急性缺血性脑卒中患者取栓术后即刻头颅CT平扫“金属征”对出血转化的预测价值

Predictive value of metallic hyperdensity sign on noncontrast CT immediately after mechanical thrombectomy for hemorrhagic transformation in patients with acute ischemic stroke

目的 评估急性缺血性脑卒中患者取栓术后即刻头颅CT平扫上“金属征”对术后脑实质血肿(PH)出血转化的预测价值。方法 回顾性分析144例于2018年1月至2020年7月在浙江省人民医院接受机械取栓治疗的前循环大血管闭塞急性缺血性脑卒中患者的资料。术后即刻完善头颅CT平扫检查。根据患者术后24 h CT平扫或72 h内磁共振影像来评估术后是否存在出血转化。如果在基底节区有直径≥1 cm的高密度影,且其最大CT值> 90HU,则定义为“金属征”阳性。结果 术后即刻头颅CT平扫上出现高密度征的患者有107例(74.3%),符合“金属征”阳性患者共39例(27.1%)。最终36例患者术后发生PH型出血转化。“金属征”阳性组较“金属征”阴性组PH型出血转化比例更高(χ^(2)=112.140,P <0.05)。术后即刻头颅CT平扫“金属征”对PH型出血预测的敏感度为86.1%,特异度为71.4%(AUC=0.832,P <0.05)。结论 接受机械取栓术的急性缺血型脑卒中患者术后即刻头颅CT平扫辨别“金属征”有助于预测术后PH型出血转化,可能有助于患者术后围手术期管理。

Objective To assess the predictive value of metallic hyperdensity sign on non-contrast CT(NCCT) performed immediately after mechanical thrombectomy for hemorrhagic transformation of parenchymatous hematoma(PH) in patients with acute ischemic stroke(AIS). Methods The data of 144 AIS patients with large vessels occlusion of the anterior circulation,who underwent NCCT immediately after mechanical thrombectomy in Zhejiang Provincial People’s Hospital between January 2018 and July 2020, was retrospectively analyzed. The head CT scan was completed immediately after surgery. The presence of hemorrhagic transformation was assessed according to the CT scan within 24 hours or magnetic resonance imaging within 72 hours after surgery. If there was a non-petechial intracerebral hyperdense lesion(diameter ≥ 1 cm) in basal ganglia and its maximum CT unit > 90(HU), it was defined as a positive metallic hyperdensity sign. Results There were 107 patients(74.3%) with high density signs on plain CT scan immediately after surgery, 39(27.1%)with metallic hyperdensity sign. PH hemorrhagic transformation occurred in 36 patients after surgery.Patients with metallic hyperdensity sign were more likely to have PH than those without(χ~2=112.140,P < 0.05). The sensitivity and specificity of metallic hyperdensity sign in predicting PH were 86.1% and 71.4%, respectively(AUC=0.832, P < 0.05). Conclusion The presence of metallic hyperdensity sign on non-contrast CT performed immediately after mechanical thrombectomy in patients with AIS is helpful to predict the occurrence of PH hemorrhagic transformation after surgery, which might be helpful in postoperative management after thrombectomy.