90秒延迟计算机断层扫描血管造影上的斑点征可提高血肿扩大和死亡率的敏感性：前瞻性研究。
Spot sign on 90-second delayed computed tomography angiography improves sensitivity for hematoma expansion and mortality: prospective study.
作者信息
Ciura Viesha A, Brouwers H Bart, Pizzolato Raffaella, Ortiz Claudia J, Rosand Jonathan, Goldstein Joshua N, Greenberg Steven M, Pomerantz Stuart R, Gonzalez R Gilberto, Romero Javier M
机构信息
From the Division of Neuroradiology, Department of Radiology (V.A.C., R.P., C.J.O., S.R.P., R.G.G., J.M.R.), Center for Human Genetic Research (H.B.B., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (H.B.B., J.R., J.N.G.), Department of Neurology, Hemorrhagic Stroke Research Group (H.B.B., J.R., J.N.G., S.M.G.), Department of Neurology, J. Philip Kistler Stroke Research Center (H.B.B., J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Harvard Medical School, Boston; and Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.).
出版信息
Stroke. 2014 Nov;45(11):3293-7. doi: 10.1161/STROKEAHA.114.005570. Epub 2014 Oct 9.
BACKGROUND AND PURPOSE
The computed tomography angiography (CTA) spot sign is a validated biomarker for poor outcome and hematoma expansion in intracerebral hemorrhage. The spot sign has proven to be a dynamic entity, with multimodal imaging proving to be of additional value. We investigated whether the addition of a 90-second delayed CTA acquisition would capture additional intracerebral hemorrhage patients with the spot sign and increase the sensitivity of the spot sign.
METHODS
We prospectively enrolled consecutive intracerebral hemorrhage patients undergoing first pass and 90-second delayed CTA for 18 months at a single academic center. Univariate and multivariate logistic regression were performed to assess clinical and neuroimaging covariates for relationship with hematoma expansion and mortality.
RESULTS
Sensitivity of the spot sign for hematoma expansion on first pass CTA was 55%, which increased to 64% if the spot sign was present on either CTA acquisition. In multivariate analysis the spot sign presence was associated with significant hematoma expansion: odds ratio, 17.7 (95% confidence interval, 3.7-84.2; P=0.0004), 8.3 (95% confidence interval, 2.0-33.4; P=0.004), and 12.0 (95% confidence interval, 2.9-50.5; P=0.0008) if present on first pass, delayed, or either CTA acquisition, respectively. Spot sign presence on either acquisitions was also significant for mortality.
CONCLUSIONS
We demonstrate improved sensitivity for predicting hematoma expansion and poor outcome by adding a 90-second delayed CTA, which may enhance selection of patients who may benefit from hemostatic therapy.
背景与目的
计算机断层血管造影（CTA）斑点征是脑出血预后不良和血肿扩大的有效生物标志物。斑点征已被证明是一个动态实体，多模态成像具有额外价值。我们研究了增加一次90秒延迟CTA采集是否能发现更多有斑点征的脑出血患者，并提高斑点征的敏感性。
方法
我们在一个学术中心前瞻性地连续纳入了18个月内接受首次通过CTA和90秒延迟CTA检查的脑出血患者。进行单因素和多因素逻辑回归分析，以评估临床和神经影像学协变量与血肿扩大和死亡率的关系。
结果
首次通过CTA时斑点征对血肿扩大的敏感性为55%，如果在任何一次CTA采集中出现斑点征，敏感性则提高到64%。在多因素分析中，斑点征的出现与显著的血肿扩大相关：如果在首次通过、延迟或任何一次CTA采集中出现斑点征，优势比分别为17.7（95%置信区间，3.7 - 84.2；P = 0.0004）、8.3（95%置信区间，2.0 - 33.4；P = 0.004）和12.0（95%置信区间，2.9 - 50.5；P = 0.0008）。任何一次采集中出现斑点征对死亡率也有显著影响。
结论
我们证明了增加一次90秒延迟CTA可提高预测血肿扩大和不良预后的敏感性，这可能有助于更好地选择可能从止血治疗中获益的患者。
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