血管内介入治疗缺血性脑卒中后脑内高密度影与出血转化的关系  

Relationships of intracerebral high-density shadow after endovascular interventional therapy of cerebral ischemic stroke and postoperative hemorrhage transformation

作　　者：何晓清[1] 梁汉欢[1] 戴顺钦 刘海安 梁东梅 黄丹丹[2] HE Xiaoqing;LIANG Hanhuan;DAI Shunqin;LIU Hai'an;LIANG Dongmei;HUANG Dandan(Department of Imaging,People's Hospital of Gaozhou City,Gaozhou 525200,China;Department of Neurology,People's Hospital of Gaozhou City,Gaozhou 525200,China)

机构地区：[1]高州市人民医院影像科,广东高州525200 [2]高州市人民医院神经内科,广东高州525200

出　　处：《中国介入影像与治疗学》2022年第7期406-410,共5页Chinese Journal of Interventional Imaging and Therapy

基　　金：广东省医学科学技术研究基金(A2020218);茂名市科技计划项目(190404151701037)。

摘　　要：目的采用双源CT量化评价经血管内介入治疗缺血性脑卒中(CIS)后脑内高密度影,探讨其与出血转化的关系。方法回顾性分析167例CIS患者经介入治疗后即刻颅脑双能量CT资料,根据术后24~72 h CT平扫或MR检查结果分为出血组(n=42)及无出血组(n=125),比较组间患者临床资料、脑内新发高密度影CT值及其体积的差异,分析影响出血转化的因素,评价CT参数与出血转化的相关性;绘制受试者工作特征曲线,评价各指标判断出血转化的效能。结果出血组患者高血脂比例低于无出血组(P<0.05);出血组新发高密度影占比、高密度影的最大CT值、平均CT值及其体积均大于无出血组(P均<0.001)。高血脂病史为出血转化的保护因素(P<0.05);新发高密度影最大CT值、平均CT值及其体积为出血转化的危险因素(P均<0.001),且均与出血转化呈正相关(P均<0.001),以之判断血管内介入治疗CIS后患者发生出血转化的曲线下面积(AUC)分别为0.950、0.910及0.888,联合应用新发高密度影最大CT值+体积、平均CT值+体积及最大CT值+平均CT值+体积判断发生出血转化的AUC分别为0.944、0.923及0.941。结论血管内介治疗CIS后即刻CT显示缺血区新发高密度影的最大CT值、平均CT值及其体积均与术后出血相关。Objective To quantify the intracerebral high-density shadow after endovascular interventional therapy of cerebral ischemic stroke(CIS)with dual source CT,and to investigate the relationships of intracerebral high-density shadow and postoperative hemorrhage transformation.Methods Dual-energy CT examination data of 167 CIS patients immediately after endovascular interventional therapy were retrospectively analyzed.The patients were divided into the hemorrhage group(n=42)and the non-hemorrhage group(n=125)according to the results of plain CT or MR examination 24—72 h after intervention.The clinical data,CT value and volume of the newly developed intracerebral high-density shadow were compared between groups.The impact factors of hemorrhage transformation were observed,and the correlations of CT parameters and hemorrhage transformation were evaluated.The receiver operating characteristic curres were drawn to evaluate the efficiency of the indexes for judging hemorrhage transformation.Results The proportion of patients with hyperlipidemia in hemorrhage group was lower than that in non-hemorrhage group(P<0.05),of newly developed high-density shadow,the maximum CT values,the average CT values and the volumes of newly developed high-density shadow in hemorrhage group were higher than those in non-hemorrhage group(all P<0.001).The medical history of hyperlipidemia was a protective factor of hemorrhage transformation(P<0.05).The maximum CT values,average CT values and the volumes of newly developed high-density shadow were all risk factors of hemorrhage transformation(all P<0.001),which were positively correlated with hemorrhage transformation(all P<0.001).The area under the curve(AUC)for judging hemorrhage transformation after endovascular interventional therapy of CIS was 0.950,0.910 and 0.888,respectively,of the combination of the maximum CT value+volume,the average CT value+volume,the maximum CT value+average CT value+volume of newly developed high-density shadow was 0.944,0.923 and 0.941,respectively.Conclusion The

关 键 词：脑卒中 脑出血 体层摄影术 X线计算机 介入治疗 

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