Dual-energy CT (DECT) is a modern imaging modality that can distinguish acute intracranial hemorrhage from contrast staining that appears in follow-up examinations of stroke patients, especially after endovascular thrombectomy. A systematic review and meta-analysis of 12 studies with 561 patients and 646 lesions demonstrated a high diagnostic accuracy of DECT with a sensitivity of 0.90 (95% CI: 0.79–0.96) and a specificity of 0.98 (95% CI: 0.94–1.00). The positive likelihood ratio was 55.91, indicating that DECT is very reliable in confirming the presence of bleeding. Subgroup analysis showed that DECT achieves better results in older patients (> 65 years) and in populations with a higher proportion of males. Studies published since 2015 have shown significantly higher diagnostic accuracy than older studies, indicating improvements in technology. Despite the high diagnostic performance, the authors point out the potential bias of the publication, which may affect the reliability of the findings. The researchers therefore emphasize the need for further high-quality studies to confirm these results.