第三代双源CT早期鉴别诊断急性缺血性脑卒中患者血管内治疗后颅内出血灶与碘对比剂  

Third generation dual-source CT in early differential diagnosis of intracranial hemorrhage and iodinated contrast medium after endovascular treatment of acute ischemic stroke patients

作　　者：吴芳[1] 杜祥颖[1] 张苗[1] 杨旗[1] 祝小莲[1] 卢洁[1] WU Fang;DU Xiangying;ZHANG Miao;YANG Qi;ZHU Xiaolian;LU Jie(Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China)

机构地区：[1]首都医科大学宣武医院放射科,北京100053

出　　处：《中国医学影像技术》2018年第5期770-774,共5页Chinese Journal of Medical Imaging Technology

基　　金：北京市医院管理局重点医学专业发展计划(ZYLX201609);国家"十二五"科技支撑计划课题项目(2012BAI10B04)

摘　　要：目的探讨第三代双源CT早期鉴别诊断急性缺血性脑卒中(AIS)血管内治疗后颅内出血灶与碘对比剂的价值。方法纳入78例接受血管内治疗的AIS患者,治疗后采用第三代双源CT行脑部CT双能量(80kV/Sn150kV)扫描,经后处理得到碘分布图和虚拟平扫图像。以发病24～48h后常规脑部CT图像为参考,计算双能量CT(DECT)诊断颅内出血的准确率、敏感度、特异度、阳性预测值(PPV)和阴性预测值(NPV)。结果共31例患者(53个颅内高密度灶)纳入分析,其中DECT正确诊断26个高密度灶为存在出血,23个高密度灶为碘对比剂;1个钙化灶误诊为出血合并对比剂,3个DECT诊断为对比剂的病灶出现延迟性出血转化。DECT鉴别诊断颅内出血灶与碘对比的敏感度、特异度和准确率分别为89.66%(26/29)、95.83%(23/24)和92.45%(49/53),PPV为96.30%(26/27),NPV为88.46%(23/26)。结论第三代双源CT能早期准确诊断AIS血管内治疗后的出血转化,有助于临床及时调整治疗方案。Objective To investigate the value of third generation dual-source CT in early differential diagnosis of intracranial hemorrhage and iodinated contrast medium after endovascular treatment of acute ischemic stroke（AIS）.Methods Totally 78 patients with AIS underwent endovascular treatment were prospectively enrolled.Dual-energy CT（DECT）examination（80 kV/Sn150 kV）of the head was performed after treatment with a third generation dual-source CT scanner.Iodine overlay maps and virtual non-contrast images were post-processed.Taking conventional brain CT images obtained 24—48 hafter AIS attack as references,the accuracy,sensitivity,specificity,positive predictive value（PPV）and negative predictive value（NPV）of DECT for identifying hemorrhage were computed respectively.Results Totally 31 patients with 53 foci of intracranial hyper-attenuation were finally enrolled.Among 53 foci,26 were correctly diagnosed as hemorrhage by DECT,23 were correctly diagnosed as iodinated contrast medium,while 1 calcification was misdiagnosed as hemorrhage combined with iodinated contrast medium,3 were misdiagnosed as contrast medium which showed delayed hemorrhagic transformation.The sensitivity,specificity and accuracy of DECT was 89.66%（26/29）,95.83%（23/24）and 92.45%（49/53）,PPV and NPV was 96.30%（26/27）and 88.46%（23/26）,respectively.Conclusion The third generation dual-source CT is available in early and accurate diagnosis of hemorrhagic transformation after endovascular treatment of AIS,which can help clinicians to adjust the subsequent treatment strategies in time.

关 键 词：急性缺血性脑卒中 血管内治疗 颅内出血 体层摄影术 X线计算机 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]