CT值在急性脑卒中血管内治疗术后预测出血性转化的双能CT研究  

Evaluation of CT value with dual-energy CT in predicting cerebral hemorrhagic transformation after endovascular treatment in patients with acute ischemic stroke

作　　者：龙斌[1] 韩瑞[1] 宋少辉[1] 彭勇[1] 蒋玮丽[1] 张蔚[1] 张东友[1] Long Bin;Han Rui;Song Shaohui;Peng Yong;Jiang Weili;Zhang Wei;Zhang Dongyou(Department of Radiology,Wuhan No.1 Hospital,Wuhan 430022,China)

机构地区：[1]武汉市第一医院放射科,430022

出　　处：《中华神经科杂志》2021年第10期1019-1024,共6页Chinese Journal of Neurology

基　　金：湖北省卫健委科研项目(WJ2019M026)。

摘　　要：目的评价双能CT(DECT)融合图CT值预测急性缺血性脑卒中(AIS)血管内治疗(EVT)术后出血性转化(HT)的价值。方法回顾性分析2018年10月至2020年1月于武汉市第一医院收治的AIS患者EVT术后即刻DECT扫描的颅内高密度灶图像,以随访72 h内患者的CT或弥散加权成像为诊断标准,将其分为HT组和非HT组。测量AIS患者高密度灶密度最高处融合图、虚拟平扫、对比剂的CT值和碘浓度,采用组内相关系数评价测量者间的一致性;采用Mann-Whitney U检验比较两组定量参数之间的差异;采用Spearman相关分析融合图CT值与对比剂CT值、虚拟平扫CT值、碘浓度之间的相关性;采用受试者工作特征曲线分析各定量参数预测HT的诊断效能。结果最终共154例AIS患者纳入研究,其中HT组65例,非HT组89例。融合图CT的组内相关系数为0.861(P<0.05)。非HT组与HT组比较,HT组融合图CT值[59.40(54.84,63.05)HU与100.10(79.90,122.40)HU,Z=-10.87,P<0.001],对比剂CT值[24.90(20.75,30.05)HU与66.60(47.10,84.15)HU,Z=-10.85,P<0.001]和碘浓度[1.10(1.00,1.30)mg/ml与2.90(2.05,3.65)mg/ml,Z=-10.85,P<0.001]均有增高,两组间虚拟平扫CT值[33.60(31.80,35.70)HU与34.30(30.90,38.00)HU,Z=-0.50,P=0.62]的差异无统计学意义;融合图CT值与碘浓度高度相关(r=0.99,P<0.01)。融合图CT值>72.60 HU为诊断预测HT的界值,敏感度、特异度分别为89.23%、95.51%,与对比剂CT值、碘浓度预测HT的诊断效能差异无统计学意义(P<0.05)。结论DECT融合图CT值可用于预测AIS患者EVT术后72 h内的HT,当不具备双能条件时,可选择常规CT扫描颅内高密度灶的密度>72.60 HU作为预测HT的界值。Objective To evaluate the value of dual-energy CT(DECT)mixed images CT in predicting hemorrhagic transformation(HT)after endovascular therapy(EVT)of acute ischemic stroke(AIS).Methods From October 2018 to January 2020,the immediate dual-energy CT images of intracranial high attenuation(HA)regions in patients with AIS after endovascular treatment in Wuhan No.1 Hospital were retrospectively analyzed.According to the diagnostic criteria of CT or diffusion weighted image in 72 hours of follow-up,they were classified into HT group and non-HT group.The CT value of mixed images,contrast media,and virtual non-enhancement(VNC)and iodine concentration in the highest attenuation areas were measured.Intragroup correlation coefficient was used to evaluate the consistency among the readers;Mann-Whitney U test was used to compare the difference between the two groups of quantitative parameters;Spearman correlation analysis was uesd for evaluating correlation between mixed images CT value and contrast media CT value,VNC CT value,and iodine concentration.The receiver operating characteristic curve was used to analyze the quantitative parameters to predict the diagnostic efficacy of HT.Results A total of 154 cases were enrolled,with 65 cases in the HT group and 89 cases in the non-HT group.The intraclass correlation coefficient of CT values of mixed images was 0.861(P<0.05).Comparing the non-HT group and the HT group,the CT value of mixed images[59.40(54.84,63.05)HU vs 100.10(79.90,122.40)HU,Z=-10.87,P<0.001],contrast agent CT value[24.90(20.75,30.05)HU vs 66.60(47.10,84.15)HU,Z=-10.85,P<0.001]and iodine concentration[1.10(1.00,1.30)mg/ml vs 2.90(2.05,3.65)mg/ml,Z=-10.85,P<0.001]both increased in the HT group,but there was no significant difference in VNC CT values between the two groups[33.60(31.80,35.70)HU vs 34.30(30.90,38.00)HU,Z=-0.50,P=0.62].There was a highly significant correlation between the CT value of mixed images and iodine concentration(r=0.99,P<0.01).Using CT value>72.60 HU as the diagnostic cutoff value for predict

关 键 词：体层摄影术 X线计算机 缺血性脑卒中 颅内出血 治疗 

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]