急性缺血性脑卒中取栓术后平板CT扫描对出血的预测价值  

Predicting hemorrhagic transformation value of postinterventional flat-panel CT for patients with acute ischemic stroke after thrombectomy

作　　者：刘邦勇 潘晓虎 朱发勇 陈雪梅 刘增辉 刘圣[3] 施海彬[3] LIU Bang-yong;PAN Xiao-hu;ZHU Fa-yong;CHEN Xue-mei;LIU Zeng-hui;LIU Sheng;SHI Hai-bin(Department of Neurology,Xuyi People’s Hospital,Jiangsu 211700,China)

机构地区：[1]盱眙县人民医院神经内科,江苏淮安211700 [2]中国人民解放军陆军第七十一集团军医院放射科,江苏徐州221000 [3]南京医科大学第一附属医院介入放射科,江苏南京210029

出　　处：《影像诊断与介入放射学》2023年第2期96-102,共7页Diagnostic Imaging & Interventional Radiology

摘　　要：目的探讨急性缺血性脑卒中(AIS)患者接受机械取栓后即刻行平板CT检查对术后出血的预测价值。方法回顾性收集并分析2019年1月~2021年12月于我院接受机械取栓治疗并在术后立即行平板CT扫描的AIS患者临床资料。出血的观察时间窗为术后5~7 d,依据头颅CT平扫结果判断。采用受试者工作特征(ROC)曲线来评估平板CT对出血预测的准确性。结果研究期间内共纳入108例患者,其中58例(53.7%)在平板CT上出现高密度征,另50例(46.3%)无高密度征。最终39例(36.1%)经随访影像学检查证实发生出血。平板CT高密度征患者发生出血比例显著高于无高密度征(58.7%比10.0%,P<0.001)。平板CT高密度征预测出血的敏感度87.2%,阴性预测值90.0%。在所有平板CT高密度征患者中,发生出血的患者具有更高的CT值(125 HU比93 HU,P=0.001)和更高比例的高密度征占位效应(67.6%比12.5%,P<0.001)。预测出血的CT值、占位效应和联合二者的ROC曲线下面积分别为0.74、0.78和0.83。结论取栓术后即刻平板CT上的高密度征可以预测AIS的出血,具有较高的阴性预测值。在高密度征患者中,结合CT值和占位效应,平板CT预测高密度征进展为出血的能力得到进一步提高。Objective The purpose of this study was to to determine the dignostic accuracy of flat-panel CT scans in predicting hemorrhagic transformation(HT)for patients with acute ischemic stroke(AIS)after thrombectomy.Methods From January 2019 to December 2021,consecutive AIS patients who received an immediate flat-panel CT scan after thrombectomy were enrolled in this study.The time window for the observation of HT was 5-7 days after the thrombectomy,which was determined according to the brain un-enhanced CT scan.The receiver operating characteristic(ROC)curve was adopted to assess the predictive accuracy of characteristics of flat-panel CT for HT.Results Totals of 108 patients were enrolled in this study,58(53.7%)patients presented with hyperdense lesions on flat-panel CT.Patients with hyperdense lesions experienced a higher proportion of HT than those patients without(58.7%vs.10.0%,P<0.001).The hyperdensity on flat-panel CT predict HT yielded a sensitivity of 87.2%and a negative predictive value of 90.0%.Among all patients with hyperdensity on flat-panel CT,patients who developed HT had higher CT values(125 HU vs.93 HU,P=0.001)and a higher proportion of mass effect(67.6 vs.12.5,P<0.001).The area under the ROC curve of CT values,mass effect,and combination of above for prediction of HT were 0.74,0.78,and 0.83,respectively.Conclusion The hyperdensity on post-thrombectomy flat-panel CT could detect HT with an excellent negative predictive value.The ability of flat-panel CT in predicting the transformation of hyperdensity into HT was improved when combined with CT values and mass effect.

关 键 词：体层摄影术 X线计算机 脑卒中 机械取栓 高密度征 出血 

分 类 号：R814.42[医药卫生—影像医学与核医学] R743.3[医药卫生—放射医学]