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Is It Intracranial Hemorrhage? A Case-Based Approach to Confident Determination Using Dual-Energy CT

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Is It Intracranial Hemorrhage? A Case-Based Approach to Confident Determination Using Dual-Energy CT
Description & Learning Objectives
Differentiating acute hemorrhage from hyperattenuating mimics remains a common problem in neuroradiology practice. High atomic number materials such as iodine, calcium, and silicone oil can be similar in attenuation to acute blood products, depending on their concentration. Dual-energy CT allows differentiation of hemorrhage from these high atomic number materials because of the differential absorption of x-ray photons at different incident energies. The primary purpose of this case review is to illustrate how to confidently and efficiently use 190-keV virtual monoenergetic images and material decomposition maps in routine neuroradiology practice when the differential diagnosis includes hemorrhage versus a high atomic number hyperattenuating mimic. We review the underlying physics of dual-energy CT, the primary output of dual-energy postprocessing, as well as pitfalls.

Upon completion of this activity, participants will gain strategies to learn how to use dual-energy CT to confidently and efficiently differentiate acute hemorrhage and hyperattenuating mimics (eg, calcification or iodinated contrast).
Instructions for Participation
To complete this activity, learners will read an article and submit a course evaluation. Once all elements are completed, a certificate will be automatically added to your transcript.
Credit Dates
Available: 8/10/2023
Expires: 8/9/2026
Planners & Faculty
ASNR would like to thank the following individuals for reviewing this article.
Joshua Nickerson, Editor in Chief
Robert Quencer, Consulting Editor
Toshio Moritani, Associate Editor
Meng Law, Associate Editor
Edward Escott, Associate Editor
Levi Chazen, Associate Editor
Scott Faro, Associate Editor
Susan Palasis, Associate Editor
Katyucia de Macedo Rodriguez, Associate Editor
Accreditation Statement
The American Society of Neuroradiology is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The American Society of Neuroradiology designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Disclosure
In compliance with ACCME requirements and guidelines, ASNR has developed a policy for disclosure and review of potential conflicts of interest and a method for resolution if a conflict does exist. ASNR maintains a tradition of scientific integrity and objectivity in its educational activities. In order to preserve these values and ensure its educational activities are independent and free of commercial bias, all individuals, including planners, presenters, moderators and evaluators, participating in an ASNR educational activity, or an activity jointly provided by ASNR must disclose all relevant financial relationships with ineligible companies, as defined by the ACCME. Unless listed below, all planners and individuals in control of content have nothing to disclose.

Kevin Hiatt: Royalties or Licenses: CaseStacks, LLC
All other authors have no disclosures.

Meng Law: Stockholder, Clinical Imaging
Edward Escott: Grant, Atherysys, Inc.; Royalties, Thieme Medical Publishers
Levi Chazen: Grant, Athersys; Stock Ownership or Private Investments: Amgen, Catalent, Charles River Labs, Intuitive Surgical, Stryker, United Health Group
Scott Faro: Royalties, Springer Publications