“动态点征”在CTP原始图像上对急性脑出血增长的预测价值

发布时间：2018-02-05 22:54

本文关键词： CT脑灌注脑出血预测卒中　出处：《首都医科大学学报》2017年01期 　论文类型：期刊论文

【摘要】：目的评价急性脑出血血肿内计算机断层扫描灌注原始图像(computed tomography perfusion source images,CTP-SI)上,动态进行性强化灶(“动态点征”)对脑出血增长的预测价值。方法前瞻性研究112例连续性急性自发性脑出血病人,症状发生6 h以内,均接受电子计算机断层扫描(computed tomography,CT)平扫及CTP检查。检查影像资料经2位有经验的神经放射医师进行观察评估。根据病人是否出现“动态点征”分为2组。将临床资料和影像资料相对应分组,对“动态点征”对脑出血血肿增长预测进行多变量评估分析。结果 112例病人中,经复查证实脑出血增长病人为28例(25.0%)。出现CTP-SI上强化灶为30例(26.8%)。强化组与无强化组的基线临床数据相同,CTP“动态点征”阳性的病人中,25例(83.3%)病人表现为脑血肿增长,而5例(16.7%)病人无血肿增长。“动态点征”预测脑内血肿增长的灵敏度、特异度、阳性预测值和阴性预测值分别为89.3%、94.0%、83.3%和96.3%,Kappa值为0.841(P0.001)。观察者间的一致性高(κ=0.92)。经单因素及多因素回归分析,CTP“动态点征”是具有独立的预测脑内血肿增长的影像征象,其中单因素OR值为131.667(29.386~590.289)(P0.000 1);多因素分析OR值为230.996(32.123~1 295.448)(P0.000 1)。结论 CTP-SI中的“动态点征”与急性脑出血血肿增长有关,是可用以临床指导进一步加强治疗及监护脑出血病人的有意义的影像学征象。
[Abstract]:Objective to evaluate computed tomography perfusion source imaging (CTP-SII) of computed tomography perfusion source in hematoma of acute intracerebral hemorrhage (AICH). Methods 112 consecutive patients with acute spontaneous intracerebral hemorrhage were studied prospectively. All the patients were examined by computed tomography CT and CTP. The imaging data were observed and evaluated by two experienced neuroradiologists. The patients were divided into two groups according to whether they had "dynamic dot sign" or not. The data and image data are grouped into groups, A multivariate evaluation analysis was made on the prediction of hematoma growth in intracerebral hemorrhage by "dynamic dot sign". Results among 112 patients, After reexamination, 28 patients with intracerebral hemorrhage growth were confirmed to have increased cerebral hemorrhage, and 30 patients with enhancement focus on CTP-SI were found to have the same baseline clinical data as that of non-enhancement group. 25 of the patients with positive "dynamic dot sign" were found to have increased cerebral hematoma. There was no hematoma growth in 5 patients. The sensitivity and specificity of "dynamic dot sign" in predicting the growth of intracerebral hematoma, The positive predictive value and negative predictive value were 89. 3% and 96. 3%, respectively, and the Kappa value was 0. 841% (P 0. 001). The consistency among observers was high (魏 0. 92). By single factor and multivariate regression analysis, CTP "dynamic dot sign" was an independent imaging sign for predicting the growth of intracerebral hematoma. The OR value of single factor was 131.66729. 386n 590.289. the OR value of multivariate analysis was 230.996 ~ 32.123.125.448% P0.00010.Conclusion the "dynamic dot sign" in CTP-SI is related to the increase of acute intracerebral hemorrhage hematoma. It is a useful imaging sign for clinical guidance to further strengthen the treatment and monitoring of patients with cerebral hemorrhage.
【作者单位】：首都医科大学附属北京天坛医院放射科北京市神经外科研究所神经影像室;
【分类号】：R445

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