CT平扫对肿瘤性出血与非肿瘤性出血血肿周围水肿的对比分析研究  

A Comparative Analysis Stydy of Perihematomal Edema in Discrimination Neoplastic and Non⁃Neoplastic Causes of Acute Intracerebral Hemorrhage Based on Plain CT

作　　者：王思慧 王晓晨 赵雪宁 孙胜军[1] WANG Sihui;WANG Xiaochen;ZHAO Xuening(Department of Radiology,Beijing Neurosurgical Institute,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]北京市神经外科研究所放射科,首都医科大学附属北京天坛医院放射科,100070

出　　处：《临床放射学杂志》2023年第4期550-555,共6页Journal of Clinical Radiology

基　　金：国家自然科学基金项目(编号:81971614);首都卫生发展科研专项项目(编号:2022-2-1074)。

摘　　要：目的分析CT平扫血肿周围水肿对肿瘤性出血及非肿瘤性出血的鉴别诊断价值。方法回顾性搜集94例急性脑出血患者(肿瘤组37例,非肿瘤组57例),使用3D-slicer软件对CT平扫周围水肿的绝对水肿体积(PHE)、相对水肿体积(rPHE)、水肿及血肿CT值进行量化,分析各个指标的组间差异,以受试者工作特征(ROC)曲线分析各独立指标及部分联合指标鉴别肿瘤性出血与非肿瘤性出血的效能。结果肿瘤组与非肿瘤组间的PHE、rPHE、平均水肿CT值与血肿CT值均存在显著差异,肿瘤组患者的PHE(59.02 cm^(3))、rPHE(0.74)均大于非肿瘤组,平均水肿CT值(23 HU)与血肿CT值(55 HU)均低于非肿瘤组。ROC曲线分析结果表明:四个指标联合的诊断效能曲线下面积(AUC)最高,为0.880,绝对水肿体积在单个指标间的诊断效能最高,AUC为0.823。平均水肿CT值作为一项创新性指标,AUC达0.806(以24.5 HU为截断值)。平均血肿CT值联合rPHE的诊断敏感度最高,为0.919。结论CT平扫周围水肿的量化指标可作为鉴别肿瘤性出血与非肿瘤性出血的有效影像学标签。Objective To analyse the value of perihematomal edema of plain CT in discrimination neoplastic and non⁃neoplasticcauses.Methods The imaging data of 94 cases of acute intracerebral hemorrhage were collected retrospective⁃ly.The perihematomal edema absolute(PHE)volume,relative perihematomal edema(rPHE),the mean value of hounsfield unit of perihematoma edema and hematoma were measured quantitatively using 3D⁃slicer sofeware,analyzing the difference between the two groups.ROC curve was used to evaluate the diagnostic efficacy of all individual indicators and partical com⁃binations of indicators in discrimination neoplastic and non⁃neoplastic causes of acute intracerebral hemorrhage.Results There were statistical differences of PHE volume,relative edema,the value of hounsfield unit of edema and hematoma be⁃tween the neoplastic and non⁃neoplastic.The PHE volume and rPHE in neoplastic group tended to be higher than the other,while the mean value of hounsfield unit of edema and hematoma were lower.ROC curve analyses showed the AUC(0.880)of the unit combining all four factors was highest and the PHE volume demonstrated the optimal diagnostic efficiency in all individual indicators with the AUC(0.823).As an innovative indicator,the AUC of the mean value of hounsfield unit of perihematomal edema was 0.806(with the cut⁃off value of 24.5 HU).In addition,the sensitivity was highest in the combi⁃nation of the mean value of hounsfield unit of hematoma and rPHE,reaching up to 0.919.Conclusion The quantitative value of edema on CT plain images can be effective imaging labels to distinguish neoplastic and non⁃neoplastic causes of a⁃cute intracerebral hemorrhage.

关 键 词：急性脑出血 周围水肿 肿瘤性与非肿瘤性 体层摄影术 X线计算机 

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]