双源双能量CT在鉴别急性缺血性脑梗死血运重建术后碘造影剂外渗和继发脑出血中的价值

发布时间：2018-03-22 20:05

本文选题：急性缺血性脑卒中　切入点：颅内出血　出处：《实用医学杂志》2017年15期 　论文类型：期刊论文

【摘要】：目的探讨双源双能量CT在鉴别急性缺血性脑梗死血运重建术后碘造影剂外渗和继发脑出血中的价值。方法 46例因急性缺血性脑卒中行动脉内溶栓治疗的患者纳入本研究,于动脉溶栓术后2 h内行双源双能量CT检查(80 k V/392 m A和140 k V/196 m A),利用图像工作站生成融合图像(即:单纯融合图像诊断法)、融合图像加虚拟平扫图像和碘叠加图像(即:叠加融合图像诊断法);术后48 h行常规CT平扫明确诊断。计算两种诊断方法诊断继发脑出血的敏感性、特异性、阳性预测值、阴性预测值和准确率。结果 34例得到确诊的病例中6例患者CT未见明显高密度影,余下28例为阳性病例并达到确诊,其中3例出血,21例造影剂外渗,余下4例同时合并出血和造影剂外渗。单纯融合图像法对出血诊断的敏感性、特异性、阳性预测值、阴性预测值和准确率分别为66.67%、100%、100%、96.15%和96.43%,叠加融合图像诊断法诊断的敏感性、特异性、阳性预测值、阴性预测值和准确率分别为100%%、96%、75%、100%和96.43%。叠加融合图像对颅内出血、造影剂外渗及出血合并造影剂外渗的诊断准确性均相对较高,且差异具有统计学意义(P0.046)。叠加融合图像的诊断准确性与临床随访确诊具有较高的一致性(Kappa=0.815),明显高于单纯融合图像(Kappa=0.564)。结论双源双能量CT在鉴别颅内出血和造影剂外渗方面有着重要的临床应用价值。
[Abstract]:Objective to investigate the value of dual-source and dual-energy CT in differentiating iodine contrast agent exosmosis from secondary cerebral hemorrhage after acute ischemic cerebral infarction after revascularization. Methods 46 patients with acute ischemic stroke underwent intra-arterial thrombolytic therapy. Within 2 hours after thrombolysis, double source and dual energy CT were performed to examine 80kV / 392mA and 140kV / 196mAn respectively. Fusion images were generated by image workstation (i.e., simple fusion image diagnosis method, fusion image plus virtual plain scan image and iodine stack). After 48 hours of operation, conventional CT plain scan was performed to make a definite diagnosis. The sensitivity of the two diagnostic methods in the diagnosis of secondary intracerebral hemorrhage was calculated. Results among 34 confirmed cases, 6 cases had no obvious high density image on CT, the remaining 28 cases were positive cases, and 21 cases had extravasation of contrast media, among which 3 cases had bleeding and 21 cases had extravasation of contrast media. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the fusion image method for diagnosis of hemorrhage were 66. 67% and 96. 43%, respectively. The diagnostic sensitivity of the superimposed fusion image method was 96. 15% and 96. 43%, respectively. The specificity, positive predictive value, negative predictive value and accuracy were 100% and 96.43%, respectively. The diagnostic accuracy of superimposed fusion images on intracranial hemorrhage, contrast media exosmosis and bleeding combined with contrast media exosmosis was relatively high. The difference was statistically significant (P 0.046). The diagnostic accuracy of superimposed fusion images was higher than that of simple fusion images. Conclusion Dual-source and dual-energy CT can distinguish intracranial hemorrhage from contrast media. Infiltration has important clinical application value.
【作者单位】：天津医科大学第二医院;
【基金】：天津市卫生局科技基金项目(编号:2013KZ101)
【分类号】：R743.33

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