双源CT双能量成像对缺血性卒中介入术后对比剂外渗与出血的早期鉴别  

Early Differential Diagnosis of Contrast Medium Extravasation and Hemorrhage after Interventional Therapy of Ischemic Stroke by Dual Source CT Dual Energy Imaging

作　　者：何晓清[1] 梁汉欢[1] 黄丹丹[2] 黄汉宁[2] 邓灵波 谢婷婷[3] 成官迅[3] HE Xiao-qing;LIANG Han-huan;HUANG Dan-dan;HUANG Han-ning;DENG Ling-bo;XIE Tingting;CHENG Guan-xun(Department of medical imaging,Gaozhou people's Hospital,Gaozhou 525200,Guangdong Province,China;Department of Neurology,people's Hospital of Gaozhou City,Gaozhou 525200,Guangdong Province,China;Department of medical imaging,Shenzhen Hospital,Peking University,Shenzhen 518036,Guangdong Province,China)

机构地区：[1]广东省高州市人民医院医学影像科,广东高州525200 [2]广东省高州市人民医院神经内科,广东高州525200 [3]北京大学深圳医院医学影像科,广东深圳518036

出　　处：《中国CT和MRI杂志》2023年第2期24-27,共4页Chinese Journal of CT and MRI

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

摘　　要：目的 探讨双源CT(dual source computed tomography,DSCT)双能量成像技术对缺血性卒中患者介入治疗后发生对比剂外渗或出血的鉴别诊断价值。方法 回顾性分析165例缺血性卒中患者介入治疗术后,1小时内利用DSCT双能量成像技术行头颅CT扫描,以术后24至72小时的影像学随访检查和最终临床诊断结果为标准评价双能量CT成像鉴别介入术后出血及对比剂外渗的敏感性、特异性、误诊率、漏诊率、阳性预测率、阴性预测率、诊断准确率;并比较双能量CT成像技术与常规CT扫描患者接受的辐射剂量。结果 165例患者中,双能量CT诊断单纯对比剂外渗的敏感性100%、特异性92.38%、误诊率7.62%、漏诊率0、阳性预测值88.24%、阴性预测值100%、诊断准确率95.15%;双能CT诊断对比剂外渗合并出血的敏感性77.14%、特异性99.23%、误诊率0.07%、漏诊率22.86%、阳性预测值96.43%、阴性预测值94.16%、诊断准确率94.55%。颅脑双能量CT扫描患者接受的辐射剂量0.85±0.09m Sv明显低于常规CT平扫1.9±0.27m Sv,差异有显著性(P<0.05)。结论 缺血性卒中患者介入治疗后1小时内行双能量CT扫描对鉴别颅内出血或对比剂外渗有较高的诊断价值,辐射剂量明显低于常规CT平扫,具有较高的临床应用价值。Objective To investigate the value of dual source CT dual energy imaging in the differential diagnosis of contrast agent extravasation or bleeding in patients with ischemic stroke after interventional therapy.Methods A total of 165 patients with ischemic stroke who underwent interventional therapy were retrospectively analyzed,and DSCT dual energy imaging technology was used for head CT scanning within 1 hours. The sensitivity,specificity,misdiagnosis rate,missed diagnosis rate,positive predictive rate,negative predictive rate and diagnostic accuracy of dual energy CT imaging in the differential diagnosis of postoperative hemorrhage and contrast agent extravasation were evaluated according to the imaging follow-up examination and final clinical diagnosis results 24 to 72 hours after intervention.The radiation dose received by patients with dual energy CT imaging technology and conventional CT scanning was compared. Results In 165 patients,the sensitivity,specificity,misdiagnosis rate,missed diagnosis rate,positive predictive value,negative predictive value and diagnostic accuracy of dual energy CT were 100%,92.38%,7.62%,0%,88.24%,100% and 95.15%,respectively;The sensitivity,sp ecificity,misdiagnosis rate,missed diagnosis rate,positive predictive value,negative predictive value and diagnostic accuracy of dual energy CT were 77.14%,99.23%,0.07%,22.86%,96.43%,94.16% and 94.55%,respectively. The radiation dose of dual energy CT(0.85 ± 0.09 mSv) was significantly lower than that of routine CT scan(1.9 ± 0.27 mSv)(P<0.05). Conclusion Dual energy CT scan within 1 hours after interventional therapy in patients with ischemic stroke has high diagnostic value in differentiating intracranial hemorrhage or contrast medium extravasation,and the radiation dose is significantly lower than that of conventional CT scan,which has high clinical application value.

关 键 词：双能量CT成像 缺血性卒中 颅内出血 对比剂外渗 

分 类 号：R445.3[医药卫生—影像医学与核医学] R540.4[医药卫生—诊断学]