CT灌注成像原始像点征预测急性自发性脑出血血肿扩大的初步研究

目的探讨CT灌注成像原始像"点征"与有临床意义的血肿体积扩大的相关性。方法选择发病6h内的急性自发性脑出血患者44例,根据是否有"点征",分为"点征"阳性组(14例)和"点征"阴性组(30例)。所有患者均接受基线CT平扫、CT灌注成像和24h后CT平扫。应用计算机辅助容积测量软件测定血肿体积并判断血肿体积有无扩大,盲法评估CT灌注成像判定"点征"及其评分。结果 31.8%的患者被判定为"点征"阳性。"点征"阳性组患者脑实质内血肿体积的变化绝对值和百分比明显大于"点征"阴性组,差异有统计学意义。CT灌注成像原始像显示的"点征"在有临床意义的脑实质内血肿扩大阳性患者与阴性患者比较,差异有统计学意义。CT灌注成像原始像的敏感性为75.0%,特异性为92.9%,阳性预测值为85.7%(OR=39.00,95% CI:6.256～243.126)。结论 CT灌注原始像"点征"可以用于预测自发性脑出血的急性期血肿扩大。

Spot sign on CTP source images predicts hematoma expansion in acute spontaneous intracerebral hemorrhage

Objective To determine whether spot sign on computed tomography perfusion source images is associated with hematoma expansion of clinical significance in intracerebral hemorrhage. Methods Forty-four patients with acute spontaneous intracerebral hemorrhage were selected.According to the presence of spot sign,the patients were divided into two groups,the positive group (14 cases) and the negative group(30 cases).All patients underwent baseline noncontrast CT and computed tomography perfusion examination within 6 hours of onset of symptoms and follow-up noncontrast CT after 24 hours.The hematoma size and growth were measured by computer assisted volumetric analysis.Blinded to growth data,the presence of the spot sign and the spot sign score were determined according to radiological criteria by two neuroradiologists.Results Of forty -four patients,31.8% presented the spot sign on initial computed tomography perfusion.The absolute value and percentage of change of hemorrhage volume demonstrated a statistically significant difference between the two groups.The presence of spot sign increased the risk of significant hematoma expansion (sensitivity 75.0% ,specificity 92.9%,positive predictive value 85.7%, OR = 39.00,95% CI:6.256 — 243.126).Conclusion Spot sign on computed tomography perfusion source images can be used to predict hematoma expansion in acute spontaneous intracerebral hemorrhage.