增强CT扫描对大面积脑梗死后出血性转化预测价值

Predictive value of enhanced CT scanning in hemorrhagic transformation after massive cerebral infarction

目的大面积脑梗死后出血性转化是脑梗死的常见并发症,影响治疗效果,早期发现出血性转化并调整治疗方案有重要临床意义。本研究探索增强CT扫描在大面积脑梗死后出血性转化(hemorrhagic transformation,HT)中的预测价值。方法选取郑州市中医院2016-08-01—2018-03-31收治的大面积脑梗死患者92例为研究对象,入院后急诊行头颅CT平扫,于发病后2448h再次行头颅CT平扫和增强扫描,7d后再次行头颅CT平扫复查,观察增强CT扫描结果。结果92例患者CT增强扫描14例有陈旧性脑梗死病灶,52例出现局灶性改变,余26例未见明显异常。发病24-48h后进行CT平扫可见7例出血性转化;经增强CT扫描可见造影剂外渗情况加强的有18例,1周后进行头颅CT平扫和增强扫描,发现有24例患者出现出血性转化,其中17例缺血灶内部、周边有条状及点状高密度影,7例可见块状高密度影;18例造影剂外渗加强患者均存在梗死灶内高密度变化,均为出血性转化,CT增强扫描对HT的预测准确率为75.0%。经CT进行HT分型,点状出血5例,弥散性出血15例,小血肿11例。结论大面积脑梗死患者急性发作期早期应用CT平扫和增强扫描有助于检出出血性转化,观察到造影剂外渗能预测HT发生,及早发现出血性转化灶。

OBJECTIVE Hemorrhagic transformation after massive cerebral infarction is a common complication of cerebral infarction,which affects the treatment effect.Early detection of hemorrhagic transformation and adjustment of treatment plan have important clinical significance.The purpose of this study is to explore the predictive value of enhanced CT scan in hemorrhagic transformation(HT)after massive cerebral infarction.METHODS A total of 92 patients with massive cerebral infarction admitted to our department of neurosurgery from August 01,2016 to March 31,2018 were selected as subjects.After admission,head CT plain scan was performed in emergency department,and head CT plain scan and enhanced scan were performed again 24 to 48 hours after onset.7 days later,the cranial CT scan was performed again,the results of enhanced CT scan were observed.RESULTS CT enhanced scans of 92 patients had old cerebral infarction lesions in 52 patients,focal changes in 52 patients,and no obvious abnormalities in the remaining 26 patients.Seven cases of hemorrhagic transformation were observed by CT plain scan 24-48 hafter onset.Through enhanced CT scan,the contrast agent extravasation was enhanced in 18 cases.After 1 week,plain CT scan and enhanced CT scan of the skull were performed and 24 patients were found to have hemorrhagic transformation,including 17 patients with striated and punctiform high-density shadow in and around the ischemic focus,and 7 patients with blocky high-density shadow.All the 18 patients with enhanced contrast agent extravasation had changes in the high density of infarction,all of which were hemorrhagic transformation.The prediction accuracy of HT by CT enhanced scan was 75.0%.HT classification by CT:5 cases of punctate hemorrhage,15 cases of diffuse hemorrhage and 11 cases of small hematoma.CONCLUSION CT plain scan and enhanced scan in the early stage of acute attack in patients with large area cerebral infarction are helpful to detect the hemorrhagic transformation in the early stage.