急性缺血性脑卒中动脉取栓术后动态颅脑CT图像上高密度影的鉴别  

Differentiation of hyperattenuation in dynamic craniocerebral CT images after arterial thrombectomy in acute ischemic stroke

作　　者：刘利静 程琳 王爱杰[1] 初金哲 叶天涛 兰受昌 李忠维[1] 于天霞[3] 张国伟[1] LIU Lijing;CHENG Lin;WANG Aijie;CHU Jinzhe;YE Tiantao;LAN Shouchang;LI Zhongwei;YU Tianxia;ZHANG Guowei(Department of Imaging,Yantaishan Hospital,Yantai 264001,China.)

机构地区：[1]山东省烟台市烟台山医院影像科,山东烟台264001 [2]山东省卫生健康委员会医疗管理服务中心,山东济南250014 [3]山东省烟台市烟台山医院神经内二科,山东烟台264001

出　　处：《中国中西医结合影像学杂志》2023年第3期295-299,共5页Chinese Imaging Journal of Integrated Traditional and Western Medicine

摘　　要：目的:通过分析急性缺血性脑卒中动脉取栓术后动态颅脑CT图像,鉴别对比剂溢出和脑出血。方法:回顾性分析129例急性缺血性脑卒中患者动脉取栓术后动态颅脑CT图像,根据图像特点将高密度影分为正常(Ⅰ型)、对比剂溢出(Ⅱ型)、出血(Ⅲ型)。结果:Ⅰ型64例,Ⅱ型30例,Ⅲ型35例,其中Ⅱ型又分A组16例、B组9例、C组5例。Ⅰ型为正常表现,颅内较大血管和大脑镰、小脑幕、上下矢状窦呈高密度。Ⅱ型表现为高密度影局部脑组织无肿胀,周围无水肿,无占位效应,48 h内消失;其中A组高密度影位于梗死区,呈点片状,即刻颅脑CT检查高密度影CT值37~133 HU;B组位于蛛网膜下腔或脑室系统,CT值40~140 HU;C组表现为脑回状或团片状高密度影,CT值40~62 HU。Ⅲ型高密度影CT值41~116 HU,复查过程中周围出现水肿,并引起占位效应,48 h后可部分吸收或增大。结论:急性缺血性脑卒中动脉取栓术后动态颅脑CT图像有一定特征,可通过复查时的CT征象鉴别高密度影的性质。Objective:To identify the extravasation of contrast agents and intracerebral hemorrhage by analyzing the dynamic craniocerebral CT images after arterial thrombectomy in acute ischemic stroke.Methods:The dynamic craniocerebral CT images of 129 acute ischemic stroke patients after arterial thrombectomy were retrospectively analyzed.According to the CT characteristics and the absorption time of hyperattenuation,the patients were divided into three types:normal(typeⅠ),contrast agent extravasation(typeⅡ)and hemorrhage(typeⅢ).Results:Sixty-four cases were typeⅠ,30 cases of typeⅡand 35 cases of typeⅢ,and among the 30 cases of typeⅡ,16 cases were in group A,9 cases in group B and 5 cases in group C.TypeⅠshowed hyperattenuation in large intracranial vessels,the falxcerebri,the tentorium cerebri,the superior and inferior sagittal sinuses.TypeⅡwas characterized by hyperattenuation,no swelling of local brain tissue,no surrounding edema,no mass effect and the hyperattenuation disappeared within 48 h.In group A,the hyperattenuation was located in the infarct area and presented a patchy shape with CT value of 37~133 HU by immediate craniocranial CT examination.In group B,the hyperattenuation was located in the subarachnoid space or ventricular with CT value of 40~140 HU.Group C showed a gyri or lamellar hyperattenuation with CT value of 40~62 HU.The hyperattenuation in typeⅢwith CT value of 37~133 HU,showed edema with a mass effect,which could be absorbed or enlarged after 48 h.Conclusions:The dynamic craniocerebral CT images after arterial thrombectomy in acute ischemic stroke have certain features,and the hyperattenuation type can be identified by CT reexamination.

关 键 词：急性缺血性脑卒中 动脉取栓术 对比剂溢出 脑出血 

分 类 号：R651.12[医药卫生—外科学]