CT混合征与CT血管成像斑点征对急性脑出血血肿扩大的预测价值

目的分析CT混合征与CT血管成像(CTA)斑点征对急性脑出血患者血肿扩大的预测价值。方法回顾性连续纳入2016年3月至2018年12月昆明医科大学第二附属医院脑血管病科收治的急性脑出血患者,发病6 h内进行基线CT及CTA扫描,明确血肿体积、部位、形态及密度(混合征及斑点征),并于发病24 h后复查CT判定是否出现血肿扩大,根据判定结果将符合纳入标准的186例急性脑出血患者分为血肿扩大组(56例)和非血肿扩大组(130例)。收集患者一般临床资料并进行组间比较,对血肿扩大的各影响因素进行Logistic回归分析,计算受试者工作特征(ROC)曲线下面积并比较混合征与斑点征对血肿扩大的预测价值。结果血肿扩大组出现混合征35.7%(20/56)]、斑点征44.6%(25/56)]的比例明显高于非血肿扩大组混合征12.3%(16/130)、斑点征15.4%(20/130)],差异均有统计学意义(χ2值分别为13.738、18.269,均P<0.01);患者入院时存在CT混合征(OR=3.273,95%CI:1.955~5.413)、CTA斑点征(OR=3.207,95%CI:1.275~8.069)及低GCS评分(OR=1.382,95%CI:1.215~1.573)、高血糖(OR=1.281,95%CI:1.088~1.509)、基线血肿体积大(OR=1.118,95%CI:1.023~1.222)、血肿形态不规则(OR=4.530,95%CI:1.297~15.828)均是血肿扩大的独立危险因素。混合征联合斑点征预测血肿扩大的敏感度、特异度、阳性预测值、阴性预测值分别为51.8%、78.5%、50.9%、79.1%,其ROC曲线下面积为0.666(P<0.01),略高于单一斑点征(曲线下面积0.642,P=0.002)及单一混合征(曲线下面积0.617,P=0.011)。结论除血糖、GCS评分、基线血肿体积、血肿形态以外,混合征、斑点征也与血肿扩大相关。混合征联合斑点征预测急性脑出血血肿扩大的能力优于单一征象。

A predictive value of the blend sign on computed tomography and the spot sign on computed tomography angiography for hematoma expansion in patients with acute intracerebral hemorrhage

Objective To explore and analyze the predictive value of the blend sign on computed tomography(CT)and the spot sign on CT angiography for hematoma expansion in patients with acute intracerebral hemorrhage.Methods A total of 186 patients with acute intracerebral hemorrhage hospitalized in the Department of Cerebrovascular Diseases,the Second Affiliated Hospital of Kunming Medical University from March 2016 to December 2018,were continuously enrolled and retrospectively analyzed.All patients were examined with CT and CT angiography within 6 hours after onset to determine the volume,location,shape and density(blend sign and spot sign)of hematoma,and reexamined with CT at 24 hours after onset to determine whether hematoma expansion occurred.Then they were divided into hematoma expansion group(56 cases)and non-expansion of hematoma group(130 cases)referred to the determination of CT.General clinical data of patients were collected and compared between groups.Logistic regression analysis was carried out on the influencing factors of hematoma enlargement.The receiver operating characteristic(ROC)curve was demonstrated and the area under the curve was calculated to compare the diagnostic value of blend sign and spot sign in predicting hematoma expansion.Results The number of blend sign(20/56)and spot sign(25/56)in hematoma expansion group was significantly higher than that in non-expansion of hematoma group(16/130 and 20/130,respectively),which were significantly different between the two groups(all P<0.01).Low GCS score(OR=1.382,95%CI:1.215-1.573),high blood glucose(OR=1.281,95%CI:1.088-1.509),large hematoma volume(OR=1.118,95%CI:1.023-1.222),irregular hematoma shape(OR=4.530,95%CI:1.297-15.828),CT blend sign(OR=3.273,95%CI:1.955-5.413),CT angiography spot sign(OR=3.207,95%CI:1.275-8.069)were independent risk factors for hematoma expansion.The sensitivity,specificity,positive predictive value,negative predictive value of blend sign combined with spot sign in predicting hematoma expansion were 51.8%,78.5%,50.9%and 79.1%respectively.The area under ROC curve of blend sign combined with spot sign(area under curve:0.666,P<0.01)was slightly larger than that of single blend sign(area under curve:0.617,P=0.011)and single spot sign(area under curve:0.642,P=0.002).Conclusions In addition to blood glucose,GCS score,baseline hematoma volume and hematoma shape,CT blend sign and CT angiography spot sign were also related to hematoma expansion.And the prediction ability of blend sign combined with spot sign is better than that of alternatively single sign.