CT在急性脑梗死介入术后脑实质高密度灶鉴别诊断中的应用  

Application of CT in differential diagnosis of cerebral intraparenchymal hyperdensity after interventional therapy of acute cerebral infarction

作　　者：蒋锡丽 张伟[1] 谢树才 欧春 姜兵[1] JIANG Xili;ZHANG Wei;XIE Shucai;OU Chun;JIANG Bing(Department of Radiology,Brain Hospital of Hu'nan Province/the Second People's Hospital of Hu'nan Province,Changsha 410007,China;Department of Critical Care Medicine,Xiangya Hospital Central South University,Changsha 410008,China)

机构地区：[1]湖南省脑科医院(湖南省第二人民医院)放射科,湖南长沙410007 [2]中南大学湘雅医院重症医学科,湖南长沙410008

出　　处：《实用放射学杂志》2023年第1期13-16,25,共5页Journal of Practical Radiology

摘　　要：目的探讨CT平扫在急性脑梗死患者介入术后脑实质高密度灶鉴别诊断中的应用价值.方法选取急性脑梗死血管内介入术后24 h内脑CT平扫显示脑实质高密度灶患者39例.根据24~48 h随访CT或MRI检查结果,将患者分为对比剂外渗组(n=12)、出血转化组(n=17)、对比剂外渗合并出血转化组(n=10).分析3组的临床资料,观察术后24 h内高密度灶的影像学特征(密度是否均匀,有无占位效应,高密度灶是否与脑梗死范围一致).结果对比剂外渗组CT表现为高密度灶密度均匀12例,无占位效应12例,与脑梗死范围一致9例;对比剂外渗合并出血转化组CT表现为高密度灶密度不均匀7例,有占位效应9例,与脑梗死范围一致8例;出血转化组CT表现为高密度灶密度均匀15例,有占位效应15例,与脑梗死范围不一致16例.对比剂外渗合并出血转化组、出血转化组的症状发生到血管内介入治疗的时间均长于对比剂外渗组(P<0.05).结论高密度灶符合脑梗死范围和缺乏占位效应的特点对鉴别对比剂外渗与早期出血转化具有重要意义;密度不均匀的特征有助于对比剂外渗合并出血转化的诊断.缩短急性脑梗死患者症状发生到血管内介入治疗时间可以减少出血转化的发生.Objectivee To investigate the application value of non-enhanced CT in the differential diagnosis of cerebral intraparenchymal hyperdensity after interventional therapy of acute cerebral infarction patients.Methods 39 patients of acute cerebral infarction who underwent intra-arterial interventional therapy were included,and their CT images within 24 hours after surgery showed cerebral intraparenchymal hyperdensity.According to the results of follow-up CT or MRI for 24-48 hours,the patients were divided into contrast agent extravasation group(n=12),hemorrhagic transformation group(n=17),and contrast agent extravasation combined with hemorrhagic transformation group(n=10).The clinical data from three groups were analyzed,and the imaging characteristics of hyperdensity lesions were observed within 24 hours after the surgery(whether the lesions density was homogeneous,whether there was any occupancy effect,and whether the hyperdensity lesions was consistent with the extent of cerebral infarction).Results CT images of the contrast agent extravasation group showed the hyperdensity lesions were homogeneous 12 cases,had no occupancy effect 12 cases,and were consistent with the extent of cerebral infarction 9 cases.CT images of the contrast agent extravasation combined with hemorrhagic transformation group showed the hyperdensity lesions were heterogeneous 7 ceses,had occupancy effect 9 ceses,and were consistent with the extent of cerebral infarction 8 ceses.CT images of the hemorrhagic transformation group showed the hyperdensity lesions were homogeneous 15 ceses,had occupancy effect 15 ceses,and were inconsistent with the extent of cerebral infarction 16 ceses.The time from symptom onset to intra-arterial interventional therapy that in the contrast agent extravasation combined with hemorrhagic transformation group and hemorrhagic transformation group was longer than in the contrast agent extravasation group(P<0.05).

关 键 词：急性脑梗死 介入治疗 对比剂外渗 出血转化 计算机体层成像 

分 类 号：R743.33[医药卫生—神经病学与精神病学] R815[医药卫生—临床医学] R814.42