不同平扫CT征象在预测脑出血血肿扩大中价值的比较研究  

A Comparative Study of Different Imaging Signs on Non-Contrast CT Scanning for Predicting Hematoma Expansion in Intracerebral Hemorrhage

作　　者：王业青 金宇轩 杨俊杰[2] 王情日 顾燕 徐亮[1] WANG Yeqing;JIN Yuxuan;YANG Junjie(Department of Radiology,The Second Affiliated Hospital of Soochow University,Suzhou,Jiangsu Province 215004,P.R.China)

机构地区：[1]苏州大学附属第二医院影像科,215004 [2]苏州大学苏州医学院,215217

出　　处：《临床放射学杂志》2023年第2期190-197,共8页Journal of Clinical Radiology

基　　金：2021年苏州大学附属第二医院青年预研基金项目(编号:SDFEYJLC2103);2021年苏州大学“医学部学生课外科研项目”(编号:KWKY05);2022年苏州市医学会“影像医星”科技项目“青年项目”(编号:2022YX-Q02)。

摘　　要：目的比较平扫CT“漩涡征”、“黑洞征”、“混杂征”、“海岛征”、“卫星征”及联合征象在脑出血患者血肿扩大中的预测价值,筛选出应用价值更大的平扫CT征象。方法选择2016年1月至2019年12月在苏州大学附属第二医院神经外科或神经内科首诊并住院治疗的544例脑出血患者纳入研究。根据有无出现血肿扩大将患者分为血肿扩大组与血肿未扩大组并进行组间比较,将组间比较差异有统计学意义的变量纳入多因素Logistic回归分析,明确血肿扩大的独立预测因素;根据征象的有无再将患者分为征象阳性组与征象阴性组,分别比较不同组别患者的影像学特征。运用受试者工作特征(ROC)曲线分析“漩涡征”,“黑洞征”,“混杂征”,“海岛征”,“卫星征”及其联合征象预测血肿扩大的准确性。结果167例血肿扩大的患者中,出现“漩涡征”94例(56.3%),“黑洞征”28例(16.8%),“混杂征”40例(24.0%),“海岛征”33例(19.8%),“卫星征”58例(34.7%),“联合征象1”40例(23.9%),“联合征象2”30例(17.9%);377例血肿未扩大的患者中,“漩涡征”152例(40.3%),“黑洞征”50例(13.3%),“混杂征”71例(18.8%),“海岛征”48例(12.7%),“卫星征”125例(33.2%),“联合征象1”64例(16.9%),“联合征象2”44例(11.7%);“漩涡征”、“海岛征”与“联合征象2”的组间差异有统计学意义(P<0.05);血肿扩大组患者的初始血肿体积更大,差异有统计学意义(P=0.012);多因素Logistic回归分析显示“漩涡征”为血肿扩大的独立预测因素(P=0.006)。与征象阴性组比较,征象阳性组患者的初始血肿体积更大,差异有统计学意义(P<0.05)。“黑洞征”阳性组与阴性组比较,阳性组患者更易出现血肿周围水肿(P=0.018)以及中线移位(P=0.000),“混杂征”阳性组更易出现蛛网膜下腔出血(SAH)(P=0.032),血肿更易破入脑室(P=0.000);“海岛征”阳性组更易出现中线Objective To compare the predictive value of non-contrast CT swirl sign,black hole sign,blend sign,island sign,satellite sign and combined signs for hematoma expansion(HE)in intracerebral hemorrhage(ICH)patients and select the more valuable sign(s).Methods There were 544 ICH patients who were first diagnosed and hospitalized in the Second Affiliated Hospital of Soochow University from January 2016 to December 2019 enrolled in the study.All patients were divided into hematoma expansion and non-hematoma expansion group according to whether happened HE,and multivariate logistic regression analysis was performed to determine the independent predicting factors for early hematoma expansion.They were also divided into imaging sign positive and negative group according to whether appeared imaging signs.The imaging data were compared between the groups.The accuracy of the five signs and combined signs in predicting hematoma expansion was analyzed using receiver-operator curve(ROC)analysis.Results Of the 167 patients with HE,94(56.3%)had swirl sign,28(16.8%)had black hole sign,40(24.0%)had blend sign,33(19.8%)had island sign,58(34.7%)had satellite sign,40(23.9%)had“combined sign 1”,and 30(17.9%)had“combined sign 2”.Of the 377 patients without HE,152(40.3%)had swirl sign,50(13.3%)had black hole sign,71(18.8%)had blend sign,48(12.7%)had island sign,125(33.2%)had satellite sign,64(16.9%)had“combined sign 1”,and 44(11.7%)had“combined sign 2”.The difference was statistically significant in swirl sign,island sign and“combined sign 2”between the two groups(P<0.05).The patients with HE had larger baseline hematoma volume(P=0.012).Multivariate logistic regression analysis showed that swirl sign was independent predicting factor for early hematoma expansion(P=0.006).Compared to the imaging sign negative group,the imaging sign positive group had larger baseline hematoma volume,the difference was statistically significant(P<0.05).The patients with black hole sign was more prone to perihematoma edema(P=0.018)and mid

关 键 词：脑出血 血肿扩大 CT征象 预测价值 

分 类 号：R743.34[医药卫生—神经病学与精神病学] R816.1[医药卫生—临床医学]