基于双能CT的造影剂渗漏征对大动脉闭塞脑梗死出血转化的预测价值  

The predictive value of contrast agent leakage based on dual-energy CT for hemorrhagic transformation in large artery occlusive infarction

作　　者：刘克勤 蒋琳[1] 阮婕 殷聪国[1] Liu keqin;Jiang Lin;Ruan Jie;Yin Congguo(Department of Neurology,Hangzhou First People’s Hospital Affiliated to Zhejiang University Medical College,Hangzhou 310006,China)

机构地区：[1]浙江大学医学院附属杭州市第一人民医院神经内科,杭州310006

出　　处：《心脑血管病防治》2020年第6期596-598,601,共4页CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT

基　　金：浙江省公益技术研究计划/社会发展基金(LGF18H090017)。

摘　　要：目的评估急性大动脉闭塞脑梗死患者基于双能CT(DECT)的造影剂渗漏测量对继发出血转化预测作用。方法纳入2016年1月至2018年10月期间在浙江大学医学院附属杭州市第一人民医院进行介入血管内治疗的92例患者,记录其发病-穿刺时间、基线美国国立卫生研究院卒中量表(NIHSS)评分、基线血压水平、术中用药、术后DECT虚拟平扫病灶密度最高值(Humax)、术后出血转化分型等资料。评估急性大动脉闭塞脑梗死患者介入取栓后继发出血转化独立危险因素。结果92例患者中有67例(72.83%)出现造影剂渗漏征象,其中4例为术后即刻出血转化。二元Logistic回归分析提示,虚拟融合CT高密度征是最终出血转化发生率的独立危险因素(OR=1.040,95%CI=1.021~1.058,P<0.01)。ROC曲线提示虚拟融合CT中最高密度值预测出血转化的最佳界值是77Hu,其敏感度80.83%,特异度74.22%(P<0.01),曲线下面积(AUC)=0.839。结论DECT可有效鉴别大动脉闭塞脑梗死介入取栓后出血转化和造影剂渗漏,同时对预测最终梗死后出血转化有重要的临床应用价值。Objective To evaluate the predictive value of contrast agent leakage measurement based on dual-energy CT(DECT)for secondary hemorrhagic transformation in patients with acute large artery occlusive infarction.Methods 92 patients who underwent intra-arterial thrombectomy(IAT)in Hangzhou first hospital,Zhejiang university school of medical were included from January 2016 to October 2018.We collected clinical and radiological data such as the onset-to-puncture time,the baseline National Institutes of Health Stroke Scale(NIHSS)score,baseline blood pressure,medicine during IAT,maximum of hounsfield units(HUmax)of the infarct areas on simulated conventional CT(sCCT)and hemorrhagic transformation subtype after IAT.Results Signs of contrast agent leakage were detected in 67 patients(72.83%)on CT immediately after IAT,and 4 patients showed hemorrhagic transformation.The Logistic analysis showed that HUmax of sCCT was the independent risk factor of hemorrhagic transformation after IAT(OR=1.040,95%CI=1.021-1.058,P<0.01).The ROC curve indicated that the cut-off value of HUmax of sCCT predicting hemorrhagic transformation was 77 Hu,which showed 80.83%sensitivity and 74.22%specificity(P<0.01),and area under the curve(AUC)was 0.839.Conclusion DECT can effectively differentiate the hemorrhage transformation and contrast agent leakage after interventional thrombectomy in large artery occlusive infarction,and have predictive value for final hemorrhagic transformation.

关 键 词：急性缺血性脑梗死 双能CT 介入血管内治疗 出血转化 

分 类 号：R743.3[医药卫生—神经病学与精神病学]