自发性脑出血CT 混合征与CTA 点征 对早期神经功能恶化的预测研究

Prediction of CT blend sign and CTA spot sign of spontaneous intracerebral hemorrhage on early neurological deterioration

摘要:

：目的 探讨CT 混合征与CT 血管造影（CTA）点征在自发性脑出血（ICH）患者早期神经功能 恶化（END）中的预测价值。方法 回顾性分析2015 年8 月-2016 年11 月该院收治的168 例基底节区ICH 患者的临床及影像学资料。根据发病6 h 内入院时CT 及CTA 图像识别混合征与点征，END 定义为发病 48 h 内：①行标准去大骨瓣减压术；②格拉斯哥昏迷评分（GCS）下降≥ 3 分。其中满足≥ 1 项为恶化组（75 例），不满足任意1 项为非恶化组（93 例）。比较入院时CT 混合征和CTA 点征与END 的关联性。结果 168 例ICH 患者均完成入院CT，其中34 例发现混合征；36 例患者完成入院CTA，8 例发现点征。75 例END 患 者中，29 例发现混合征；完成CTA 的16 例END 患者中，6 例出现点征。入院CT 混合征及CTA 点征均可 预测END。结论 CT 混合征在平扫CT 中容易识别，与CTA 点征均为ICH 后END 的预测因素。

Abstract:

Objective To investigate the predictive value of CT blend sign and CTA spot sign of spontaneous intracerebral hemorrhage (ICH) on early neurological deterioration (END). Methods The clinical and imaging data of 168 patients with intracerebral hemorrhage in basal ganglia from August 2015 to November 2016 in Qinghai Provincial People’s hospital were retrospectively analyzed. According to CT and CTA images of patients on admission within 6 hours of onset, CT blend sign and CTA spot sign were identified and END was defined within 48 hours of onset as: ① early hemicraniectomy under standardized criteria; ② decrease of Glasgow coma scale (GCS) ≥ 3 points. Patients who satisfied over one item above were grouped to aggravation group, while were divided into non-aggravation group when satisfied none above.The association of CT blend sign and CTA spot sign with END was compared. Results A total of 168 patients with ICH completed CT, 34 cases presented with blend sign; of 36 patients completed CTA, 8 presented with spot signs; of 75 patients with END, 29 were presented with blend sign; of 16 patients completed CTA with END, 6 (37.5%) were presented with spot sign. Conclusions CT blend sign is easy to be identified in non-contrast CT, and both of CTA spot sign and CT blend sign are independent predictors of END after ICH.