超急性期脑梗死大脑中动脉高密度征的综合分析  

Comprehensive analysis of the high density of middle cerebral artery sign in hyperacute cerebral infarction

作　　者：林惠花 王瑞芳 宁清灵 徐志华 杨本强[3] 张梦知 蔡晓楠[3] 侯洁 段阳[3] LIN Hui-hua;WANG Rui-fang;NING Qing-lin;XU Zhi-hna;YANG Ben-qiang;ZHANG Meng-zhi;CAI Xiao-nan;HOU Jie;DUAN Yan(Jinzhou Medical University,General Hospital of Shenyang Military Region Command Training Base for Graduate,Shenyang 110016,China;Department of Radiology,Liaoning General Hospital of Armed Police,Shenyang 110034,China;Department of Radiology,General Hospital of Shenyang Military Region Command of PLA,Shenyang 110016,China)

机构地区：[1]锦州医科大学中国人民解放军沈阳军区总医院研究生培养基地,辽宁沈阳110016 [2]武警辽宁总医院放射科,辽宁沈阳110034 [3]中国人民解放军沈阳军区总医院放射科,辽宁沈阳110016

出　　处：《中国临床医学影像杂志》2018年第9期609-611,619,共4页Journal of China Clinic Medical Imaging

基　　金：辽宁省自然科学基金计划项目(No.201602768)

摘　　要：目的 :综合分析非增强CT(NECT)图像单侧大脑中动脉高密度征(HMCAS),初步探索超急性期脑梗死患者单侧HMCAS识别的客观指标。方法:回顾性分析116例超急性期脑梗死患者,由两位观察者对HMCAS识别进行观察者内与观察者间重复性分析(Kappa分析)。通过ROC曲线确定超急性期脑梗死患者大脑中动脉(MCA)近段CT值与CT值比值(患侧/健侧)的最佳阈值,分析HMCAS识别的灵敏度及特异度。结果:观察者内与观察者间对HMCAS主观识别具有高度重复性(K值0.82、0.86),结合临床病史,重复性更佳(K值0.95)。CT值≥40 HU、CT值比值(患侧/健侧)≥1.2为HMCAS识别的最佳阈值,且灵敏度(91.23%)与特异度(100%)相对其他标准最高。结论:结合临床病史及CT值变化,可以有效识别HMCAS;MCA近段CT值≥40 HU、CT值比值(患侧/健侧)≥1.2为最佳阈值。Objective： To explore objective criteria which are suitable for clinical application by comprehensive analysis of unilateral hyperdense middle cerebral artery sign（HMCAS） on non-enhanced computed tomography（NECT）. Methods： One hun dred sixteen patients with hyperacute cerebral infarction were retrospectively evaluated. The presence of HMCAS was evaluated between inter and intra-observers. K value was calculated. The cut off value of MCA attenuation and MCA ratio（the affected side/the healthy side） in the HMCAS（＋） and HMCAS（-） was measured through the ROC curve in all patients with hyperacute cerebral infarction. The sensitivity and specificity was analyzed. Results： The interobserver and intraobserver agreement were substantial（K value of 0.82 and 0.86, respectively） and increased to almost perfect（K value of 0.95） when the reader was provided with clinical information. MCA attenuationS40 HU and MCA ratio≥1.2 was the best threshold for HMCAS recognition. When both MCA attenuations≥40 HU and MCA ratio≥1.2 were satisfied, sensitivity （91.23%） and specificity （100%） were the highest relative to other standards. Conclusion： It is effective and feasible to evaluate the unilateral HMCAS on NECT images by combining with clinical history. MCA attenuations≥40 HU and MCA ratio≥1.2 was the best threshold for HMCAS recogni- tion, which is suitable for application in daily clinical practice.

关 键 词：脑梗塞 大脑中动脉 体层摄影术 螺旋计算机 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R814.42[医药卫生—临床医学]