MRI与CT在重型高血压脑出血术后早期脑缺血的诊断价值  

Value of MRI and CT in the diagnosis of early cerebral ischemia after operation of severe hypertensive cerebral hemorrhage

作　　者：熊覃 屈薇 李晓欢[1] 易世雄[3] 梁席锋 XIONH qin;QU Wei;LI Xiaohuan;YI Shixiong;LIANG Xifeng(Department of Radiology,Dazhou Centeral Hospital,Dazhou 635000,Sichuan,China;Department of Gastroenterology,Dazhou Central Hospital,Dazhou 635000,Sichuan,China;Department of Rehabilitation,Chongqing Hospital of Traditional Chinese Medicine,Chongqing 400021,China)

机构地区：[1]达州市中心医院放射科,四川达州635000 [2]达州市中心医院消化内科,四川达州635000 [3]重庆市中医院康复科,重庆400021

出　　处：《西部医学》2023年第2期303-307,F0003,共6页Medical Journal of West China

基　　金：四川省卫生和计划生育委员会科研课题(18PJ151)。

摘　　要：目的探讨MRI与CT对重型高血压脑出血术后早期脑缺血的诊断价值。方法回顾性分析2017年1月~2021年1月在达州市中心医院接受手术治疗的125例重型高血压脑出血患者的一般临床资料,所有患者均于术后接受MRI和CT检查,术后根据是否发生脑缺血将患者分为脑缺血组(n=32)和非脑缺血组(n=93),比较两组患者的一般临床资料、MRI和CT影像学特征,Logistic回归分析法分析MRI、CT影像学特征与术后早期脑缺血的相关性,并构建列线图预测模型,评估二者对术后早期脑缺血的诊断价值。结果脑缺血组患者的脑血流量(CBF)和脑血容量(CBV)均小于非脑缺血组,对比剂平均通过时间(MTT)高于非脑缺血组(P<0.05)。Logistic回归分析结果显示,高血压史、收缩压、舒张压、脑水肿范围、血肿量、CBF、CBV和MTT是影响重型高血压脑出血患者术后早期脑缺血的相关因素(P<0.05)。据此构建的列线图预测模型的C-index为0.781(95%CI:0.716~0.848),具有良好的区分度;ROC曲线分析结果显示,预测模型曲线下面积为0.845(P<0.001),敏感度和特异度分别为0.872、0.856。MRI诊断术后早期脑缺血的准确率明显高于CT诊断(P<0.05)。结论CT灌注成像(CTP)相关参数与重型高血压脑出血患者术后早期脑缺血相关,基于以上CTP相关参数等指标构建的风险预测模型具有良好预测效能;与CT相比,MRI对重型高血压脑出血术后早期脑缺血的诊断价值更高,可为临床诊治提供准确的影像学依据。Objective To explore the diagnostic value of MRI and CT for early cerebral ischemia after operation of severe hypertensive cerebral hemorrhage.Methods A retrospective analysis was performed on the general clinical data of 125 patients with severe hypertensive cerebral hemorrhage who underwent operation in the hospital from January 2017 to January 2021.All patients were subjected to MRI and CT examinations after operation.According to presence or absence of cerebral ischemia,the patients were divided into cerebral ischemia group(n=32)and non-cerebral ischemia group(n=93).General clinical data,MRI and CT characteristics of the two groups were compared.Logistic regression analysis was conducted to analyze the correlation between MRI and CT features and early postoperative cerebral ischemia.Anomogram prediction model was constructed to evaluate the diagnostic value of the two methods for postoperative early cerebral ischemia.Results The cerebral blood flow(CBF)and cerebral blood volume(CBV)in the cerebral ischemia group were smaller than those in the non-cerebral ischemia group,and the mean transit time(MTT)of contrast agent was longer than that in the non-cerebral ischemia group(P<0.05).Logistic regression analysis showed that history of hypertension,systolic blood pressure,diastolic blood pressure,range of cerebral edema,hematoma volume,CBF,CBV and MTT were related factors affecting early postoperative cerebral ischemia in patients with severe hypertensive cerebral hemorrhage(P<0.05).The C-index of the nomogram prediction model constructed based on these factors was 0.781(95%CI:0.716-0.848),which indicated good discrimination.ROC curve analysis showed that the area under the curve of this prediction model was 0.845(P<0.001),and its sensitivity and specificity were 0.872 and 0.856,respectively.The accuracy rate of MRI in diagnosing postoperative early cerebral ischemia was significantly higher than that of CT(P<0.05).Conclusion CT perfusion imaging(CTP)related parameters are related to early postoperative cerebral i

关 键 词：重型高血压脑出血 早期脑缺血 磁共振成像 电子计算机断层扫描 

分 类 号：R445.2[医药卫生—影像医学与核医学]