颅脑CT联合征象对早期颅内血肿扩大的预测价值  

Predictive Value of Cranial CT Combined Sign for Early Intracranial Hematoma Expansion

作　　者：张学峰 侯明丽 王瑞 闻燕妮 张定义 朱力[1] ZHANG Xuefeng;HOU Mingli;WANG Rui;WEN Yanni;ZHANG Dingyi;ZHU Li(Department of Radiology,General Hospital of Ningxia Medical University,Yinchuan 750004,China;Department of Radiology,Affiliated Guyuan People’s Hospital of Ningxia Medical University,Guyuan 756000,China;Department of Radiology,People’s Hospital of Ningxia Hui Autonomous Region,Yinchuan 750002,China)

机构地区：[1]宁夏医科大学总医院放射科,银川750004 [2]宁夏医科大学附属固原市人民医院放射科,固原756000 [3]宁夏回族自治区人民医院放射科,银川750002

出　　处：《宁夏医科大学学报》2023年第2期155-160,共6页Journal of Ningxia Medical University

摘　　要：目的探讨颅脑CT对自发性脑出血(SICH)患者早期颅内血肿扩大(HE)的预测价值。方法回顾性分析SICH患者440例,均于发病6 h内行首次颅脑CT及24 h内复查颅脑CT,按照复查CT结果分为HE组(193例)与NHE组(247例),比较两组患者的相关临床及影像学资料。结果两组患者的吸烟史、血肿位置、发病至首次CT时间、初始血肿体积、入院收缩压、入院舒张压、合并破入脑室、岛征、混合征及漩涡征的差异均有统计学意义(P均<0.05)。多因素Logistic回归分析显示,初始血肿体积、合并破入脑室、岛征、混合征及漩涡征是早期颅内HE的独立危险因素(P均<0.05)。经受试者工作特征(ROC)曲线分析,岛征、混合征及漩涡征的联合征象预测早期颅内HE的曲线下面积(AUC)均高于单一征象,其敏感度(71.3%)、特异度(86.5%)、阳性预测值(80.8%)及阴性预测值(79.1%)均处于较高水平,且约登指数为0.578。结论岛征、混合征及漩涡征的联合征象对早期颅内HE的预测价值极高,可将其作为影像学标志纳入评分预测模型。Objective To explore the predictive value of cranial CT for early intracranial hematoma expansion(HE)in patients with spontaneous intracerebral hemorrhage(SICH).Methods A total of 440 patients with SICH were retrospectively analyzed,all of whom received the first cranial CT within 6 h of onset and CT reexamination within 24 h after admission.All patients were divided into HE group(n=193)and non-HE group(n=247)according to the CT reexamination results.The relevant clinical and imaging data were compared between the two groups.Results The differences in smoking history,hematoma location,time from onset to first CT,initial hematoma volume,admission systolic blood pressure,admission diastolic blood pressure,combined with ventricular invasion,island sign,blend sign and swirl sign between the two groups were statistically significant(P all<0.05).Multivariate Logistic regression analysis showed initial hematoma volume,combined with ventricular invasion,island sign,blend sign and swirl sign were independent risk factors for early intracranial HE(P all<0.05).After the analysis of the receiver operating characteristic(ROC)curve,the area under curve(AUC)of the combined sign of island sign,blend sign and swirl sign for predicting early intracranial HE were higher than those of the single sign,its sensitivity(71.3%),specificity(86.5%),positive predictive value(80.8%)and negative predictive value(79.1%)were all at high levels,and the Youden Index(0.578)was closer to 1.Conclusion The combined sign of island sign,blend sign and swirl sign has a high predictive value for early intracranial HE and can be included as an imaging marker in the scoring prediction model.

关 键 词：自发性脑出血 血肿扩大 颅脑CT 岛征 混合征 漩涡征 

分 类 号：R445.3[医药卫生—影像医学与核医学] R743.34[医药卫生—诊断学]