常见NCCT征象预测脑血肿增长量及预后不良的价值  

The Value of Common Non-Contrast Computed Tomography Features in Predicting Hematoma Enlargement and Poor Prognosis

作　　者：崔伟 吕国义[1] 王喜丰 张明月 CUI Wei;LüGuoyi;WANG Xifeng;ZHANG Mingyue(Wuhan Fourth Hospital,Wuhan 430000,China)

机构地区：[1]武汉市第四医院影像科,湖北省武汉市430030

出　　处：《中国医学计算机成像杂志》2024年第3期277-282,共6页Chinese Computed Medical Imaging

基　　金：湖北省自然科学基金面上项目(2015CKC905)。

摘　　要：目的:分析并比较非增强CT(NCCT)征象对自发性脑出血患者血肿增长量(IHE)的预测效能。方法:回顾性纳入2018年8月至2021年8月在我院就诊的脑出血患者,IHE定义为随访CT(72 h内)血肿体积较基线血肿体积变化的绝对值。根据IHE将患者分为4组:“无扩大组”、“微小扩大组(≤5.1 mL)”、“中度扩大组(5.1~12.5 mL)”和“大量扩大组(>12.5 mL)”。比较患者的基本临床资料、影像资料(NCCT征象特点,如黑洞征、卫星征、岛征、混合密度征等)、格拉斯哥预后评分(GOS)。对IHE的相关因素进行线性回归分析,以确定其独立预测因子;采用组间比较及Kendall’s tau-b检验相关性分析方法,分析各组IHE与NCCT征象的相关性。计算NCCT征象预测IHE的受试者工作特征(ROC)曲线下面积(AUC),并比较其预测能力。结果:共有311例患者纳入研究。ROC曲线分析显示,混合密度征、黑洞征AUC分别为0.70、0.64。此外,混合密度征、黑洞征与IHE分层呈正相关(混合密度征:r=0.39,P<0.001;黑洞征:r=0.36,P<0.001)。在校正已知的预后预测因素后,与“无扩大”组患者相比,混合密度征与不良预后的发生率有较高相关性。结论:黑洞征、混合密度征均能预测血肿增长量,其中混合密度征的预测价值相对较高。Purpose:To evaluate the efficacy of the non-contrast computed tomography(NCCT)features for predicting the increase of hematoma expansion(IHE)in patients with spontaneous intracerebral hemorrhage(ICH).Methods:Patients with ICH were retrospectively reviewed from August 2018 to August 2021.The IHE was defined as the absolute value of the change of hematoma volume in CT(within 72 hours)compared with the baseline hematoma volume.According to IHE,the patients were categorized into four groups:"no growth";"minimal change"(≤5.1 mL);"moderate change"(5.1-12.5 mL)and"massive change"(>12.5 mL).The basic clinical data,imaging data(NCCT signs,such as black hole sign,satellite sign,island sign,blend sign,etc.)and Glasgow outcome scale(GOS)were compared.Linear regression analysis was used to determine the independent predictors of IHE,and the correlation between IHE and NCCT signs was analyzed by inter-group comparison and Kendall's tau-b test correlation analysis.The area under the curve(AUC)of IHE was predicted by NCCT signs,and its prediction ability was compared.Results:A total of 311 patients were included in the study.The receiver operating characteristic analysis showed that the AUC of the blend sign was 0.70,the black hole sign was 0.64 in predicting IHE,respectively.In addition,the blend sign and black hole sign had positive correlations with the hematoma growth category(blend sign:r=0.39,P<0.001;black hole sign:r=0.36,P<0.001).After adjusting for known predictors of outcome,there was a higher correlation between the blend sign and the incidence of poor prognosis compared with patients in the"no growth"group.Conclusion:The blend sign and the black hole sign are all independent predictors of IHE,but the blend sign shows the best prediction accuracy.

关 键 词：计算机体层成像 CT平扫征象 血肿增大 脑出血 

分 类 号：R445.3[医药卫生—影像医学与核医学]