不同影像学征象对SICH血肿进展预测价值的比较研究

目的比较不同影像学征象对自发性脑出血（slCH）患者血肿进展的预测价值。方法2015年1月至2016年6月sICH患者63例。患者入院即同时给予首次头颅CT和CTA扫描，头颅CT用于评估血肿的混杂密度征和黑洞征。头颅CTA用于评估血肿的斑点征和漏出征。血肿进展定义为24h内复查头颅CT比首次头颅CT血肿体积增大〉30％。分别计算并比较混杂密度征、黑洞征、斑点征和漏出征对血肿进展预测的敏感性，特异性，阳性预测值和阴性预测值。采用ROC曲线分析计算并比较混杂密度征、黑洞征、斑点征和漏出征对血肿进展的预测能力。结果四个影像学特征中，混杂密度征对血肿进展预测的特异度最高，而漏出征对血肿进展预测的灵敏度最高。漏出征和混杂密度征对血肿进展的预测能力整体好于黑洞征和斑点征。具备混杂密度征或黑洞征认为是阳性结果时，预测灵敏度643％，AUC=0．736（95％CI：0．607．0．865）。如仅具备宽点征或漏出征认为是阳性结果时，预测灵敏度75．0％，AUC=0．732（95％CI：0．604—0．860）。结论混杂密度征对sICH血肿进展预测的特异度最高，而漏出征对血肿进展预测的灵敏度最高。漏出征和混杂密度征对血肿进展的预测能力整体好于黑洞征和斑点征。结合不同影像学征象可以提高对sICH血肿进展的预测能力。

Objective To compare the predictive value of different imaging signs on hematoma progression in patients with spontaneous intracerebral hemorrhage （ sICH ） . Methods 63 patients with sICH admitted to department of neurosurgery from January 2015 to June 2016 were collected, CT and CTA scans were performed at the time of admission, head CT was used to assess the blend sign and black hole sign. The head CTA was used to assess the leakage sign and spot sign. Hematoma progression was defined as more than 30% increase after follow-up CT scan within 24 hours. The sensitivity, specificity, positive predictive value, negative predictive value and ROC （ Receiver Operating Characteristic ） were calculated for the four imaging signs respectively. Results In the four imaging signs, the blend sign had the highest specificity for hematoma progression and the leakage sign had the highest sensitivity. The predictive value of blend sign and leakage sign for predicting hematoma progression were better than the black hole and the spot sign. When either the blend sign or black hole sign was considered as a positive result, the sensitivity could be increased to 64.3%, AUC-0.736 （ 95%CI： 0.607-0.865 ） . Similarly, When either the leakage sign or spot sign was considered as a positive result, the sensitivity could be increased to 75%, AUC=0.732 （ 95%CI ： 0.604-0.860 ） . Conclusion The blend sign has the highest specificity and the leakage sign has the highest sensitivity for hematoma progression. The predictive value of blend sign and leakage sign for predict hematoma progression are better than the black hole and the spot sign. Combining different imaging signs can improve the predictive ability for hematoma progression in slCH.