Inflvencing factors of hematoma enlargement in cerebral hemorrhage based on CT plain scan imaging findings and hematoma volume evaluation
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摘要:
目的 分析多层螺旋CT（MSCT）肺动脉造影相关参数诊断急诊肺动脉栓塞的临床价值。 方法 选取2021年10月~2022年1月于本院接受CT平扫影像学检查的80例脑出血患者的临床资料进行回顾性研究，依据血肿是否扩大将其分为血肿扩大组（n=32）和非血肿扩大组（n=48）。记录所有患者的CT平扫影像学征象及血肿体积，比较两组比较CT平扫影像学征象及血肿体积的差异，采用Spearman相关性分析单一征象、血肿体积与脑出血患者血肿扩大的相关性，以ROC曲线分析CT平扫影像学征象、血肿体积评估血肿扩大的价值，采用Logistic多因素回归分析血肿扩大的相关影响因素。 结果 血肿扩大组的CT平扫出现“岛征”、“黑洞征”、“混杂征”占比均高于非血肿扩大组（P < 0.05）；血肿扩大组的血肿体积大于非血肿扩大组（P < 0.05）。Spearman相关性分析显示，“岛征”、“黑洞征”、“混杂征”、血肿体积与脑出血患者血肿扩大均呈正相关关系（r=0.423、0.456、0.427、0.516，P < 0.05）。ROC曲线分析结果显示，“岛征”、“黑洞征”、“混杂征”联合血肿体积评估血肿扩大的曲线下面积为0.934，敏感度为87.5%，特异性为89.6%，均高于单一征象及血肿体积。Logistic多因素回归分析显示，岛征、黑洞征、混合征、初诊血肿体积增大是血肿扩大的独立危险因素（P < 0.05）。 结论 基于CT平扫影像学表现及血肿体积对脑出血患者血肿扩大具有一定的评估价值，且联合评估价值更高。 Abstract:Objective To analyze the clinical value of multi-slice spiral CT (MSCT) pulmonary angiography parameters in the diagnosis of emergency pulmonary embolism. Methods The clinical data of 80 patients with intracerebral hemorrhage who received plain CT imaging examination in our hospital from October 2021 to January 2022 were retrospectively studied. According to whether the hematoma was enlarged, they were divided into the enlarged hematoma group (n=32) and the enlarged non-hematoma group (n=48). The CT imaging signs and hematoma volume of all patients were recorded, and the differences of CT imaging signs and hematoma volume were compared between the two groups. Spearman correlation was used to analyze the correlation between single sign, hematoma volume and hematoma enlargement in patients with intracerebral hemorrhage. ROC curve was used to analyze CT imaging signs and hematoma volume to evaluate the value of hematoma enlargement, and Logistic multifactor regression was used to analyze the related influencing factors of hematoma enlargement. Results The proportion of "island sign", "black hole sign" and "mixed sign" in CT plain scan of hematoma expansion group was significantly higher than that of non-hematoma expansion group (P < 0.05). The volume of hematoma in the enlarged group were significantly higher than that in the non-enlarged group (P < 0.05). Spearman correlation analysis showed that "island sign", "black hole sign", "mixed sign" and hematoma volume were positively correlated with hematoma enlargement in patients with intracerebral hemorrhage (r=0.423, 0.456, 0.427, 0.516, P < 0.05). ROC curve analysis showed that the area under the curve of "island sign", "black hole sign" and "hybrid sign" combined with hematoma volume for evaluation of hematoma enlargement was 0.934, the sensitivity was 87.5%, and the specificity was 89.6%, which were all higher than single sign and hematoma volume. Logistic multifactor regression analysis showed that island sign, black hole sign, mixed sign and newly diagnosed hematoma volume increase were independent risk factors for hematoma enlargement (P < 0.05). Conclusion CT imaging findings and hematoma volume have certain evaluation value for hematoma enlargement in patients with cerebral hemorrhage, and the combined evaluation value is higher. -
图 1 脑出血患者CT平扫影像学表现
A: 左侧丘脑出血; B: 右侧丘脑出血; C: 右侧丘脑出血破入脑室.
Figure 1. Imaging manifestations of CT scan in patients with cerebral hemorrhage.
图 2 CT平扫影像学征象、血肿体积及联合检测评估血肿扩大的ROC曲线
Figure 2. ROC curve of CT plain scan imaging signs, hematoma volume and combined detection to evaluate hematoma enlargement.
表 1 血肿扩大组及非血肿扩大组的征象及血肿体积比较
Table 1. Comparison of signs and hematoma volume between hematoma enlargement group and non hematoma enlargement group
指标 血肿扩大组（n=32） 非血肿扩大组（n=48） χ2/t P 岛征[n(%)] 16（50.00） 7（14.58） 11.757 0.001 混杂征[n(%)] 20（62.50） 8（16.67） 17.729 < 0.001 黑洞征[n(%)] 13（40.62） 6（12.50） 8.387 0.004 血肿体积（mm3, Mean±SD） 30.89±6.84 24.56±5.74 4.473 < 0.001 
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表 2 CT平扫影像学征象、血肿体积对血肿扩大的评估价值分析
Table 2. Analysis of evaluation value of CT plain scan imaging signs and hematoma volume on hematoma enlargement
变量 面积 标准误 P 95% CI 下限 上限 岛征 0.677 0.052 0.001 0.563 0.777 混杂征 0.729 0.051 ＜0.001 0.618 0.823 黑洞征 0.641 0.050 0.005 0.526 0.745 血肿体积 0.773 0.058 ＜0.001 0.665 0.859 联合诊断 0.934 0.030 ＜0.001 0.855 0.977
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表 3 影响血肿扩大的独立危险因素分析
Table 3. Analysis of independent risk factors affecting hematoma enlargement
相关因素 回归系数 标准误 P OR 95% CI 年龄 0.033 3.341 0.421 2.033 1.452~2.435 性别 0.013 3.152 1.301 2.574 1.785~3.198 破入脑室 0.101 4.452 0.068 3.737 1.657~4.463 岛征 0.328 4.654 0.031 4.665 1.208~8.985 混杂征 0.304 6.168 0.019 6.621 2.711~10.523 黑洞征 0.311 5.322 0.017 5.134 3.374~12.258 血肿体积 0.344 3.578 0.023 4.642 2.243~13.156
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