脑出血患者早期造影剂外渗率的临床意义

摘要

Objective The computed tomography angiography exosmosis rate in patients with cerebral hemor-rhage denotes hematoma enlargement, this study evaluated that whether the perfusion computed tomography (PCT) and permeability surface-area product (PS) could detect early CT contrast agent extravasation rate difference and its significance. Methods Twenty patients with cerebral hemorrhage underwent CT examination on admission and after 24 h of admission,and all patients also underwent PCT-PS scanning after 24 h of admission. Compare PS values of re-gions of interest by Wilcoxon rank as following: ①the lesions with spot sign;②the lesions with post contrast CT leak-age(PCCT-L);③the lesions eliminating leakage of hematoma; ④the lesions with extravasation leaking to contralateral region; ⑤hematoma in patients without extravasation; ⑥contralateral area of hematoma without extravasation. In ad-dition,compare the hematoma expansion after 24 h. Results PS value was (6.5 ±1.6), (1.0 ±0.4), (0.12 ±0.39), (0.26±0.09), (0.4±0.3), (0.09±0.32)ml·min-1·(100 g)-1·PS values of spot sign lesions and PCCT-L lesions were significantly different from the other regions respectively (P<0.05). Hematoma volume increased from (34 ±41) ml to (40±46) ml for extravasation-positive patients and decreased from (20±32) ml to(17±27) ml for extravasation-negative patients. Conclusion Compared with PCCT-L lesions and hematoma,the PCT-PS parameters showed a higher rate for contrast media exosmosis in CTA spot sign lesions, implying that early extravasation was associated with hematoma expansion.%目的：脑出血患者CT造影外渗率可提示血肿扩大，本研究评价脑灌注CT（PCT）推导表面渗透性（PS）是否可检测早期CT造影剂外渗率差异及其意义。方法20例脑出血患者入院时及入院24 h后进行CT检查，入院时进行PCT-PS扫描。采用Wilcoxon秩和检验比较下列兴趣区的PS值：①斑点征病灶；②造影剂渗漏（PCCT-L）病灶；③排除外渗的血肿；④外渗至对侧区域；⑤无外渗患者的血肿；⑥无外渗患者血肿的对侧面积。此外，比较24 h后的血肿扩展情况。结果上述6项参数的PS分别为（6．5±1．6）、（1．0±0．4）、（0．12±0．39）、（0．26±0．09）、（0．4±0．3）、（0．09±0．32）ml×min-1×（100 g）-1。斑点征病灶的PS值和PCCT-L病灶的PS与其他几项参数比较差异有统计学意义（P＜0．05）。外渗阳性患者的血肿体积由（34±41）ml增加至（40±46）ml，外渗阴性患者则由（20±32）ml降至（17±27）ml。结论与PCCT-L病灶和血肿比较，PCT-PS参数检测显示CTA斑点征病灶造影剂较高外渗率，早期外渗与血肿扩展相关。