CT平扫岛征和混合征对自发性脑出血患者早期血肿扩大的预测作用

Predictive values of island signs and blend signs on non-contrast CT in early hematoma enlargement of spontaneous intracerebral hemorrhage

目的探讨自发性脑出血患者(sICH)头颅CT平扫的岛征和混合征及其联合征象对早期血肿扩大的预测作用。方法连续纳入2015年1月至2017年12月成都市温江区人民医院神经外科收治的sICH患者84例。患者从发病到首次CT检查时间均≤6 h,首次CT复查时间均≤24 h,根据2次检查结果将患者分为早期血肿扩大组(35例)和血肿无扩大组(49例)。回顾性分析CT平扫的岛征和混合征及联合征象对早期血肿扩大的影响,及其对早期血肿增大的诊断效能。结果CT平扫显示,早期血肿扩大组有岛征者占60.0%(21/35),有混合征者占71.4%(25/35);与血肿未扩大组的14.3%(7/49)、24.5%(12/49)比较,差异均有统计学意义(均P<0.01)。多因素logistic回归分析显示,岛征(OR=12.720,95%CI:3.501~46.218,P<0.01)和混合征(OR=10.793,95%CI:3.172~36.727,P<0.01)均为血肿早期扩大的独立预测因素。岛征诊断血肿早期扩大的灵敏度、特异度、阳性预测值、阴性预测值及约登指数分别为60.0%、85.7%、75.0%、75.0%、45.7%,混合征分别为71.4%、75.5%、67.6%、78.7%、46.9%,岛征联合混合征分别为91.4%、63.3%、64.0%、91.2%、54.7%。结论岛征、混合征均为sICH患者血肿早期扩大的独立预测因素。岛征联合混合征对血肿早期扩大的诊断效能较单一征象高。

Objective To explore the predictive values of island signs and blend signs on non-contrast CT in early hematoma enlargement of spontaneous intracerebral hemorrhage(sICH).Methods A total of 84 patients with sICH were admitted to Department of Neurosurgery,Wenjiang District People′s Hospital of Chengdu from January 2015 to December 2017 and consecutively enrolled into this study.The time from onset to the first CT examination was≤6 h,and the second CT examination time was≤24 h.According to the results of those 2 examinations,the patients were divided into the early hematoma enlargement group(35 cases)and the hematoma non-enlargement group(49 cases).The effects of CT island signs and blend signs on early hematoma enlargement and their diagnostic efficacy for early hematoma enlargement were analyzed.Results Non-contrast CT scan showed that 60.0%(21/35)in the early hematoma enlargement group had island sign,and 71.4%(25/35)had blend sign.Compared with 14.3%(7/49)and 24.5%(12/49)in non-enlargement group,those differences were statistically significant(both P<0.01).Multivariate logistic regression analysis revealed that both island sign(OR=12.720,95%CI:3.501-46.218,P<0.01)and blend sign(OR=10.793,95%CI:3.172-36.727,P=0.01)were independent predictors of early hematoma enlargement.The sensitivity,specificity,positive predictive value,negative predictive value and Youden index of island sign for early hematoma enlargement were 60.0%,85.7%,75.0%,75.0%and 45.7%respectively.The sensitivity,specificity,positive predictive value,negative predictive value and Youden index of blend sign for early hematoma enlargement were 71.4%,75.5%,67.6%,78.7%and 46.9%respectively.The sensitivity,specificity,positive predictive value,negative predictive value and Youden index of island sign combined with blend sign for early hematoma enlargement were 91.4%,63.3%,64.0%,91.2%and 54.7%respectively.Conclusions Island sign and blend sign are independent predictors of early enlargement of hematoma.The diagnostic performance with the combination of island sign and blend sign seems higher than the that of either single indicator.