能谱CT在早期鉴别脑血管病介入术后出血转化及造影剂渗漏的价值及相关影响因素研究

Value of dudl-energy CT in early differential diagnosis of hemorrhagic transformation and contrast agent leakage after interventional radiology for cerebrovascular diseases

目的探讨能谱CT(DE-CT)在早期鉴别脑血管病介入术后出血转化及造影剂渗漏的应用价值及可能的影响因素。方法回顾性分析2019年11月至2020年12月在首都医科大学附属北京友谊医院神经内科行脑动脉支架术后DE-CT检查的50例患者的影像学资料,以头部DE-CT为标准,分析DE-CT检测脑出血转化的灵敏度及特异度。根据DE-CT颅内是否存在异常高密度影分为异常组(n=16)和正常组(n=34);根据DE-CT判断是否为造影剂渗出分为渗出组(n=10)和未渗出组(除外出血转化3例,n=37)。比较高密度影异常组和正常组、造影剂渗出组和未渗出组的周围脑白质DE-CT检测值、人口统计学及生化检测指标差异。采用多因素Logistic回归分析分析影响介入术后颅内异常高密度影出现及造影剂渗出的危险因素。结果DE-CT检测出血的阳性预测值(PPV)为66.65%,阴性预测值(NPV)为86.68%,灵敏度50.00%,特异度92.78%。异常组的周围脑白质CT值、碘(水)基值、水(碘)基值均高于正常组,高脂血症患者比率、PT、D-D水平均低于正常组,差异均有统计学意义(P<0.05)。渗出组的周围脑白质CT值、碘(水)基值、PT、D-D水平均高于未渗出组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,周围脑白质CT值(OR=1.080,95%CI:1.019~1.144;P=0.009)、碘(水)基值(OR=1.291,95%CI:1.071~1.557;P=0.008)、水(碘)基值(OR=1.128,95%CI:1.040~1.223;P=0.004)、高脂血症(OR=5.457,95%CI:1.240~24.091;P=0.025)是介入术后颅内异常高密度影出现的独立影响因素,周围脑白质CT值(OR=1.089,95%CI:1.020~1.163;P=0.011)、碘(水)基值(OR=1.252,95%CI:1.039~1.510;P=0.018)是造影剂渗出的独立影响因素。结论DE-CT可对脑动脉支架术后颅内异常高密度影进行及时准确地鉴别,及时发现脑出血转化,为患者争取更多的治疗时间。对于合并周围脑白质CT值较高、碘(水)基值较高以及血脂降低的患者,更可能出现颅内异常高密度影或者造影剂渗漏,需要引起格外关注。

Objective To evaluate the value of dudl-energy CT(DE-CT)in early differential diagnosis of hemorrhagic transformation and contrast agent leakage after interventional radiology for cerebrovascular diseases and its possible influencing factors.Methods The imaging data of 50 patients who underwent cerebral artery stenting and post-operative DE-CT examination at the Department of Neurology,Beijing Friendship Hospital,Capital Medical University from November 2019 to December 2020 were retrospective analyzed.All patients were examined by DE-CT,the sensitivity and specificity of DE-CT in detecting the transformation of intracerebral hemorrhage were analyzed.The patients were divided into abnormal group(n=16)and normal group(n=34)according to whether their was abnormal dersity or not in the bras by DE-CT;according to energy spectrum CT,the exudation of contrast medium was divided into exudation group(n=10)and non-exudation group(except for the transformation of hemorrhage in 3 cases,n=37).The differences in peripheral white matter DE-CT detection values,demographic and biochemical indicators between the high-density shadow abnormality group and the normal group,as well as the contrast agent exudate group and the non exudate group were compared.The risk factors affecting the occurrence of intracranial abnormal high-density shadows and contrast agent leakage after interventional surgery were analyzed using multiple Logistic regression.Results The positive predictive value(PPV)and negative predictive value(NPV)of DE-CT were 66.65%and 86.68%,respectively.The sensitivity of DE-CT was 50.00%,the specificity was 92.78%.The CT values,iodine(water)base values,and water(iodine)base values of the peripheral white matter in the abnormal group were higher than those in the normal group,while the proportion of hyperlipidemic patients,PT,and D-D water were lower on average than those in the normal group,the differences were statistically significant(P<0.05).The peripheral white matter CT values,iodine(water)base values,PT,and D-D levels in the exudate group were significantly higher than those in the non exudate group,the differences were statistically significant(P<0.05).Multiple Logistic regression analysis showed that the CT value of peripheral white matter(OR=1.080,95%CI:1.019-1.144;P=0.009),basic value of iodine(water)(OR=1.291,95%CI:1.071-1.557;P=0.008),basic value of water(iodine)(OR=1.128,95%CI:1.040-1.223;P=0.004),hyperlipidemia(OR=5.457,95%CI:1.240-24.091;P=0.025)were the independent influencing factors for the occurrence of abnormal intracranial hyperdensity after interventional surgery;the peripheral white matter CT value(OR=1.089,95%CI:1.020-1.163;P=0.011)and the base value of iodine(water)(OR=1.252,95%CI:1.039-1.510;P=0.018)were the independent influencing factors.Conclusion DE-CT can timely and accurately identify abnormal intracranial high-density opacities after cerebral artery stenting,detect the transformation of cerebral hemorrhage in time,and obtain more treatment time for patients.For patients with high peripheral white matter CT values,high iodine(water)base values,and decreased blood lipids,they are more likely to experience intracranial abnormal high-density shadows or contrast agent leakage,which requires special attention.