Evidence map›Paper›PMID 42776213›Full record

ArticleNeuroradiology2026

Characterizing clot composition and stroke etiology through hounsfield units.

Andres Gudino, Carlos Dier, Martin Cabarique, Alexander Van Dam, Alina Rivadeneira-Limongi, Emily Baniewicz, Mario S Hinojosa-Figueroa, Arshaq Saleem, Divanshu Sharma, Navami Shenoy and 6 more

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Article in Neuroradiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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4 · The record

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5 · Who and what money

Authors and funding

16 authors.

Andres GudinoDepartment of Neurology, University of Iowa, Iowa City, USA.ORCID http://orcid.org/0009-0003-0123-6138
Carlos DierDepartment of Neurology, University of Iowa, Iowa City, USA.ORCID https://orcid.org/0009-0009-8243-9087
Martin CabariqueDepartment of Neurology, University of Iowa, Iowa City, USA.
Alexander Van DamDepartment of Neurology, University of Iowa, Iowa City, USA.
Alina Rivadeneira-LimongiDepartment of Neurology, University of Iowa, Iowa City, USA.
Emily BaniewiczDepartment of Neurology, University of Iowa, Iowa City, USA.
Mario S Hinojosa-FigueroaDepartment of Neurology, University of Iowa, Iowa City, USA.
Arshaq SaleemDepartment of Neurology, University of Iowa, Iowa City, USA.
Divanshu SharmaDepartment of Neurology, University of Iowa, Iowa City, USA.
Navami ShenoyDepartment of Neurology, University of Iowa, Iowa City, USA.
Elena SaguesDepartment of Neurology, University of Iowa, Iowa City, USA.
Arathi AshokDepartment of Neurology, University of Iowa, Iowa City, USA.
Susan A WalshIowa Institute for Biomedical Imaging, University of Iowa, Iowa City, USA.ORCID https://orcid.org/0000-0002-6632-5583
Malik GhannamDepartment of Neurology, University of Iowa, Iowa City, USA.
Osorio Lopes Abath NetoDepartment of Pathology, University of Iowa, Iowa City, USA.ORCID https://orcid.org/0000-0003-2787-5483
Edgar A SamaniegoDepartment of Neurology, University of Iowa, Iowa City, USA. edgar-samaniego@uiowa.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeWe aimed to analyze clot composition using Hounsfield Units (HU) in non-enhanced computed tomography (NECT).

methodsThrombi retrieved from mechanical thrombectomy (MT) were imaged on micro-computed tomography (micro-CT) and histologically analyzed. Micro-CT slides were matched to histological sections. Spearman's rank correlation was performed to correlate micro-CT HU with red blood cells (RBCs) and fibrin composition. A sensitivity analysis was conducted between micro-CT HU and histological slides with > 70% of these components. The same clots were then localized in the pre-MT NECT, and NECT HU values were obtained. Micro-CT HU and NECT HU were correlated for histologically informed interpretation. Receiver operating characteristic analysis was performed to retrieve NECT HU thresholds. A dataset of patients who presented with large vessel occlusion of cardioembolic, large artery atherosclerosis (LAA), and cryptogenic strokes were then assessed through NECT HU.

resultsTen thrombi were analyzed. Micro-CT HU were strongly correlated with histological sections with > 70% of RBCs (Rho 0.675) but not to sections with > 70% of fibrin (Rho 0.325). Micro-CT HU and NECT HU of clots that had > 70% of RBCs were strongly correlated (Rho 0.774). NECT HU of 44 had a sensitivity of 67% and specificity of 86% to determine clots with > 70% of RBCs. A total of 240 NECT images were analyzed including 80 cardioembolic, 80 LAA and 80 cryptogenic strokes. NECT HU assessment showed that 75% of cardioembolic, 40% of LAA and 55% of cryptogenic clots are composed of RBCs.

conclusionNECT HU is a promising tool to assess clot RBCs composition and infer stroke etiology.

Indexed as

Acute ischemic strokeClot compositionHounsfield unitsStroke etiology

Identifiers

PMID42776213

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