宝石能谱CT预测急性脑出血血肿扩大的应用研究

The Value of Gemstone Spectral CT in Predicting Hematoma Expansion of Acute Cerebral Hemorrhage

目的探讨宝石能谱成像(GSI)碘浓度参数预测自发性脑出血(ICH)急性期血肿扩大的应用价值。方法回顾性搜集78例急性ICH患者,入院均行CT平扫和能谱CT增强扫描。由两名影像医师观察评估CTA斑点征,并测量能谱CT碘图中血肿内碘浓度最大值及血肿内总碘浓度。根据24 h头颅CT复查结果,分为血肿扩大组与血肿未扩大组。通过多因素Logistic回归分析、受试者工作特征(ROC)曲线分析评价三种指标的预测效能。结果78例患者中38例(48.72%)出现血肿扩大。血肿扩大组与血肿未扩大组的基线临床数据无显著差异,碘浓度最大值[cut-off:8.035100μg/ml,曲线下面积(AUC):0.909]相比总碘浓度(cut-off:3.038100μg/ml,AUC:0.786)、CTA斑点征(AUC:0.753)具有更高的诊断效能,且预测血肿扩大的敏感度、特异度及准确率最高。碘浓度最大值、总碘浓度预测血肿扩大的准确率均高于CTA斑点征。多因素逻辑回归分析提示CTA斑点征、碘浓度最大值可作为血肿扩大的独立预测因子(OR:20.536,95%CI:4.223~90.654,P<0.01;OR:2.208,95%CI:1.784~2.853,P<0.001)。结论宝石能谱CT的碘浓度参数在预测血肿扩大方面具有较高的应用价值。

Objective To investigate the value of GSI(CT Gemstone Spectral imaging)iodine concentration in predicting hematoma expansion in intracerebral hemorrhage(ICH).Methods 78 patients with acute ICH were retrospectively collected and received non-contrast CT scan and enhanced spectrum CT scan.CTA spot sign was observed and evaluated by 2 radiologists,and the maximum iodine concentration and total iodine concentration in the hematoma were measured in the GSI-CT iodine map.According to the results of 24 hours CT examination,the hematoma was divided into two groups:the enlarged group and the non-enlarged group.The prediction efficiency of the three indexes was evaluated by multivariate Logistic regression analysis and receiver operating characteristic curve(ROC)analysis.Results Hematoma expansion occurred in 38 of 78 patients(48.72%).The baseline clinical data of the enlarged and non-enlarged hematoma groups were the same,maximum iodine concentration(Cut-off:8.035,AUC:0.909)compared with total iodine concentration(Cut-off:3.038,AUC:0.786)and CTA spot sign(AUC:0.753)had higher diagnostic efficiency,and had the highest sensitivity,specificity and accuracy in predicting hematoma expansion.The accuracy of maximum iodine concentration and total iodine concentration in predicting hematoma expansion was higher than that of CTA spot sign.Multivariate Logistic regression analysis suggested that CTA spot sign and the maximum iodine concentration could be an independent predictor of hematoma expansion(OR:20.536,95%CI:4.223-90.654,P<0.01;OR=2.208,95%CI:1.784-2.853,P<0.001).Conclusion The iodine concentration parameter of GSI CT is valuable in predicting hematoma expansion.