本文選題：急性缺血性腦卒中　切入點：顱內(nèi)出血　出處：《實用醫(yī)學(xué)雜志》2017年15期 　論文類型：期刊論文

【摘要】：目的探討雙源雙能量CT在鑒別急性缺血性腦梗死血運重建術(shù)后碘造影劑外滲和繼發(fā)腦出血中的價值。方法 46例因急性缺血性腦卒中行動脈內(nèi)溶栓治療的患者納入本研究,于動脈溶栓術(shù)后2 h內(nèi)行雙源雙能量CT檢查(80 k V/392 m A和140 k V/196 m A),利用圖像工作站生成融合圖像(即:單純?nèi)诤蠄D像診斷法)、融合圖像加虛擬平掃圖像和碘疊加圖像(即:疊加融合圖像診斷法);術(shù)后48 h行常規(guī)CT平掃明確診斷。計算兩種診斷方法診斷繼發(fā)腦出血的敏感性、特異性、陽性預(yù)測值、陰性預(yù)測值和準(zhǔn)確率。結(jié)果 34例得到確診的病例中6例患者CT未見明顯高密度影,余下28例為陽性病例并達到確診,其中3例出血,21例造影劑外滲,余下4例同時合并出血和造影劑外滲。單純?nèi)诤蠄D像法對出血診斷的敏感性、特異性、陽性預(yù)測值、陰性預(yù)測值和準(zhǔn)確率分別為66.67%、100%、100%、96.15%和96.43%,疊加融合圖像診斷法診斷的敏感性、特異性、陽性預(yù)測值、陰性預(yù)測值和準(zhǔn)確率分別為100%%、96%、75%、100%和96.43%。疊加融合圖像對顱內(nèi)出血、造影劑外滲及出血合并造影劑外滲的診斷準(zhǔn)確性均相對較高,且差異具有統(tǒng)計學(xué)意義(P0.046)。疊加融合圖像的診斷準(zhǔn)確性與臨床隨訪確診具有較高的一致性(Kappa=0.815),明顯高于單純?nèi)诤蠄D像(Kappa=0.564)。結(jié)論雙源雙能量CT在鑒別顱內(nèi)出血和造影劑外滲方面有著重要的臨床應(yīng)用價值。
[Abstract]:Objective to investigate the value of dual-source and dual-energy CT in differentiating iodine contrast agent exosmosis from secondary cerebral hemorrhage after acute ischemic cerebral infarction after revascularization. Methods 46 patients with acute ischemic stroke underwent intra-arterial thrombolytic therapy. Within 2 hours after thrombolysis, double source and dual energy CT were performed to examine 80kV / 392mA and 140kV / 196mAn respectively. Fusion images were generated by image workstation (i.e., simple fusion image diagnosis method, fusion image plus virtual plain scan image and iodine stack). After 48 hours of operation, conventional CT plain scan was performed to make a definite diagnosis. The sensitivity of the two diagnostic methods in the diagnosis of secondary intracerebral hemorrhage was calculated. Results among 34 confirmed cases, 6 cases had no obvious high density image on CT, the remaining 28 cases were positive cases, and 21 cases had extravasation of contrast media, among which 3 cases had bleeding and 21 cases had extravasation of contrast media. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the fusion image method for diagnosis of hemorrhage were 66. 67% and 96. 43%, respectively. The diagnostic sensitivity of the superimposed fusion image method was 96. 15% and 96. 43%, respectively. The specificity, positive predictive value, negative predictive value and accuracy were 100% and 96.43%, respectively. The diagnostic accuracy of superimposed fusion images on intracranial hemorrhage, contrast media exosmosis and bleeding combined with contrast media exosmosis was relatively high. The difference was statistically significant (P 0.046). The diagnostic accuracy of superimposed fusion images was higher than that of simple fusion images. Conclusion Dual-source and dual-energy CT can distinguish intracranial hemorrhage from contrast media. Infiltration has important clinical application value.
【作者單位】： 天津醫(yī)科大學(xué)第二醫(yī)院;
【基金】：天津市衛(wèi)生局科技基金項目(編號:2013KZ101)
【分類號】：R743.33

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