能谱CT对急性脑梗死介入术后颅内异常高密度影的鉴别诊断分析
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摘要
背景急性脑梗死介入术后,有极少数患者合并脑出血转化。采用常规CT检查时,介入术中使用的对比剂与脑出血转化均表现为高密度,二者不能被及时有效鉴别,而关于能谱CT鉴别二者的研究也鲜见报道。目的探讨能谱CT对急性脑梗死介入术后颅内异常高密度影的鉴别诊断价值。方法回顾性分析河南省中医院2014年5月—2017年10月收治的21例急性脑梗死介入术后即刻行能谱CT平扫出现颅内异常高密度影的急性脑梗死患者图像,以术后24 h常规CT复查结果为标准,将21例颅内异常高密度影分为对比剂渗出组(渗出组,11例)和脑出血转化组(出血组,10例),分别测量各组颅内异常高密度影及其周围正常脑白质的CT值、水(碘)基值、碘(水)基值,计算这3个观察指标的相对值,并比较两组的差异。结果两组颅内异常高密度影CT值比较,差异无统计学意义(P>0.05);渗出组水(碘)基值小于出血组,碘(水)基值大于出血组(P<0.05)。两组颅内异常高密度影周围正常脑白质CT指标比较,差异无统计学意义(P>0.05)。两组CT值相对值比较,差异无统计学意义(P>0.05),在CT扫描图上均表现为相似的高密度;渗出组水(碘)基值相对值小于出血组(P<0.05),在水(碘)基图上,对比剂渗出表现为等低密度,出血表现为高密度;渗出组碘(水)基值相对值大于出血组(P<0.05),在碘(水)基图上,对比剂渗出表现为高密度,出血表现为等低密度。结论能谱CT可以通过碘-水基物质对图对急性脑梗死介入术后CT图像上出现的颅内异常高密度影进行及时有效地鉴别诊断。
Background There are a few patients with hemorrhagic transformation after interventional procedure for acute cerebral infarction.However,on conventional CT,hemorrhagic transformation and contrast exudation used in interventional procedure are hyperdensity,which can not be identified effectively in time,and the study on the identification of the two by Spectral CT is rarely reported.Objective To evaluate the value of differential diagnosis of intracranial hyperdensity after interventional procedure for acute cerebral infarction by spectral CT.Methods The hyperdensity CT images which immediately obtained in 21 patients with acute cerebral infarction in Henan Traditional Chinese Medicine Hospital between May 2015 to October 2017,after interventional procedure were analyzed retrospectively.According to the results of conventional CT 24 hours after interventional procedure,21 cases were divided into two groups:contrast exudation group(n=11) and hemorrhagic transformation group(n=10).CT value,iodine(water) and water(iodine) based value,and relative value between these values and the value of periventricular normal-appearing white matter were measured in each group,and the difference between the two groups were compared.Results There was no significant difference in the CT value of intracranial hyperdensity between the two groups(P>0.05).Water(iodine) value in exudation group was lower than that in hemorrhage group,and the iodine(water) value in exudation group was higher than that in hemorrhage group(P<0.05).There was no significant difference in CT indexes between the two groups(P>0.05).There was no significant difference in the relative value between the two groups(P>0.05),and CT density images showed similar high density.The relative value of the water(iodine) in exudation group was lower than that of the hemorrhage group(P<0.05).On the water(iodine) images,the contrast extravastion showed low density,and the hemorrhage showed high density.The relative value of iodine(water) value of the contrast extravasation group was larger than that of hemorrhage group(P<0.05).On the iodine(water) images,the contrast extravasation showed high density,and the hemorrhage showed low density.Conclusion The spectral CT can be used to differentiate intracranial abnormal high density after interventional procedure of acute cerebral infarction in a timely and effective manner.
Background There are a few patients with hemorrhagic transformation after interventional procedure for acute cerebral infarction.However,on conventional CT,hemorrhagic transformation and contrast exudation used in interventional procedure are hyperdensity,which can not be identified effectively in time,and the study on the identification of the two by Spectral CT is rarely reported.Objective To evaluate the value of differential diagnosis of intracranial hyperdensity after interventional procedure for acute cerebral infarction by spectral CT.Methods The hyperdensity CT images which immediately obtained in 21 patients with acute cerebral infarction in Henan Traditional Chinese Medicine Hospital between May 2015 to October 2017,after interventional procedure were analyzed retrospectively.According to the results of conventional CT 24 hours after interventional procedure,21 cases were divided into two groups:contrast exudation group(n=11) and hemorrhagic transformation group(n=10).CT value,iodine(water) and water(iodine) based value,and relative value between these values and the value of periventricular normal-appearing white matter were measured in each group,and the difference between the two groups were compared.Results There was no significant difference in the CT value of intracranial hyperdensity between the two groups(P>0.05).Water(iodine) value in exudation group was lower than that in hemorrhage group,and the iodine(water) value in exudation group was higher than that in hemorrhage group(P<0.05).There was no significant difference in CT indexes between the two groups(P>0.05).There was no significant difference in the relative value between the two groups(P>0.05),and CT density images showed similar high density.The relative value of the water(iodine) in exudation group was lower than that of the hemorrhage group(P<0.05).On the water(iodine) images,the contrast extravastion showed low density,and the hemorrhage showed high density.The relative value of iodine(water) value of the contrast extravasation group was larger than that of hemorrhage group(P<0.05).On the iodine(water) images,the contrast extravasation showed high density,and the hemorrhage showed low density.Conclusion The spectral CT can be used to differentiate intracranial abnormal high density after interventional procedure of acute cerebral infarction in a timely and effective manner.
引文
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[10]耿云平,郭广春,刘蕾,等.灌注CT微血管通透性对缺血性脑卒中患者出血性转化的预测[J].中华老年心脑血管病杂志,2015,17(12):1286-1288.DOI:10.3969/j.issn.1009-0126.2015.12.016.GENG Y P,GUO G C,LIU L,et al.Microvascular permeability detected by perfusion CT predicts hemorrhagic transformation in ischemic stroke patients[J].Chinese Journal of Geriatric Heart Brain and Vessel Diseases,2015,17(12):1286-1288.DOI:10.3969/j.issn.1009-0126.2015.12.016.
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[12]徐谢生,王开福,邓桂珍,等.脑血管造影术后脑梗死病人即刻头颅CT影像的原因探讨[J].中西医结合心脑血管病杂志,2017,15(14):1779-1781.DOI:10.3969/j.issn.1672-1349.2017.14.032.XU X S,WANG K F,DENG G Z,et al.The cause of immediate CT imaging in cerebral infarction patients after cerebral angiography[J].Chinese Journal of Integrative Medicine on Cardio/Cerebrovascular Disease,2017,15(14):1779-1781.DOI:10.3969/j.issn.1672-1349.2017.14.032.
[13]黄仁军,李勇刚.能谱CT的临床应用与研究进展[J].放射学实践,2015,30(1):81-83.DOI:10.13609/j.cnki.1000-0313.2015.01.022.HUANG R J,LI Y G.Spectral CT:clinical application and research progress[J].Radiologic Practice,2015,30(1):81-83.DOI:10.13609/j.cnki.1000-0313.2015.01.022.
[14]FERDA J,NOVáK M,MíRKA H,et al.The assessment of intracranial bleeding with virtual unenhanced imaging by means of dual-energy CT angiography[J].Eur Radiol,2009,19(10):2518-2522.DOI:10.1364/AO.48.002308.
[15]GUPTA R,PHAN C M,LEIDECKER C,et al.Evaluation of dual-energy CT for differentiating intracerebral hemorrhage from iodinated contrast material staining[J].Radiology,2010,257(1):205-211.DOI:10.1148/radiol.10091806.
[16]PHAN C M,YOO A J,HIRSCH J A,et al.Differentiation of hemorrhage from iodinated contrast in different intracranial compartments using dual-energy head CT[J].AJNR Am JNeuroradiol,2012,33(6):1088-1094.DOI:10.3174/ajnr.A2909.
[17]TIJSSEN M P,HOFMAN P A,STADLER A A,et al.The role of dual energy CT in differentiating between brain haemorrhage and contrast medium after mechanical revascularisation in acute ischaemic stroke[J].European Radiology,2014,24(4):834-840.DOI:10.1007/s00330-013-3073-x.
[2]杜彬,姜卫剑,金旻,等.脑动脉狭窄支架成形术后即刻头颅CT影像分析[J].中华放射学杂志,2005,39(1):39-42.DOI:10.3760/j.issn:1005-1201.2005.01.009.DU B,JIANG W J,JIN M,et al.The prompt CT scan features following cerebrovascular stenting[J].Chinese Journal of Radiology,2005,39(1):39-42.DOI:10.3760/j.issn:1005-1201.2005.01.009.
[3]NAKANO S,ISEDA T,KAWANO H,et al.Parenthetical hyperdensity on computed tomography after intra-arterial reperfusion therapy for acute middle cerebral artery occlusion:incidence and clinical significance[J].Stroke,2001,32(9):2042-2048.DOI:10.1161/hs0901.095602.
[4]陈艳超,雷春艳,刘鸣.脑梗死后出血转化不同亚型与预后关系的系统评价[J].中国卒中杂志,2015,10(10):827-834.DOI:10.3969/j.issn.1673-5765.2015.10.004.CHEN Y C,LEI C Y,LIU M.Association between clinical outcome and hemorrhagic transformation after acute,cerebral infarction:a system review[J].Chinese Journal of Stroke,2015,10(10):827-834.DOI:10.3969/j.issn.1673-5765.2015.10.004.
[5]MOKIN M,MORR S,FANOUS A A,et al.Correlation between cerebral blood volume values and outcomes in endovascular therapy for acute ischemic stroke[J].J Neurointerv Surg,2015,7(10):705-708.DOI:10.1136/neurintsurg-2014-011279.
[6]TERRUSO V,DCANELIO M,DIBENEDETTO N,et al.Frequency and determinants for hemorrhagic transformation of cerebral infarction[J].Neuroepidemiology,2009,33(3):261-265.DOI:10.1159/000229781.
[7]LEE J H,PARK K Y,SHIN J H,et al.Symptomatic hemorrhagic transformation and its predictors in acute ischemic stroke with atrial fibrillation[J].Eur Neurol,2010,64(4):193-200.DOI:10.1159/000319048.
[8]LIN S,WU B,HAO Z L,et al.Characteristics,treatment and outcome of ischemic stroke with atrial fibrillation in a Chinese hospital-based stroke study[J].Cerebrovasc Dis,2011,31(5):419-426.DOI:10.1159/000323221.
[9]GUAN W,KOZAK A,FAGAN S C.Drug repurposing for vascular protection after acute ischemic stroke[J].Acta Neurochir Suppl,2011,111(111):295-298.DOI:10.1007/978-3-7091-0693-8-49.
[10]耿云平,郭广春,刘蕾,等.灌注CT微血管通透性对缺血性脑卒中患者出血性转化的预测[J].中华老年心脑血管病杂志,2015,17(12):1286-1288.DOI:10.3969/j.issn.1009-0126.2015.12.016.GENG Y P,GUO G C,LIU L,et al.Microvascular permeability detected by perfusion CT predicts hemorrhagic transformation in ischemic stroke patients[J].Chinese Journal of Geriatric Heart Brain and Vessel Diseases,2015,17(12):1286-1288.DOI:10.3969/j.issn.1009-0126.2015.12.016.
[11]王健楠,南光贤.脑梗死出血性转化的相关因素[J].中国老年学杂志,2015,36(20):5976-5978.DOI:10.3969/j.issn.1005-9202.2015.20.146.WANG J N,NAN G X.Factors related to hemorrhagic transformation of cerebral infarction[J].Chinese Journal of Gerontology,2015,36(20):5976-5978.DOI:10.3969/j.issn.1005-9202.2015.20.146.
[12]徐谢生,王开福,邓桂珍,等.脑血管造影术后脑梗死病人即刻头颅CT影像的原因探讨[J].中西医结合心脑血管病杂志,2017,15(14):1779-1781.DOI:10.3969/j.issn.1672-1349.2017.14.032.XU X S,WANG K F,DENG G Z,et al.The cause of immediate CT imaging in cerebral infarction patients after cerebral angiography[J].Chinese Journal of Integrative Medicine on Cardio/Cerebrovascular Disease,2017,15(14):1779-1781.DOI:10.3969/j.issn.1672-1349.2017.14.032.
[13]黄仁军,李勇刚.能谱CT的临床应用与研究进展[J].放射学实践,2015,30(1):81-83.DOI:10.13609/j.cnki.1000-0313.2015.01.022.HUANG R J,LI Y G.Spectral CT:clinical application and research progress[J].Radiologic Practice,2015,30(1):81-83.DOI:10.13609/j.cnki.1000-0313.2015.01.022.
[14]FERDA J,NOVáK M,MíRKA H,et al.The assessment of intracranial bleeding with virtual unenhanced imaging by means of dual-energy CT angiography[J].Eur Radiol,2009,19(10):2518-2522.DOI:10.1364/AO.48.002308.
[15]GUPTA R,PHAN C M,LEIDECKER C,et al.Evaluation of dual-energy CT for differentiating intracerebral hemorrhage from iodinated contrast material staining[J].Radiology,2010,257(1):205-211.DOI:10.1148/radiol.10091806.
[16]PHAN C M,YOO A J,HIRSCH J A,et al.Differentiation of hemorrhage from iodinated contrast in different intracranial compartments using dual-energy head CT[J].AJNR Am JNeuroradiol,2012,33(6):1088-1094.DOI:10.3174/ajnr.A2909.
[17]TIJSSEN M P,HOFMAN P A,STADLER A A,et al.The role of dual energy CT in differentiating between brain haemorrhage and contrast medium after mechanical revascularisation in acute ischaemic stroke[J].European Radiology,2014,24(4):834-840.DOI:10.1007/s00330-013-3073-x.