February 2024. Cerebral multispectral computed tomography (CT) iodine mean concentrations were measured and compared with 1:1 matched controls using the CT constructor's workstation in the whole brain and in specific regions of interest (ROIs) corresponding to a vascular territory downstream of the procedure. Concentration values were compared with paired samples t‑test. During the study period, 1097 patients underwent aneurysm embolization and 137 arteriovenous malformation (AVM) embolization procedures. So-called CIE was suspected in 25 patients after aneurysm or AVM embolization (2%). Mean iodine concentrations in the procedure vascular territory ROIs were higher in suspected CIE cases (mean 543 ± 147 µg/cm CIE may be associated with modest increase in CT iodine concentration in the procedure vascular territory after neurointerventional procedures. The underlying pathophysiology of this condition remains uncertain and merits further investigation. Contrast-induced encephalopathy (CIE) is known as a rare neurologic condition following iodine contrast media use in neuroendovascular interventions, with unclear pathophysiology. This study provides evidence that suspected CIE is associated with higher cerebral iodine concentrations in affected vascular territories, a novel quantifiable change. Implications for research, practice, or policy: These findings suggest the potential for iodine concentration monitoring to refine CIE diagnosis and prevention strategies in clinical practice.
Sections du résumé
BACKGROUND AND PURPOSE
OBJECTIVE
So-called contrast-induced encephalopathy (CIE) is a rare but worrying condition occurring after cerebral angiography or neuroendovascular interventions using iodine contrast media. This study aimed to compare cerebral iodine concentrations in patients suspected of having CIE after endovascular procedures to those in matched controls.
METHODS
METHODS
This is a retrospective monocentric study of 25 suspected CIE patients in a tertiary care teaching hospital diagnosed from June 2017 to February 2024. Cerebral multispectral computed tomography (CT) iodine mean concentrations were measured and compared with 1:1 matched controls using the CT constructor's workstation in the whole brain and in specific regions of interest (ROIs) corresponding to a vascular territory downstream of the procedure. Concentration values were compared with paired samples t‑test.
RESULTS
RESULTS
During the study period, 1097 patients underwent aneurysm embolization and 137 arteriovenous malformation (AVM) embolization procedures. So-called CIE was suspected in 25 patients after aneurysm or AVM embolization (2%). Mean iodine concentrations in the procedure vascular territory ROIs were higher in suspected CIE cases (mean 543 ± 147 µg/cm
CONCLUSIONS
CONCLUSIONS
CIE may be associated with modest increase in CT iodine concentration in the procedure vascular territory after neurointerventional procedures. The underlying pathophysiology of this condition remains uncertain and merits further investigation.
KEY MESSAGES
CONCLUSIONS
Contrast-induced encephalopathy (CIE) is known as a rare neurologic condition following iodine contrast media use in neuroendovascular interventions, with unclear pathophysiology.
WHAT THIS STUDY ADDS
CONCLUSIONS
This study provides evidence that suspected CIE is associated with higher cerebral iodine concentrations in affected vascular territories, a novel quantifiable change. Implications for research, practice, or policy: These findings suggest the potential for iodine concentration monitoring to refine CIE diagnosis and prevention strategies in clinical practice.
Identifiants
pubmed: 39134672
doi: 10.1007/s00062-024-01438-8
pii: 10.1007/s00062-024-01438-8
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.
Références
Li M, et al. Risk factors of transient cortical blindness after cerebral angiography: a multicenter study. Front Neurol. 2019;10:1005.
doi: 10.3389/fneur.2019.01005
pubmed: 31620076
pmcid: 6759592
Meijer FJA, et al. Contrast-induced encephalopathy-neuroimaging findings and clinical relevance. Neuroradiology. 2022;64(6):1265–8.
doi: 10.1007/s00234-022-02930-z
pubmed: 35290482
pmcid: 9117370
Diamandis E, Swiatek VM, Behme D. Fully reversible contrast-induced encephalopathy mimicking stroke after flow diverter treatment of carotid cave aneurysm. Neurointervention. 2023;18(1):58–62.
doi: 10.5469/neuroint.2022.00353
pubmed: 36420561
Chu YT, et al. Contrast-induced encephalopathy after endovascular thrombectomy for acute Ischemic stroke. Stroke. 2020;51(12):3756–9.
doi: 10.1161/STROKEAHA.120.031518
pubmed: 33121385
Junck L, Marshall WH. Neurotoxicity of radiological contrast agents. Ann Neurol. 1983;13(5):469–84.
doi: 10.1002/ana.410130502
pubmed: 6347033
Jacobsen MC, et al. Dual-energy CT: lower limits of iodine detection and quantification. Radiology. 2019;292(2):414–9.
doi: 10.1148/radiol.2019182870
pubmed: 31237496
Mulé S, et al. Can dual-energy CT replace perfusion CT for the functional evaluation of advanced hepatocellular carcinoma? Eur Radiol. 2018;28(5):1977–85.
doi: 10.1007/s00330-017-5151-y
pubmed: 29168007
Harada Y, et al. Pearls & Oy-sters: contrast-induced encephalopathy following coronary angiography: a rare stroke mimic. Neurology. 2020;94(23):e2491–e4.
doi: 10.1212/WNL.0000000000009590
pubmed: 32381554
Spina R, et al. Contrast-induced encephalopathy following cardiac catheterization. Catheter Cardiovasc Interv. 2017;90(2):257–68.
doi: 10.1002/ccd.26871
pubmed: 27896904
Sim SY, Shin YS. Silent microembolism on diffusion-weighted MRI after coil embolization of cerebral aneurysms. Neurointervention. 2012;7(2):77–84.
doi: 10.5469/neuroint.2012.7.2.77
pubmed: 22970416
pmcid: 3429848
Kim KH, et al. Risk factor analyses of contrast leakage and contrast-induced encephalopathy following coil embolization for unruptured intracranial aneurysm. J Neurointerv Surg. 2023;.
Al-Hussain F, et al. Incidence of silent Ischemic infarct after diagnostic conventional cerebral angiogram. J Coll Physicians Surg Pak. 2021;31(3):314–7.
doi: 10.29271/jcpsp.2021.03.314
pubmed: 33775022