Payabvash Seyedmehdi, Qureshi Mushtaq H, Khan Shayaan M, Khan Mahnoor, Majidi Shahram, Pawar Swaroop, Qureshi Adnan I
Zeenat Qureshi Stroke Institute, Dinnaken Office Building, 925 Delaware Street SE, Suite 300, Minneapolis, MN, 55414, USA.
Neuroradiology. 2014 Sep;56(9):737-44. doi: 10.1007/s00234-014-1381-8. Epub 2014 Jun 13.
This study aimed to identify the imaging characteristics that can help differentiate intraparenchymal hemorrhage from benign contrast extravasation on post-procedural noncontrast CT scan in acute ischemic stroke patients after endovascular treatment.
We reviewed the clinical and imaging records of all acute ischemic stroke patients who underwent endovascular treatment in two hospitals over a 3.5-year period. The immediate post-procedural CT scan was evaluated for the presence of hyperdense lesion(s). The average attenuation of the lesion(s) was measured. Intraparenchymal hemorrhage was defined as a persistent hyperdensity visualized on follow-up CT scan, 24 h or greater after the procedure.
Of the 135 patients studied, 74 (55%) patients had hyperdense lesion(s) on immediate post-procedural CT scan. Follow-up scans confirmed the diagnosis of intraparenchymal hemorrhage in 20 of these 74 patients. A receiver operating characteristic analysis showed that the average attenuation of the most hyperdense lesion can differentiate intraparenchymal hemorrhage from contrast extravasation with an area under the curve of 0.78 (p = 0.001). An average attenuation of <50 Hounsfield units (HU) in the most visually hyperattenuating hyperdense lesion had 100 % specificity and 56% sensitivity for identification of contrast extravasations. Petechial hyperdensity was seen in 46/54 (85%) patients with contrast extravasation versus 9/20 (45%) patients with intraparenchymal hemorrhage on the immediate post-procedural CT scan (p < 0.001).
An average attenuation <50 HU of the most hyperattenuating hyperdense parenchymal lesion on immediate post-procedural CT scan was very specific for differentiating contrast extravasation from intraparenchymal hemorrhage in acute ischemic stroke patients after endovascular treatment.
本研究旨在确定在急性缺血性中风患者血管内治疗后的术后非增强CT扫描中，有助于区分脑实质内出血与良性对比剂外渗的影像学特征。
我们回顾了在3.5年期间于两家医院接受血管内治疗的所有急性缺血性中风患者的临床和影像学记录。对术后即刻CT扫描评估是否存在高密度病变。测量病变的平均衰减值。脑实质内出血定义为在术后24小时或更长时间的随访CT扫描中可见的持续性高密度。
在研究的135例患者中，74例（55%）在术后即刻CT扫描中有高密度病变。在这74例患者中，20例经随访扫描确诊为脑实质内出血。受试者工作特征分析显示，最高密度病变的平均衰减值可区分脑实质内出血与对比剂外渗，曲线下面积为0.78（p = 0.001）。在视觉上最强化的高密度病变中，平均衰减值<50亨氏单位（HU）对识别对比剂外渗具有100%的特异性和56%的敏感性。在术后即刻CT扫描中，46/54（85%）例对比剂外渗患者出现瘀点状高密度，而脑实质内出血患者为9/20（45%）（p < 0.001）。
术后即刻CT扫描中，最强化的高密度脑实质病变平均衰减值<50 HU，对于区分急性缺血性中风患者血管内治疗后脑实质内出血与对比剂外渗具有很高的特异性。
