双能量CT在AIS血管内治疗术后即刻颅内出血诊断中的应用价值

doi:10.3877/cma.j.issn.2095-5782.2021.02.014

目的

探讨双能量CT（DECT）在急性缺血性卒中（AIS）血管内治疗术后即刻鉴别脑出血及对比剂外渗中的临床应用价值。

方法

连续收集50名AIS并接受血管内治疗的患者，于术后立即行DECT扫描，经后处理获得混合能量图（MIX）、虚拟平扫图（VNC）、碘覆盖图（IOM）及虚拟去钙图（VNCa），经综合分析诊断，以术后24～48 h随访CT平扫或磁共振SWAN序列为标准进行对照，计算DECT诊断出血的敏感度、特异度、阳性预测值、阴性预测值、准确率。

结果

50例患者中41例患者MIX图上见高密度影。DECT后处理分析诊断对比剂外渗29例，后经随访证实24例为对比剂外渗，余5例继发出血转化；DECT诊断出血合并对比剂外渗12例，后经随访全部证实；DECT诊断10处不典型钙化，后经随访或结合前片对照全部证实。DECT识别AIS血管内治疗术后即刻颅内出血敏感度为70.6%（12/17）、特异度为100%（36/36）、阳性预测率为100%（12/12）、阴性预测率为87.8%（36/41）、准确率为90.6%（48/53）。

结论

急性缺血性卒中血管内治疗术后可以即刻运用双能量CT对颅内早期出血准确诊断。

关键词: 双能量CT, 颅内出血, 急性缺血性脑卒中, 虚拟平扫图, 出血性转化

Objective

To explore the clinical value of DECT in differentiating between intracranial hemorrhage and contrast medium extravasation immediately after endovascular treatment of acute ischemic stroke (AIS).

Methods

50 patients with acute ischemic stroke who underwent endovascular treatment and follow-up DECT immediately were included. Mixed energy images (MIX), virtual non-contrast images (VNC), iodine overlay maps (IOM) and virtual non-calcium images (VNCa) were obtained and evaluated after post-processing. Taking the conventional CT or MR susceptibility weighted angiography (SWAN) images within 24~48 h after operation as the reference standard, the sensitivity, specificity, positive and negative predictive value, accuracy of dual energy CT in the diagnosis of hemorrhage were calculated.

Results

Among the 50 patients, 41 patients had high density on MIX. 29 cases were diagnosed as contrast medium extravasation by DECT, 24 of them were confirmed by follow-up scan, the other 5 cases were identified as hemorrhagic transformation. 12 cases were diagnosed as intracranial hemorrhage complicated with contrast medium extravasation by DECT, all were confirmed by follow-up scan. 10 were diagnosed as atypical calcification by DECT, all were confirmed by follow-up or former scan. The sensitivity, specificity, positive and negative predictive value, accuracy of DECT in the diagnosis of hemorrhage after endovascular treatment of AIS were 70.6% (12/17), 100% (36/36), 100% (12/12), 87.8% (36/41) and 90.6% (48/53), respectively.

Conclusions

DECT can be used to accurately diagnose intracranial hemorrhage immediately after endovascular treatment of AIS.

Key words: Dual-energy CT, Intracranial hemorrhage, Acute ischemic stroke, Virtual non-contrast images, Hemorrhagic transformation

图1 男，50岁，取栓介入术后即刻DECT扫描，术后30 h常规CT复查

图2 男，67岁，取栓介入术后即刻DECT扫描，术后24 h常规CT复查

图3 女，74岁，溶栓后DECT扫描，与术前常规CT对照

图4 双能量CT物质鉴别原理图

图5 男，62岁，取栓介入术后即刻DECT扫描，术后24 h常规CT复查

图6 男，70岁，取栓介入术后即刻DECT扫描，术后24 h常规CT复查

图7 女，76岁，取栓介入术后即刻DECT扫描，术后47 h常规CT复查

[1]	中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志, 2018, 51(9): 666-682.
[2]	尹海燕，李澄，张新江, 等. 急性脑梗死动脉溶栓的现状、影像学评价与进展[J]. 国际医学放射学杂志, 2011, 34(1): 55-60.
[3]	中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组，中华医学会神经病学分会神经血管介入协作组. 中国急性缺血性脑卒中早期血管内介入诊疗指南2018[J]. 中华神经科杂志, 2018, 51(9): 683-691.
[4]	Mokin M, Kan P, Kass-Hout T, et al. Intracerebral hemorrhage secondary to intravenous and endovascular intraarterial revascularization therapies in acute ischemic stroke: an update on risk factors, predictors, and management[J]. Neurosurg Focus, 2012, 32(4): E2.
[5]	Balami JS, White PM, McMeekin PJ, et al. Complications of endovascular treatment for acute ischemic stroke: prevention and management[J]. Int J Stroke, 2018, 13(4): 348-361.
[6]	Kim JT, Heo SH, Cho BH, et al. Hyperdensity on non-contrast CT immediately after intra-arterial revascularization[J]. J Neurol, 2012, 259(5): 936-943.
[7]	周龙江，王苇，张新江, 等. 颅内介入术后即刻头颅CT高密度影像分析[J]. 放射学实践, 2010, 25(6): 612-615.
[8]	Khalilzadeh O, Sabel B, Sung Y, et al. Temporal evolution of intraparenchymal hyperdensity after intra-arterial therapy in patients with ischemic stroke: optimal discrimination between hemorrhage and iodinated contrast[J]. Clin Neuroradiol, 2014, 24(4): 365-371.
[9]	Kamalian S, Lev MH, Pomerantz SR. Dual-energy computed tomography angiography of the head and neck and related applications[J]. Neuroimaging Clin N Am, 2017, 27(3): 429-443.
[10]	Wolman DN, Patel BP, Wintermark M, et al. Dual-energy computed tomography applications in neurointervention[J].J Comput Assist Tomogr, 2018, 42(6): 831-839.
[11]	Gibney B, Redmond CE, Byrne D, et al. A review of the applications of dual-energy CT in acute neuroimaging[J]. Can Assoc Radiol J, 2020, 71(3): 253-265.
[12]	Hu R, Daftari Besheli L, Young J, et al. Dual-energy head CT enables accurate distinction of intraparenchymal hemorrhage from calcification in emergency department patients[J]. Radiology, 2016, 280(1): 177-183.
[13]	Hu R, Padole A, Gupta R. Dual-energy computed tomographic applications for differentiation of intracranial hemorrhage, calcium, and iodine[J]. Neuroimaging Clin N Am, 2017, 27(3): 401-409.
[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.
[15]	Gupta R, Phan CM, 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.
[16]	Phan CM, Yoo AJ, Hirsch JA, et al. Differentiation of hemorrhage from iodinated contrast in different intracranial compartments using dual-energy head CT[J]. AJNR Am J Neuroradiol, 2012, 33(6): 1088-1094.
[17]	Bonatti M, Lombardo F, Zamboni GA, et al. Iodine extravasation quantification on dual-energy CT of the brain performed after mechanical thrombectomy for acute ischemic stroke can predict hemorrhagic complications[J]. AJNR Am J Neuroradiol, 2018, 39(3): 441-447.

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Application of dual-energy CT immediately in the diagnosis of intracranial hemorrhage after endovascular treatment of acute ischemic stroke

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Application of dual-energy CT immediately in the diagnosis of intracranial hemorrhage after endovascular treatment of acute ischemic stroke