CT、CTA影像征象对自发性脑出血早期血肿扩大的预测价值

Value of CT and CTA imaging signs in prediction of early hematoma enlargement in patients with spontaneous intracerebral hemorrhage

目的 探讨非对比剂增强CT扫描(NCCT)征象与双能谱CT血管造影(CTA)碘征对自发性脑出血(SICH)早期血肿扩大的预测价值。方法 回顾性分析2017年8月至2021年8月收治的146例SICH的影像资料。发病6 h内完成基线NCCT和双能谱CTA检查,24 h内复查NCCT判断血肿扩大情况。结果 NCCT复查显示血肿扩大68例(扩大组),无血肿扩大78例(无扩大组)。扩大组NCCT征象(黑洞征、卫星征、混合征)和双能谱CTA碘征阳性率明显提高(P<0.001)。多因素logistic回归分析显示,黑洞征、卫星征、混合征和碘征是早期血肿扩大的独立预测因子(P<0.001)。ROC曲线显示,黑洞征、卫星征、混合征和碘征预测血肿扩大的曲线下面积(AUC)分别为0.659、0.701、0.799和0.823;混合征联合碘征的AUC为0.899,明显高于任一单独指标(P<0.001)。结论 NCCT征象与双能谱CTA碘征是预测SICH早期血肿扩大的重要影像学表现,混合征联合碘征预测血肿扩大的效能最佳。

Objective To analyze the value of CT and CTA imaging signs in the prediction of early hematoma expansion(EHE)in patients with spontaneous intracerebral hemorrhage(SICH).Methods The imaging data of 146 patients with SICH who were admitted to our hospital from August 2017 to August 2021 were retrospectively analyzed.Non-contrast enhanced computed tomography(NCCT)and dual energy spectral CT angiography(CTA)were performed in all the patients within 6 hours after hemorrhage,and reexamination of NCCT was performed within 24 hours to detect the EHE.Results EHE occurred in 68 patients(expansion group)and did not in 78 patients(non-expansion group).The positive rates of black hole sign,satellite sign,and mixed sign on NCCT and iodine sign on dual energy spectral CTA in expansion group were significantly higher than those in non-expansion group(P<0.05).Multivariate logistic regression analysis showed that black hole sign,satellite sign,mixed sign and iodine sign were independent predictors of EHE(P<0.05).ROC curve showed that the AUC of black hole sign,satellite sign,mixed sign and iodine sign for predicting EHE were 0.659,0.701,0.799 and 0.823,respectively;the AUC of mixed sign combined with iodine sign was 0.899,which was significantly higher than any single sign(P<0.001).Conclusions NCCT signs(black hole sign,satellite sign and mixed sign)and dual energy spectral CTA iodine sign are the important imaging manifestations for predicting EHE in patients with SICH.Mixed sign combined with iodine sign is better than any other signs in predicting EHE.