Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
Departments of Neurology, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Biomed Res Int. 2021 Apr 13;2021:5527101. doi: 10.1155/2021/5527101. eCollection 2021.
Hyperdense lesions are frequently revealed on flat panel CT (FP-CT) immediately after endovascular thrombectomy in patients with acute ischemic stroke. This study is aimed at discriminating hyperdense lesions caused by extravasation plus hemorrhage from those caused by contrast extravasation alone.
We retrospectively analyzed clinical and radiological data of patients who underwent an immediate postprocedure FP-CT scan and a follow-up noncontrast CT 24 hours after thrombectomy. We especially focused on the Maximum Hounsfield Units (HU) of each hyperdense lesion. A hyperdense lesion was judged to be hemorrhagic when it persisted on noncontrast CT and/or developed a mass effect.
Of 81 patients included in this study, 32 (39.5%) patients presented 41 hyperdense lesions on FP-CT. The chance of hemorrhagic transformation is higher in patients with hyperdense lesions on FP-CT than that in patients without hyperdense lesions (23/32 vs. 1/49, < 0.001). The HU of hyperdensity on FP-CT can predict hemorrhagic transformation with an area under the curve of 0.805 (95% CI: 0.67-0.94, = 0.02). The sensitivity, specificity, positive, and negative predictive values of hyperdensity on FP-CT for hemorrhagic transformation were 96%, 84%, 72%, and 98%, respectively. A HU of >600 predicted hemorrhagic transformation with a sensitivity of 50% and a specificity of 100%.
The presence of hyperdensity on FP-CT can predict hemorrhagic transformation with a high sensitivity and negative predictive value. The measurement of HU of hyperdense lesion on FP-CT can be applied to the management of patients undergoing endovascular recanalization.
在急性缺血性脑卒中患者血管内血栓切除术后立即进行平板 CT（FP-CT）检查时，经常会发现高密度病灶。本研究旨在区分由外渗伴出血引起的高密度病灶和单纯由造影剂外渗引起的高密度病灶。
我们回顾性分析了行即刻术后 FP-CT 扫描和血栓切除术后 24 小时行非增强 CT 随访的患者的临床和影像学资料。我们特别关注每个高密度病灶的最大 CT 值（HU）。当高密度病灶在非增强 CT 上持续存在和/或出现肿块效应时，即可判断为出血性。
本研究共纳入 81 例患者，其中 32 例（39.5%）患者的 FP-CT 上有 41 个高密度病灶。FP-CT 上有高密度病灶的患者发生出血性转化的几率高于无高密度病灶的患者（23/32 比 1/49， < 0.001）。FP-CT 上高密度病灶的 HU 可以预测出血性转化，曲线下面积为 0.805（95%CI：0.67-0.94， = 0.02）。FP-CT 上高密度病灶对出血性转化的敏感度、特异度、阳性预测值和阴性预测值分别为 96%、84%、72%和 98%。HU＞600 预测出血性转化的敏感度为 50%，特异度为 100%。
FP-CT 上高密度病灶的存在可以高度敏感和阴性预测出血性转化。测量 FP-CT 上高密度病灶的 HU 值可应用于血管内再通治疗患者的管理。
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