头颅CT平扫诊断脑静脉窦血栓的应用价值

The application value of non-contrast enhanced craniocerebral CT in the diagnosis of cerebral venous sinus thrombosis

目的:探讨头颅CT平扫诊断脑静脉窦血栓形成的应用价值。方法:回顾性选取2020年1月—2022年12月在广西柳州市工人医院经磁共振静脉成像(magnetic resonance venography,MRV)或数字减影血管造影(digital subtraction angiography,DSA)确诊的脑静脉窦血栓形成患者20例,观察其头颅CT平扫影像特征及临床表现,测量MRV或DSA对应的病变静脉窦及非病变静脉窦CT值,比较两者差异,绘制受试者操作特征(receiver operating characteristic,ROC)曲线确定其临界值。结果:20例患者年龄在16~72岁,平均(40.90±16.93)岁,以头痛为主要症状,头颅CT平扫显示15例累及2个以上静脉窦,直接征象表现为静脉窦内高密度征,病变静脉窦区最高CT值范围为61.3~87.9 HU,平均(74.19±7.65)HU,非病变静脉窦区最高CT值范围为43.9~65.1 HU,平均(56.31±4.65)HU,两者之间差异显著(P<0.001)。ROC分析结果显示:以CT值为63.05 HU作为辅助诊断脑静脉窦血栓形成临界值时,曲线下面积为0.994,灵敏度为100%,特异度为90%。结论:静脉窦内高密度征+CT值(63.05 HU以上)+年龄+头痛等临床症状可有效初步筛查脑静脉窦血栓形成。

Objective To investigate the value of non-contrast enhanced CT in the diagnosis of cerebral venous sinus thrombosis.Methods A retrospective study was conducted on 20 patients with cerebral venous sinus thrombosis diagnosed by magnetic resonance venography(MRV)or digital subtraction angiography(DSA)at Liuzhou Workers'Hospital in Guangxi from January 2020 to December 2022.The CT features and clinical manifestations of their heads were observed,and the CT values of the diseased and non diseased venous sinuses corresponding to MRV or DSA were measured,and the differences between the two were compared,draw a receiver operating characteristic(ROC)curve to determine its threshold value.Results 20 patients aged between 16 and 72 year,mean(40.90±16.93)years,with a headache as the main symptom,Plain cranial CT scan showed 15 patients involving more than two venous sinuses,direct signs showing high-density signs within the venous sinuses,The highest CT values in the diseased venous sinus area was 61.3-87.9 HU,average(74.19±7.65)HU,the highest CT values in the non-diseased venous sinus region ranged from 43.9-65.1HU,average(56.31±4.65)HU,by the paired t-test,significant difference between them(P<0.001),ROC analysis showed that when the CT value of 63.05 HU was used as the auxiliary diagnosis of cerebral venous sinus thrombosis,The area under the curve was 0.994,sensitivity of 100%,the specificity was 90%.Conclusion Clinical symptoms such as CT value(above 63.05 HU),age and headache can be effective in preliminary the patients with cerebral venous sinus thrombosis.