CT平扫漩涡征与黑洞征在预测脑出血早期血肿扩大中的价值研究

Swirl sign and black hole sign on CT scanning in predicting early hematoma expansion in intracerebral hemorrhage:a comparative study

目的比较CT平扫漩涡征、黑洞征及"漩涡征和黑洞征"在自发性脑出血患者早期血肿扩大中的预测价值。方法选择自2012年1月至2018年12月在苏州大学附属第二医院神经内科首诊并住院治疗的210例自发性脑出血患者进入研究,按照有无出现早期血肿扩大将患者分为血肿扩大组及血肿未扩大组,按照按征象的有无再将患者分为征象阳性组与征象阴性组,分别比较不同组别患者的影像学及临床特征。运用受试者工作特征(ROC)曲线分析漩涡征、黑洞征及"漩涡征和黑洞征"预测早期血肿扩大的准确性,运用多因素Logistic回归分析明确早期血肿扩大的独立危险因素。结果(1)57例早期血肿扩大的患者中,出现漩涡征21例(36.8%),黑洞征17例(29.8%);153例血肿未扩大的患者中,出现漩涡征12例(7.8%),黑洞征22例(14.4%);影像学征象阳性患者比例差异有统计学意义(P<0.05)。与血肿未扩大组患者比较,血肿扩大组患者入院收缩压显著升高,破入脑室者比例显著增多,差异均有统计学意义(P<0.05)。(2)漩涡征阳性(33例)与漩涡征阴性(177例)患者临床及影像学各项指标差异均无统计学意义(P>0.05)。黑洞征阳性患者(39例)的初始血肿量较黑洞征阴性患者(171例)明显增加,差异有统计学意义(P<0.05)。"漩涡征和黑洞征"阳性患者初始血肿量较阴性患者明显增加,差异有统计学意义(P<0.05)。(3)漩涡征、黑洞征及"漩涡征和黑洞征"的ROC曲线下面积分别为0.645、0.577与0.570。(4)多因素Logistic回归分析结果显示,入院收缩压、漩涡征与黑洞征均为早期血肿扩大的独立危险因素(P<0.05)。结论相较于CT平扫黑洞征及"漩涡征和黑洞征",漩涡征在自发性脑出血患者早期血肿扩大中的预测价值更大。

Objective To compare the predictive values of swirl sign and black hole sign on CT scanning in early hematoma expansion in spontaneous intracerebral hemorrhage(SICH)patients.Methods Two hundred and ten firstly diagnosed SICH patients,admitted to our hospital from January 2012 to December 2018,were enrolled in the study.All patients were divided into hematoma expansion and non-hematoma expansion group according to whether early hematoma expansion appeared;and they were also divided into positive imaging sign group and negative imaging sign group according to whether imaging signs appeared;the clinical and imaging data were compared between these groups,respectively.The accuracies of swirl sign and black hole sign in predicting early hematoma expansion were analyzed using receiver operator characteristic(ROC)curve.Multivariate Logistic regression analysis was performed to determine the independent risk factors for early hematoma expansion.Results(1)In the 57 patients with early hematoma expansion,21(36.8%)had swirl sign,and 17(29.8%)had black hole sign;in the 153 patients without hematoma expansion,12(7.8%)had swirl sign and 22(14.4%)had black hole sign;the differences between the two groups were statistically significant(P<0.05).As compared with those in the non-hematoma expansion group,the admission systolic blood pressure increased significantly and number of patients with intraventricular hemorrhage was significantly larger in the hematoma expansion group(P<0.05).(2)There were no statistical differences in clinical and imaging data between the patients with swirl sign(n=33)and patients without swirl sign(n=177,P>0.05);the hematoma volume in patients with black hole sign(n=39)was significantly increased as compared with that in patients without black hole sign(n=171,P<0.05),and there were no statistical differences in other clinical and imaging data between patients with and without black hole sign(P>0.05).(3)The areas under ROC curve of swirl sign,black hole sign,and"swirl sign combined with black hole sign"were 0.645,0.577,and 0.570,respectively.(4)Multivariate Logistic regression analysis showed that admission systolic blood pressure,swirl sign and black hole sign were independent risk factors for early hematoma expansion(P<0.05).Conclusion In comparison to black hole sign and"swirl sign combined with black hole sign",the swirl sign has higher predictive value in early hematoma expansion in ICH patients.