双能量CT对急性缺血性脑卒中支架取栓术后颅内出血的早期诊断及预测  

Dual-energy CT diagnosis and prediction of intracranial hemorrhage after stent thrombectomy for acute ischemic stroke

作　　者：王震汕 陈婉琪 林海韬 罗世炜[3] 黄伟鹏[2] 刘源[1,4] WANG Zhen-shan;CHEN Wan-qi;LIN Hai-tao;LUO Shi-wei;HUANG Wei-peng;LIU Yuan(Shantou University Medical College,Guangdong 515041,China)

机构地区：[1]汕头大学医学院,广东汕头515041 [2]揭阳市人民医院医学影像科,广东揭阳522000 [3]揭阳市人民医院神内三科,广东揭阳522000 [4]汕头大学附属第一医院放射科,广东汕头515041

出　　处：《影像诊断与介入放射学》2020年第2期89-94,共6页Diagnostic Imaging & Interventional Radiology

基　　金：揭阳市科技计划项目(2018wsyl015)。

摘　　要：目的研究双能量CT(DECT)在急性缺血性脑卒中Solitaire支架取栓术后早期诊断颅内出血以及预测患者出血转化/出血增多风险的临床价值。方法收集急性缺血性卒中接受Solitaire支架取栓术的病例,术中造影均采用浓度为370 mg I/ml的碘对比剂,于术后1 h内行双能量CT扫描,重组获得线性融合图像、虚拟平扫及碘图,经综合分析确定诊断。术后24 h行常规CT平扫作为确诊标准,评价DECT早期诊断颅内出血的敏感度、特异度、阳性预测值、阴性预测值和符合率。在碘图上测量颅内病灶的碘浓度,以后续随访结果为标准,采用ROC曲线分析,获取发生出血转化或出血增多的阈值,并评价其特异度、准确度及曲线下面积。结果共44例病例被纳入本研究,其中DECT综合分析诊断单纯碘对比剂外渗25例,合并颅内出血19例,与术后24 h CT随访对照,2例DECT诊断为单纯碘对比剂外渗的患者出现颅内出血,其余23例均诊断准确,19例诊断为碘对比剂外渗合并出血均诊断准确,DECT早期诊断术后颅内出血的敏感度为90.5%、特异度为100%、阳性预测率为100%、阴性预测率为92.0%、符合率为95.5%。44例患者共86个颅内病灶进行了碘浓度测量,在后续随访中,其中19个病灶出现出血转化/出血增多,平均碘浓度为(3.5±1.6)mg I/ml,67个病灶无出血转化/出血增多,平均碘浓度为(1.4±0.9)mg I/ml,两组具有显著差异,即高碘外渗区域更易出现出血转化/出血增多,ROC分析两组之间的Cut-off值为2.7 mg/ml,DECT预测支架取栓术后出现出血转化/出血增多的敏感度、特异度分别为73.7%、92.5%。结论双能量CT在急性缺血性脑卒中Solitaire支架取栓术后早期诊断及预测颅内出血具有重要的临床价值。Objective The aim of our study was to assess the value of dual-energy CT(DECT)in the early diagnosis of the intracranial hemorrhage and the risk prediction of hemorrhagic transformation or increased bleeding in patients with acute ischemic stroke after thrombectomy using Solitaire stent.Methods Forty-four patients with acute ischemic stroke who had undergone thrombectomy using Solitaire stent and DECT within 1 hour after surgery were included.Contrast-enhanced DECT with 370 mg/mL iodinated contrast agent and reconstruction was performed to obtain linear fusion images,virtual plain scans and iodine maps.The diagnosis was confirmed by comprehensive analysis.Routine CT was performed at 24 hours postoperatively as the standard for definite diagnosis.The sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),and accuracy for early diagnosis of intracranial hemorrhage with DECT were evaluated.The iodine concentration of intracranial lesions was measured on the iodine map.The receiver operating characteristic(ROC)curve analysis was used to obtain the threshold of hemorrhagic transformation or increased bleeding as well as the specificity,accuracy and area under the ROC curve were evaluated.Results On DECT,25/44 patients showed contrast extravasation only with confirmation on follow-up CT(23/25).The remaining 2/25 patients had combined contrast extravasation and intracranial hemorrhage on follow-up.The DECT diagnosis of contrast extravasation combined with intracranial hemorrhage was confirmed in 19/44 patients.DECT had 90.5%sensitivity,100%specificity,100%PPV,92.0%NPV,and 95.5%accuracy for early diagnosis of postoperative intracranial hemorrhage.In 44 patients,86 intracranial lesions were measured for iodine concentration with 19/86 lesions showing hemorrhagic transformation or increased bleeding on follow-up and significantly higher average iodine concentration of(3.5±1.6)mg/mL than that of 67/86 lesions showing no hemorrhagic transformation/increased bleeding on follow-up(average iodine

关 键 词：急性缺血性脑卒中 碘对比剂外渗 颅内出血 双能量 体层摄影术 X线计算机 机械取栓 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R816.1[医药卫生—临床医学]