高血压脑出血电子计算机断层扫描血管造影原始图像点征预测血肿扩大的价值

Value of Computed Tomography Angiography Source Images Spot Sign Forecasting Hematoma Enlargement in Acute Hypertensive Intracerebral Hemorrhage

目的探索电子计算机断层扫描血管造影(computed tomography angiography,CTA)原始图像中点征在预测血肿扩大中的应用价值。方法对53例高血压脑出血患者在发病6小时内进行电子计算机断层扫描(computed tomography,CT)平扫及CTA检查,并在发病24h后复查CT平扫。由3名放射科医师在CTA原始图像中寻找点征,同时对比两次检查的血肿体积。结果 13例患者(24.5%)CTA原始图像中点征为阳性。共有15例患者(28.3%)发生血肿扩大,其中12例为点征阳性患者。CTA原始图像预测血肿扩大的灵敏度、特异度、阳性预测值、阴性预测值分别为80.0%、97.4%、92.3%、92.5%。点征阳性患者初诊和复诊的血肿体积差异具有统计学意义(P<0.05),而点征阴性患者初诊和复诊的血肿体积差异不具有统计学意义(P>0.05)。结论在急性高血压脑出血惠者中,CTA点征可以给我们提供更多的影像学信息,有效预测血肿扩大。

Objective To explore the spot sign on computed tomography angiography source image（CTA- SI） in order to assist in individualizing therapeutic decisions for patients by possibly forecasting hematoma enlargement. Methods Fifty-three patients with spontaneous intracerebral hemorrhage（ICH） were examined by non-contrast computed tomography（CT） and computed tomography angiography（CTA） within 6 hours after symptom onset. CTA-S1 was reviewed by 3 neuroradiologists to make sure presence or absence of the spot sign. Hematoma volumes were determined from non-contrast CT images and compared between first and second CT images. Results Thirteen patients（24.5%） present of spot sign. Hematoma expansion occurred in 15 patients（28.3%） on follow-up. In which 12 patients present of spot sign. Sensitivity, specificity, positive predictive value, and negative predictive value for expansion were 80.0%, 97.4%, 92.3%, 92.5%, respectively. In patients with the spot sign, hematoma volume has significant difference in first and second CT images（P〈0.05）. In patients without the spot sign, hematoma volume has no significant difference in first and second CT images（P〉0.05）. Conclusions In acute 1CH patients, CTA spot sign provided more radiological information that maybe assisted in individualizing therapeutic decisions for patients by possibly forecasting hematoma enlargement.