多模态CT大脑中动脉高密度征对急性缺血性脑卒中出血转化的预测价值的探讨  

Study on the predictive value of high density sign of middle cerebral artery in acute ischemic stroke under multi-mode CT

作　　者：黄文磊 吴雯菁 姜亦伦 HUANG Wenlei;WU Wenjing;JIANG Yilun(Imaging Department, Xishan People's Hospital, Jiangsu Province, Wuxi 214000, China)

机构地区：[1]江苏省无锡市锡山人民医院影像科,江苏无锡214100

出　　处：《医学影像学杂志》2022年第6期919-923,共5页Journal of Medical Imaging

基　　金：江苏省卫生健康委科研项目立项(编号:Z2019047)。

摘　　要：目的探讨多模态CT大脑中动脉高密度征(HMCAS)对急性缺血性脑卒中(AIS)患者出血转化的预测价值。方法选取2017年6月~2020年5月起病6 h内到达我院接受治疗的182例AIS患者的临床资料。使用Logistic回归分析HMCAS与脑梗死后出血转化的相关性,并利用受试者工作曲线(ROC)分析其预测出血转化的价值。结果多模态CT检查及图像后处理平均用时为(30.3±5.4)min;头颈部CT血管成像(CTA)检查显示超过2 mm的责任血管闭塞者81例(44.5%),CT灌注成像(CTP)判断存在缺血半暗带者70例(38.5%),CT平扫(NCCT)显示40例HMCAS(22.0%,右侧大脑17例,左侧23例);住院期间随访头部CT检查发现29例(15.9%)患者发生了出血转化,单因素分析初步筛选出了4个(房颤、静脉溶栓、院内感染、HMCAS)与出血转化相关的危险因素;多因素Logistic回归分析显示对出血转化的危险因素贡献度从高到低依次为:HMCAS(OR=10.334)、房颤(OR=4.440)、静脉溶栓(OR=7.498);绘制HMCAS、房颤的ROC曲线,曲线下面积(AUC)分别为0.781、0.605,二者比较差异无统计学意义(Z=4.924,P<0.05),提示HMCAS预测出血转化的价值明显更高。结论HMCAS是AIS患者出血转归的独立危险因素,可通过HMCAS辅助预测AIS患者出血转化情况。Objective To explore the predictive value of high density sign of middle cerebral artery(HMCAS)in patients with acute ischemic stroke(AIS).Methods The clinical data of 182 patients with AIS who arrived at our hospital for treatment within 6 h from June 2017 to May 2020 were retrospectively analyzed.Logistic regression was used to analyze the correlation between HMCAS and hemorrhage transformation after cerebral infarction,and the value of predicting haemorrhage transformation was analyzed using receiver operating Characteristic(ROC).Results The average time of multi-mode CT examination and image post-processing was(30.3±5.4)min;Head and neck CT angiography(CTA)showed 81 cases(44.5%)with occlusions of responsible vessels over 2 mm,CT perfusion imaging(CTP)showed 70 cases(38.5%)with ischemic penumbra,and CT scanning(NCCT)showed 40 cases of HMCAS(22.0%,17 cases of right brain,23 cases of left brain);During follow-up head CT examination during hospitalization,29 patients(15.9%)were found to have bleeding transformation.Univariate analysis preliminarily identified 4 risk factors(atrial fibrillation,intravenous thrombolysis,nosocomial infection,HMCAS)associated with bleeding transformation;Multivariate Logistic regression analysis showed that the risk factors contributing to bleeding transformation were HMCAS(OR=10.334),atrial fibrillation(OR=4.440)and intravenous thrombolysis(OR=7.498)in descending order;The ROC curve of HMCAS and ATRIAL fibrillation was drawn,and the AUC was 0.781 and 0.605,respectively.The difference between them was not statistically significant(Z=4.924,P<0.05),suggesting that THE value of HMCAS in predicting bleeding transformation was significantly higher.Conclusion HMCAS is an independent risk factor for the outcome of bleeding in AIS patients,and can be used to predict the bleeding transformation of AIS patients.

关 键 词：大脑中动脉高密度征 急性缺血性脑卒中 出血转化 体层摄影术 X线计算机 多模式 

分 类 号：R743.33[医药卫生—神经病学与精神病学] R814.42[医药卫生—临床医学]