采用双能量 CT 对急性缺血性脑卒中机械取栓术后患者颅内出血的早期诊断和预测。
Early diagnosis and prediction of intracranial hemorrhage using dual-energy computed tomography after mechanical thrombectomy in patients with acute ischemic stroke.
机构信息
Medical Imaging Center, Jieyang People's Hospital, Jieyang, Guangdong, China.
Neurology, Jieyang People's Hospital, Jieyang, Guangdong, China.
出版信息
Clin Neurol Neurosurg. 2021 Apr;203:106551. doi: 10.1016/j.clineuro.2021.106551. Epub 2021 Feb 10.
PURPOSE
This study assesses the clinical value of dual-energy computed tomography (DECT) in the early diagnosis of intracranial hemorrhage and evaluates the risk of hemorrhagic transformation in patients with acute ischemic stroke (AIS) after mechanical thrombectomy.
METHODS
Patients with AIS who have undergone thrombectomy with Solitaire stent and DECT within one hour after surgery were prospectively enrolled. Linear mixed energy images, virtual non-contrast (VNC) image, and iodine overlay map (IOM) were obtained. Routine CT scan was performed 24 h postoperatively. The sensitivity, specificity, positive and negative predictive values, and accuracy of DECT in the early diagnosis of intracranial hemorrhage was evaluated. The iodine concentration of intracranial lesions was measured by IOM with the follow-up results taken as reference. Receiver operating characteristic (ROC) analysis was performed to obtain the threshold of hemorrhagic transformation and increased bleeding.
RESULTS
Among the 44 patients enrolled in this study, 25 (56.8 %) were diagnosed with simple extravasation of iodinated contrast agent, and 19 (43.2 %) showed intracranial hemorrhage in DECT. Compared with the follow-up CT 24 h after surgery, early diagnosis of postoperative intracranial hemorrhage using DECT demonstrated a sensitivity of 90.5 %, specificity of 100 %, positive predictive rate of 100 %, negative predictive rate of 92.0 %, and accuracy of 95.5 %. Among the 86 intracranial lesions that underwent iodine concentration measurement, 19 were diagnosed with hemorrhagic transformation or increased bleeding, and 67 were diagnosed without the aforementioned conditions. The sensitivity and specificity for differentiating the two groups were 73.7 % and 92.5 %, respectively, with a cut-off value of 2.7 mg/mL.
CONCLUSION
DECT is clinically valuable in early diagnosis and prediction of intracranial hemorrhage after mechanical thrombectomy in AIS patients.
目的
本研究评估双能 CT（DECT）在颅内出血早期诊断中的临床价值，并评估急性缺血性卒中（AIS）患者机械取栓术后发生出血性转化的风险。
方法
前瞻性纳入接受 Solitaire 支架机械取栓术且术后 1 小时内行 DECT 检查的 AIS 患者。获得线性混合能量图像、虚拟非对比（VNC）图像和碘覆盖图（IOM）。术后 24 小时行常规 CT 扫描。评估 DECT 对颅内出血早期诊断的灵敏度、特异度、阳性预测值、阴性预测值和准确率。以随访结果为参照，通过 IOM 测量颅内病灶的碘浓度。采用受试者工作特征（ROC）分析获得出血性转化和出血增加的阈值。
结果
本研究纳入 44 例患者，25 例（56.8%）被诊断为单纯碘造影剂外渗，19 例（43.2%）在 DECT 上显示颅内出血。与术后 24 小时的随访 CT 相比，DECT 早期诊断术后颅内出血的灵敏度为 90.5%，特异度为 100%，阳性预测率为 100%，阴性预测率为 92.0%，准确率为 95.5%。在接受碘浓度测量的 86 个颅内病灶中，19 个诊断为出血性转化或出血增加，67 个诊断为无上述情况。两组之间的灵敏度和特异度分别为 73.7%和 92.5%，截断值为 2.7mg/mL。
结论
DECT 在 AIS 患者机械取栓术后颅内出血的早期诊断和预测方面具有临床价值。
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