ARRS 2022 Abstracts

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E1446. Hemorrhage versus Contrast: A Simplified Approach to Dual-Energy CT
Authors
  1. Wisam Witwit; Yale New Haven Hospital
  2. Christian Pedersen; Yale New Haven Hospital
  3. Mariam Aboian; Yale New Haven Hospital
  4. Ichiro Ikuta; Yale New Haven Hospital
Background
Dual-energy CT provides tissue characterization and differentiation by analyzing the different attenuation of tissues at different photons energy levels. One important implication of dual-energy CT is the differentiation between hemorrhage and iodine contrast.

Educational Goals / Teaching Points
Dual-energy CT helps differentiate between traumatic hemorrhage versus tumor enhancement in an intrinsically hyperattenuating neoplasm in a trauma setting.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
A 50-year-old male with a new diagnosis of brain tumor (glioblastoma grade IV, IDH positive, MGMT unmethylated) presented due to trauma with dangerous mechanism during his hospital stay. Initial noncontrast CT head scan obtained 1 day earlier demonstrated a large intra-axial tumor involving both frontal lobes with mixed hyperattenuating areas of hypercellularity and hypoattenuating necrotic areas. Noncontrast dual-energy CT head virtual monoenergetic images (VMI) following severe head trauma demonstrated new areas of increased attenuation within the tumor. These hyperattenuating areas were suspicious for hemorrhage within the tumor. Iodine map (IOM) demonstrated orange hue overlying the new areas of increased attenuation, indicating increased iodine contrast concentration in these areas; a note was made of a preceding CTA chest (with IV contrast) scan for full trauma assessment 3 hours earlier. Virtual non-contrast (VNC) images showed increased attenuation of the intra-axial mass suggestive of increased cellularity, similar to initial noncontrast CT head images. Accordingly, dual-energy CT confirmed that the increased post-traumatic hyperattenuating areas are from tumoral hypercellularity and recent contrast injection rather than new traumatic hemorrhage. MRI images obtained the next day confirmed regions of contrast enhancement corresponded to regions of increased attenuation on CT. Accordingly, dual-energy CT confirmed that the increased post-traumatic hyperattenuating areas are from tumoral hypercellularity and recent contrast injection rather than new traumatic hemorrhage. MRI images obtained the next day confirmed regions of contrast enhancement corresponding to regions of increased attenuation on CT.

Conclusion
Dual-energy CT is an appropriate tool to differentiate tumor hypercellularity and contrast enhancement from hemorrhage within a tumor in a trauma setting.