早期CT对外伤性颅内出血的诊断价值分析  

Analysis of diagnostic value of early CT in traumatic intracranial hemorrhage

作　　者：顾伟光[1] 钱林清[1] 李义昌[1] GU Wei-guang;QIAN Lin-qing;LI Yi-chang(Department of Radiology,Wuzhong People's Hospital,Suzhou 215128,China)

机构地区：[1]苏州市吴中人民医院放射科,215128

出　　处：《中国实用医药》2024年第3期64-67,共4页China Practical Medicine

摘　　要：目的探索早期CT对外伤性颅内出血的诊断价值。方法回顾性选取239例头部外伤且昏迷的患者为研究对象,收集患者入院早期CT及后期诊疗的影像学[CT和(或)磁共振成像(MRI)]及病历资料,明确患者CT征象上是否存在脑出血、出血部位及出血量,进一步调取后续资料明确实际颅脑损伤情况。对比早期CT检查与后期明确出血患者在出血部位及出血量上的差异。结果239例头部外伤患者中,后期经影像学检查及手术等方式确诊为脑出血的患者188例(78.66%),无脑出血51例(21.34%);早期CT检出准确167例(69.87%),漏诊21例(8.79%),误诊18例(7.53%),早期CT对外伤性颅内出血的诊断灵敏度为88.83%,特异度为64.71%,诊断曲线下面积(AUC)为0.768[95%置信区间=(0.685,0.851),P<0.001];早期CT对基底节[(18.32±3.85)ml]及脑室区[(18.44±4.02)ml]的出血量评估较后期明确的实际出血量[(34.23±5.94)、(27.31±4.92)ml]明显偏低(P<0.05)。结论早期CT对于外伤性颅内出血具有良好的检出价值,但某些部位的脑出血仍需进一步完善头颅MRI或手术探查才能完善确诊。Objective To explore the diagnostic value of early CT in traumatic intracranial hemorrhage.Methods 239 patients with head trauma and coma were selected as the study subjects.The imaging[CT and/or magnetic resonance imaging(MRI)]and medical records of the patients'early CT and late diagnosis and treatment were collected to clarify whether cerebral hemorrhage,bleeding location and bleeding amount were present on the CT signs of the patients,and follow-up data were further obtained to determine the actual craniocerebral injury.The difference between patients with early CT examination and those with late definitive bleeding in the bleeding site and bleeding volume was compared.Results Among 239 patients with head trauma,188 patients(78.66%)were diagnosed with cerebral hemorrhage at a later stage by imaging and surgery,and 51 patients(21.34%)had no cerebral hemorrhage.Early CT was accurate in 167 cases(69.87%),missed in 21 cases(8.79%),and misdiagnosed in 18 cases(7.53%).The diagnostic sensitivity of early CT for traumatic cerebral hemorrhage was 88.83%,the specificity was 64.71%,and the area under the curve(AUC)was 0.768[95%confidence interval=(0.685,0.851),P<0.001].The amount of blood loss in basal ganglia[(18.32±3.85)ml]and ventricular area[(18.44±4.02)ml]assessed by early CT was significantly lower than the actual amount of blood loss[(34.23±5.94),(27.31±4.92)ml]determined at a later stage(P<0.05).Conclusion Early CT has a good value in the detection of traumatic cerebral hemorrhage,but some parts of cerebral hemorrhage still need to be further improved head MRI or surgical exploration to complete the diagnosis.

关 键 词：外伤性颅内出血 早期CT检查 诊断价值 

分 类 号：R651.15[医药卫生—外科学]