本文關(guān)鍵詞： CT腦灌注 腦出血 預(yù)測 卒中　出處：《首都醫(yī)科大學(xué)學(xué)報》2017年01期 　論文類型：期刊論文

【摘要】：目的 評價急性腦出血血腫內(nèi)計算機(jī)斷層掃描灌注原始圖像(computed tomography perfusion source images,CTP-SI)上,動態(tài)進(jìn)行性強(qiáng)化灶(“動態(tài)點(diǎn)征”)對腦出血增長的預(yù)測價值。方法 前瞻性研究112例連續(xù)性急性自發(fā)性腦出血病人,癥狀發(fā)生6 h以內(nèi),均接受電子計算機(jī)斷層掃描(computed tomography,CT)平掃及CTP檢查。檢查影像資料經(jīng)2位有經(jīng)驗(yàn)的神經(jīng)放射醫(yī)師進(jìn)行觀察評估。根據(jù)病人是否出現(xiàn)“動態(tài)點(diǎn)征”分為2組。將臨床資料和影像資料相對應(yīng)分組,對“動態(tài)點(diǎn)征”對腦出血血腫增長預(yù)測進(jìn)行多變量評估分析。結(jié)果 112例病人中,經(jīng)復(fù)查證實(shí)腦出血增長病人為28例(25.0%)。出現(xiàn)CTP-SI上強(qiáng)化灶為30例(26.8%)。強(qiáng)化組與無強(qiáng)化組的基線臨床數(shù)據(jù)相同,CTP“動態(tài)點(diǎn)征”陽性的病人中,25例(83.3%)病人表現(xiàn)為腦血腫增長,而5例(16.7%)病人無血腫增長�！皠討B(tài)點(diǎn)征”預(yù)測腦內(nèi)血腫增長的靈敏度、特異度、陽性預(yù)測值和陰性預(yù)測值分別為89.3%、94.0%、83.3%和96.3%,Kappa值為0.841(P0.001)。觀察者間的一致性高(κ=0.92)。經(jīng)單因素及多因素回歸分析,CTP“動態(tài)點(diǎn)征”是具有獨(dú)立的預(yù)測腦內(nèi)血腫增長的影像征象,其中單因素OR值為131.667(29.386~590.289)(P0.000 1);多因素分析OR值為230.996(32.123~1 295.448)(P0.000 1)。結(jié)論 CTP-SI中的“動態(tài)點(diǎn)征”與急性腦出血血腫增長有關(guān),是可用以臨床指導(dǎo)進(jìn)一步加強(qiáng)治療及監(jiān)護(hù)腦出血病人的有意義的影像學(xué)征象。
[Abstract]:Objective to evaluate computed tomography perfusion source imaging (CTP-SII) of computed tomography perfusion source in hematoma of acute intracerebral hemorrhage (AICH). Methods 112 consecutive patients with acute spontaneous intracerebral hemorrhage were studied prospectively. All the patients were examined by computed tomography CT and CTP. The imaging data were observed and evaluated by two experienced neuroradiologists. The patients were divided into two groups according to whether they had "dynamic dot sign" or not. The data and image data are grouped into groups, A multivariate evaluation analysis was made on the prediction of hematoma growth in intracerebral hemorrhage by "dynamic dot sign". Results among 112 patients, After reexamination, 28 patients with intracerebral hemorrhage growth were confirmed to have increased cerebral hemorrhage, and 30 patients with enhancement focus on CTP-SI were found to have the same baseline clinical data as that of non-enhancement group. 25 of the patients with positive "dynamic dot sign" were found to have increased cerebral hematoma. There was no hematoma growth in 5 patients. The sensitivity and specificity of "dynamic dot sign" in predicting the growth of intracerebral hematoma, The positive predictive value and negative predictive value were 89. 3% and 96. 3%, respectively, and the Kappa value was 0. 841% (P 0. 001). The consistency among observers was high (魏 0. 92). By single factor and multivariate regression analysis, CTP "dynamic dot sign" was an independent imaging sign for predicting the growth of intracerebral hematoma. The OR value of single factor was 131.66729. 386n 590.289. the OR value of multivariate analysis was 230.996 ~ 32.123.125.448% P0.00010.Conclusion the "dynamic dot sign" in CTP-SI is related to the increase of acute intracerebral hemorrhage hematoma. It is a useful imaging sign for clinical guidance to further strengthen the treatment and monitoring of patients with cerebral hemorrhage.
【作者單位】： 首都醫(yī)科大學(xué)附屬北京天壇醫(yī)院放射科北京市神經(jīng)外科研究所神經(jīng)影像室;
【分類號】：R445

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