# Diagnostic performance of dual-energy CT for differentiating acute intracranial hemorrhage from contrast staining: a systematic review and meta-analysis

## TL;DR

Dual-energy CT is highly accurate at telling the difference between brain bleeding and contrast staining in stroke patients, especially in older people and recent studies.

## Contribution

This study provides a meta-analysis of DECT's diagnostic accuracy for differentiating acute intracranial hemorrhage from contrast staining.

## Key findings

- DECT showed high pooled sensitivity (90%) and specificity (98%) for differentiating AIH from CS.
- Subgroup analysis found better performance in older patients and those with a higher male proportion.
- Recent studies (2015 onwards) showed significantly higher diagnostic accuracy than older studies.

## Abstract

Accurate differentiation between acute intracranial hemorrhage (AIH) and contrast staining (CS) on follow-up computed tomography (CT) scans in patients with acute stroke, particularly after endovascular thrombectomy, is a critical clinical challenge. Dual-energy CT (DECT), with its capability for material decomposition, has emerged as a promising solution. This systematic review and meta-analysis aims to determine the overall diagnostic accuracy of DECT for this crucial distinction.

We conducted a systematic search of PubMed, Embase, the Cochrane Library, and Web of Science from their inception until September 30, 2025. The quality of the included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Diagnostic performance was evaluated by calculating pooled estimates for sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and the area under the summary receiver operating characteristic curve (AUC).

Twelve studies, involving 561 patients and 646 lesions, met the eligibility criteria and were included. The pooled diagnostic performance of DECT for differentiating AIH from CS was as follows: sensitivity, 0.90 (95% CI: 0.79–0.96); specificity, 0.98 (95% CI: 0.94–1.00); PLR, 55.91 (95% CI: 14.64–213.53); NLR, 0.10 (95% CI: 0.04–0.23); DOR, 154.76 (95% CI: 64.55–371.02); and AUC, 0.99 (95% CI: 0.97–0.99). Subgroup analysis revealed that in populations with a male proportion ≥60%, DECT demonstrated higher sensitivity, a lower NLR, and a higher AUC. Studies published in or after 2015 showed a significantly higher AUC than those published before 2015. Additionally, the subgroup of patients aged >65 years had a higher AUC compared to younger age groups.

DECT exhibits high diagnostic performance in differentiating AIH from CS. It shows particularly superior results in populations with a higher proportion of males, in older patients, and in more recent studies. However, the presence of potential publication bias may affect the reliability of these findings, underscoring the need for further high-quality studies for validation.

https://inplasy.com/wp-content/uploads/2025/10/INPLASY-Protocol-8414.pdf, identifier (INPLASY2025100088).