Department of Radiology, New York Presbyterian Hospital, Weill-Cornell Medical College, New York, NY, USA.
J Neuroimaging. 2012 Apr;22(2):160-6. doi: 10.1111/j.1552-6569.2010.00562.x. Epub 2010 Dec 9.
Multimodal CT with CT angiography (CTA) and CT perfusion (CTP) are increasingly used in stroke triage. Our aim was to identify parameters most predictive of hemorrhagic transformation (HT), especially symptomatic intracerebral hemorrhage (SICH).
This retrospective study included patients evaluated by baseline multimodal CT ≤ 9 hours from ictus with acute nonlacunar middle cerebral artery (MCA) territory infarction. Two readers independently evaluated CTP maps for ischemic severity and CTA source images (CTA-SI) for infarct extent (as measured by ASPECTS). Presence of proximal occlusion (ICA or M1) and degree of collateralization (collateral score) were also assessed on CTA. HT was defined as SICH if associated with deterioration ≥ 4-points on NIHSS. Multivariate logistic regression analysis identified independent predictors of SICH. ROC curves selected optimal thresholds.
Of 84 patients reviewed, HT occurred in 22 (26.2%) and SICH in 8 (9.5%). Univariate predictors for SICH were proximal occlusion (OR = 8.65, P= .049), collateral score (OR = .34, P= .017), ASPECTS (OR = .46, P= .001), and CBV (OR = .001, P= .005). Multivariate analysis revealed ASPECTS as the only independent predictor with optimal threshold ≤ 5 and sensitivity and specificity of 75.0% and 85.5%, respectively.
For acute MCA infarcts ≤ 9 hours, the strongest predictor of SICH on multimodal CT was ASPECTS on CTA-SI.
CT 血管造影（CTA）和 CT 灌注（CTP）的多模态 CT 越来越多地用于中风分诊。我们的目的是确定最能预测出血转化（HT）的参数，尤其是症状性颅内出血（SICH）。
这项回顾性研究纳入了发病后 9 小时内接受基线多模态 CT 评估的急性非腔隙性大脑中动脉（MCA）区域梗死患者。两位读者独立评估 CTP 图上的缺血严重程度和 CTA 源图像（CTA-SI）上的梗死范围（以 ASPECTS 测量）。还在 CTA 上评估近端闭塞（ICA 或 M1）和侧支循环程度（侧支评分）。HT 定义为 NIHSS 恶化≥4 分的 SICH。多变量逻辑回归分析确定 SICH 的独立预测因素。ROC 曲线选择最佳阈值。
在 84 例患者中，22 例（26.2%）发生 HT，8 例（9.5%）发生 SICH。SICH 的单变量预测因素包括近端闭塞（OR=8.65，P=0.049）、侧支评分（OR=0.34，P=0.017）、ASPECTS（OR=0.46，P=0.001）和 CBV（OR=0.001，P=0.005）。多变量分析显示 ASPECTS 是唯一的独立预测因素，最佳阈值≤5，敏感性和特异性分别为 75.0%和 85.5%。
对于发病后≤9 小时的急性 MCA 梗死，CTA-SI 上的 ASPECTS 是 SICH 的最强预测因素。
