CT岛征和黑洞征及其联合征象对原发性脑出血早期血肿扩大的预测价值

The predictive value of CT island sign,black hole sign and their combined signs for the hematoma enlargement in patients with early stage of primary intracerebral hemorrhage

目的探讨CT岛征和黑洞征及其联合征象预测原发性脑出血(ICH)患者早期血肿扩大(HE)的价值。方法将纳入的328例ICH患者根据其是否存在HE分为HE组(100例)和非HE组(228例)。对2组患者相关临床资料,影像学征象包括岛征、黑洞征及岛征/黑洞征构成进行单因素分析,对差异有统计学意义的因素进行Logistic回归分析。2名放射科医师对岛征、黑洞征及岛征/黑洞征的判读一致性采用Kappa检验;比较3种征象预测早期HE的诊断价值。结果HE组入院收缩压、初始血肿量、高血压史、岛征、黑洞征及岛征/黑洞征构成比例高于非HE组(P<0.05),HE组入院格拉斯哥昏迷(GCS)评分低于非HE组(P<0.05)。Logistic回归分析显示,较低入院GCS评分、有岛征、有黑洞征及有岛征/黑洞征均是早期HE的独立危险因素(P<0.05)。2名医师对岛征、黑洞征、岛征/黑洞征判读的一致性均较高,Kappa值分别为0.858、0.881和0.896。岛征、黑洞征及岛征/黑洞征预测早期HE的敏感度分别32.0%、29.0%及49.0%,特异度分别为92.3%,93.9%及88.2%,约登指数分别为0.250、0.229及0.372,其中岛征/黑洞征的约登指数较岛征和黑洞征单独诊断升高。结论与单一征象相比,岛征联合黑洞征对原发性ICH患者早期HE的预测能力更好。

ObjectiveTo explore the value of CT island sign,black hole sign and their combined signs in predicting early hematoma enlargement(HE)in patients with primary intracerebral hemorrhage.MethodsA total of 328 patients with primary intracerebral hemorrhage were retrospectively collected.They were divided into HE group(100 cases)and non-HE group(228 cases)according to the presence of the early HE.The related clinical data and imaging characteristics(island sign,black hole sign,and island sign/black hole sign)were collected,and the above factors were compared between the two groups.The Logistic regression analysis was used for the significant factors in the two groups.The consistency of interpretation of imaging signs was analyzed by Kappa consistency.The clinical values of the three signs in predicting the early HE compared.ResultsThe proportion values of admission systolic blood pressure,initial hematoma volume,history of hypertension,island sign,black hole sign,and island sign/black hole sign were higher in the HE group than those in the non-HE group(P<0.05).The admission GCS score was lower in the HE group than that in the non-HE group(P<0.05).Logistic regression analysis showed that the lower admission GCS,island sign,black hole sign,and island sign/black hole sign were all independent risk factors for the early HE(P<0.05).The two doctors had high consistency in the interpretation of the island sign,black hole sign and island sign/black hole sign.The Kappa values were 0.858,0.881 and 0.896,respectively.The sensitivity values of the island sign,black hole sign and island sign/black hole sign for the predicting early HE were 32.0%,93.0%,29.0%,and specificity were 93.9%,49.0%,88.2%.The Youden index values were 0.250,0.229 and 0.372 respectively;the Youden index of the island sign/black hole sign was larger than that of the island sign and black hole sign.Conclusion Compared with the single sign,the island sign combined with the black hole sign shows a better predictive ability for the early HE in primary intracerebral hemorrhage patients.