急性脑出血“动态点征”区域CT灌注参数定量评估血肿扩大  

CT perfusion parameters in"dynamic spot sign"region of acute intracerebral hemorrhage for quantitative assessment of hematoma expansion

作　　者：王晓晨 王思慧 赵雪宁 孙胜军[1,2] WANG Xiaochen;WANG Sihui;ZHAO Xuening;SUN Shengjun(Department of Radiology,Beijing Neurosurgical Institute,Beijing 100070,China;Department of Radiology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]北京市神经外科研究所放射科,北京100070 [2]首都医科大学附属北京天坛医院放射科,北京100070

出　　处：《中国医学影像技术》2022年第8期1134-1138,共5页Chinese Journal of Medical Imaging Technology

基　　金：国家自然科学基金(81971614);首都卫生发展科研专项(首发2022-2-1074)。

摘　　要：目的观察急性脑出血(AICH)“动态点征”区域CT灌注(CTP)参数定量预测血肿扩大的价值。方法回顾性分析45例AICH首诊平扫CT、CTP原始图像、灌注参数图及24h内复查CT,根据CTP原始图像有无“动态点征”分为阳性组(n=21)和阴性组(n=24);比较组间血肿体积变化、“点征”/密度最高区域(强化区),血肿全部区域相对脑血流量(rCBF)及相对脑血容量(rCBV)差异。绘制受试者工作特征曲线,计算曲线下面积(AUC),评价强化区灌注参数预测血肿扩大的效能;以Spearman相关性分析评估阳性组血肿体积变化与“动态点征”总出现时间的相关性。结果首诊2组血肿体积差异无统计学意义(P>0.05)。复查中,阳性组血肿体积明显大于阴性组(P<0.05);阳性组17例(17/21,80.95%)、阴性组2例血肿扩大(2/24,8.33%)。阳性组强化区rCBF、rCBV及强化区与血肿区rCBF、rCBV差值均显著高于阴性组(P均<0.05)。以rCBF=8.90ml/(min·100g)、rCBV=6.55ml/100g为截断值,预测血肿扩大的AUC分别为0.877和0.889。阳性组血肿体积变化与“动态点征”总出现时间呈正相关(r=0.628,P<0.05)。结论CTP“动态点征”区域灌注参数可用于预测血肿扩大;血肿体积变化与对比剂渗漏总时间呈正相关。Objective To explore the value of CT perfusion(CTP)parameters for assessing hematoma expansion in patients with acute intracerebral hemorrhage(AICH).Methods The initial CT,source images of CTP,perfusion parameter maps,as well as the follow-up CT within 24 h of 45 AICH patients were retrospectively analyzed.The patients were divided into positive group(n=21)and negative group(n=24)according to the presence or absence of"dynamic spot sign"on CTP source images.The changes of hematoma volume,relative cerebral blood flow(rCBF)and relative cerebral blood volume(rCBV)were compared between groups.Receiver operating characteristic curves were drawn,and the areas under the curves(AUC)were calculated to evaluate the efficiency of perfusion parameters in the enhanced area for assessing hematoma expansion.Spearman correlation analysis was used to evaluate the correlations of hematoma volume changes and the total time of the appearance of"dynamic spot sign"in positive group.Results No significant difference of hematoma volume was found on initial CT between groups(P>0.05),but the follow-up hematoma volume in positive group was significantly larger than that of negative group(P<0.05).Hematoma enlargement was observed in 17 cases(17/21,80.95%)of positive group and 2 cases(2/24,8.33%)of negative group.rCBF and rCBV in the enhanced area,also the differences of rCBF and rCBV between enhanced area and hematoma area in positive group were all significantly higher than those in negative group(all P<0.05).Taken rCBF=8.90 ml/(min·100 g)and rCBV=6.55 ml/100 g as the cut-off values,AUC for predicting hematoma enlargement was 0.877 and 0.889,respectively.There was a positive correlation between changes of hematoma volume and the total time of"dynamic spot sign"appearance in positive group(r=0.628,P<0.05).Conclusion CTP"dynamic spot sign"regional perfusion parameters could be used to assess hematoma expansion.The changes of hematoma volume was positively correlated with the total time of contrast medium leakage.

关 键 词：脑出血 灌注成像 体层摄影术 X线计算机 

分 类 号：R743.34[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]