黑洞征和岛征对急性自发性脑出血血肿扩大的预测价值

Predictive value of the black hole sign and the island sign for hematoma expansion in patients with acute spontaneous intracerebral hemorrhage

目的探讨非增强CT原始图像的黑洞征以及岛征对急性自发性脑出血血肿扩大的预测价值。方法在发病6 h内对156例急性自发性脑出血患者行颅脑CT平扫,并于发病24 h后复查。利用ROC曲线分析两者的预测价值。结果与无血肿扩大组比较,血肿扩大组首次CT扫描时间、首次出血量、入院时收缩压及黑洞征和岛征比率差异具有统计学意义(均P<0.01)。多元Logistic回归分析显示,首次CT扫描时间、首次出血量、入院时收缩压、黑洞征、岛征为血肿扩大的独立危险因素(P<0.05~0.01)。黑洞征预测血肿扩大的敏感度、特异度、阳性预测值、阴性预测值、曲线下面积分别为52.7%、87.1%、69.0%、77.2%、0.699,岛征敏感度、特异度、阳性预测值、阴性预测值、曲线下面积分别为67.3%、89.1%、77.1%、83.3%、0.782。岛征对血肿扩大的预测价值优于黑洞征。结论首次CT扫描时间、首次出血量、入院时收缩压、黑洞征及岛征为脑出血血肿扩大的独立危险因素。非增强CT黑洞征及岛征均可预测血肿扩大,岛征的预测价值优于黑洞征。

Objective To explore predictive value of the predictive value of black hole sign and island sign on non-contrast CT in predicting hematoma expansion(HE) in patients with acute spontaneous intracerebral hemorrhage(ICH). Methods One hundred and fifty-six patients with acute spontaneous ICH were examined by non-contrast CT within 6 h after symptom onset, and reexamined at 24 h after onset. The accuracy of two signs in predicting HE was analyzed by ROC. Results Compared with those in non-HE group, there were significant differences in the time-to-admission CT scan, baseline hematoma volume on admission CT, the systolic blood pressure at admission, the presence of black hole sign and island sign in HE group(all P<0.01). Multivariate Logistic regression analysis showed that the time-to-admission CT scan, baseline hematoma volume, the systolic blood pressure at admission, black hole sign and island sign were independent risk factors of HE(P<0.05-0.01). The sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV) and the area under the curve(AUC) of back hole sign for predicting HE were 52.7%, 87.1%, 69.0%, 77.2% and 0.699;the sensitivity, specificity, PPV, NPV and AUC of island sign for predicting HE were 67.3%, 89.1%, 77.1%, 83.3% and 0.782, respectively. The predictive value of island sign for HE was better than that of black hole sign. Conclusions The time-to-admission CT scan, baseline hematoma volume, the systolic blood pressure at admission, black hole sign and island sign are independent risk factors for HE in patients with ICH. Both the black hole sign and island sign appeared to have good predictive value for HE on non-contrast CT, but island sign is a better predictor than black hole sign.