头颅非增强CT“卒中窗”设置对早期缺血改变的诊断价值  

Evaluation of stroke window＇in non- enhanced computed tomography of the brain in the diagnosis of early ischemic changes

作　　者：张树清[1] 尹剑兵[2] 朱丽[2] Sanjeev Kumar PS 王天乐[2] 崔磊[2] 刘佳 葛莉[4] 钱澄 

机构地区：[1]南通大学第二附属医院心导管室,江苏南通226001 [2]南通大学第二附属医院影像科 [3]精鼎医药研究开发(印度海得拉巴)有限公司影像事业部,印度海得拉巴500020 [4]南通大学第二附属医院图书馆

出　　处：《徐州医科大学学报》2017年第12期816-820,共5页Journal of Xuzhou Medical University

基　　金：2015年南通市卫计委青年医学人才科研基金立项课题（WQ2015020）;2016年南通市卫计委青年医学人才科研基金立项课题（WQ2016035）

摘　　要：目的通过头颅非增强CT（NECT）标准化“卒中窗”设置，评估其对早期缺血改变（EIC）的诊断价值。方法回顾性分析168例在症状发作的360min内检查并经MRI或DSA确认EIC的患者。2名放射科住院医师间隔2周先后使用默认窗宽窗位（100HU、35HU）、“卒中窗”（30HU、35HU）评估EIC及其各种征象，以2名主治医师的最终确认为“金标准”，分别比较住院医师使用默认窗和“卒中窗”对EIC征象的诊断准确率。结果最终确认存在各种EIC征象的患者有113例（67．3％），其中，大脑中动脉高密度征59例，大脑后动脉高密度征5例，基底节轮廓消失征42例，脑岛带消失征35例，皮质脑沟变浅征29例，局灶性低密度征31例。住院医师使用默认窗仅发现72例（42．9％）EIC，显著少于“金标准”（P〈0．01）；但使用“卒中窗”检测到EIC107例（63．7％），与“金标准”的差异有统计学意义（P〉0．05）；住院医师使用“卒中窗”检测到EIC显著高于默认窗（P〈0．01）。除了大脑后动脉高密度征，在EIC的其他各种征象方面，住院医师使用默认窗EIC检出率均显著少于“金标准”（P〈0．05）；尽管使用“卒中窗”检测到EIC的征象少于“金标准”，但差异均无统计学意义（P〉0．05）；住院医师使用“卒中窗”检测到EIC的征象显著高于默认窗（P〈0．05）。结论通过“卒中窗”观察可以显著提高住院医师对EIC的发现率。Objective To evaluate a standardised gtoke window＇in non -enhanced computed tomography （NECT） of the brain in the diagnosis of early isehemic changes （ EIC ）. Methods Retrospective analysis was performed using clinical data from 168 patients who had been diagnosed with EIC by MRI or DSA within the first 360 minutes of an onset. Two resident physicians of the Radiology Department used the default window （ 100 HU, 35 HU） and a ＂stoke window＂ （ 30 HU, 35 HU） to assess EIC and its various signs every other two weeks. The final confirmation by two attending phy- sicians was set as the gold standard. The diagnostic accuracy of the two windows was compared. Results A total of 113 patients （67.3%） were confirmed with EIC signs, including 59 patients with hyperdense middle cerebral artery sign （ HMCAS）, 5 with hyperdense posterior cerebral artery sign （ HPCAS）, 42 with disappearing basal ganglia sign, 35 with loss of the insular ribbon sign, 29 with cortical sulcal effacement sign and 31 with focal hypodensity sign. The resident physicians detected 72 EIC cases （42.9%） using the default window, which was remarkably reduced compared with ＂the gold standards＂ （P 〈 0.01 ）. In contrast, 107 cases （63.7%） were detected when the ＂ stroke window＂ was ap- plied, which was not statistical different from the results by the gold standards （ P 〉 0.05 ）. Comparing with the default window, marked more EIC cases were found using the ＂stroke window＂ （P 〈 0. O1 ）. Except for the HPCAS, the detec- tion rate by the defauh window based on other EIC signs were substantially dec, reased compared with the ＂gold standard＂ （ P 〈 0.05 ）. No statistical difterence was found through fewer signs were detected by the residents using the gtroke win- dow＇than the ＂gold standard＂ （P 〉 0.05 ）. Remarkable more signs were detected by the residents using the gtroke win- dow＇compared with the default window （P 〈 0.05 ）. Conclusions ＂Stroke window＂ observa

关 键 词：脑缺血 体层摄影术 X线计算机 

分 类 号：R445.3[医药卫生—影像医学与核医学]