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(P<0.001)。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)(P<0.000 1);多因素分析OR值为230.996(32.123~1 295.448)(P<0.000 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。
Objective To evaluate the association between the presence of tiny dynamic progressive enhancing foci （＂dynamic spot sign＂） in acute intracerebral hematoma on computed tomography perfusion source images （CTP-SI） and hematoma expansion. Methods Totally 121 consecutive patients with spontaneous intracerebral hemorrhage （ICH） by no-contrast-enhanced CT （NCCT）, computed tomography perfusion（CTP） examination within 6 hours after symptom onset were included in this prospective study. Imaging data were evaluated by two experienced radiologists. Patients were dichotomized according to the presence or absence of the dynamic spot sign on CTP-SI in hematoma. Clinical and radiological outcomes were compared between groups. The predictive value of this sign was assessed in univariate and multivariate regression analysis.Results Hematoma expansion occurred in 28 patients （25.0%） on follow-up. Thirty patients （26.8%） were demonstrated dynamic spot sign. On CTP-SI, about 25（83.3%） patients with hematoma expansion and 5 （16.7%） without demonstrated by the dynamic spot sign were pound. Sensitivity, specificity, positive predictive value, negative predictive value, and Kappa value for expansion were 89.3%, 94.0%, 83.3%, 96.3%, and Kappa is 0.814 （P〈0.001）, respectively. Interobserver agreement was high （κ=0.92）. In multiple regression, the presence of CTP dynamic spot sign within acute hematomas independently predicted hematoma expansion, univariate analysis OR value was 131.667（29.386-590.289）（P〈0.000 1）. Moreover, multivariate analysis CTP dynamic spot sign OR value was 203.996 （32.123-1295.488）（P〈0.000 1）.Conclusion The computed tomography perfusion source images dynamic spot sign is associated with the presence and extent of hematoma expansion. CTP dynamic spot sign is more direct for showing active ongoing bleeding. It can be used as a guide for further strengthening the treatment and monitoring of patients with cerebral hemorrhage.
出处
《首都医科大学学报》
CAS
北大核心
2017年第1期72-77,共6页
Journal of Capital Medical University
基金
北京市自然科学基金(7142033)~~
关键词
CT脑灌注
脑出血
预测
卒中
computed tomography perfusion
intracerebral hemorrhage
prognosis
stroke
