CT Perfusion Spot Sign Improves Sensitivity for Prediction of Outcome Compared with CTA and Postcontrast CT
CT Perfusion Spot Sign Improves Sensitivity for Prediction of Outcome Compared with CTA and Postcontrast CT
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DOI：
10.3174/ajnr.a3338
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发表时间：
2013-05-01
影响因子：
3.5
通讯作者：
Aviv, R. I.
中科院分区：
文献类型：
--
作者：
Koculym, A.;Huynh, T. J.;Aviv, R. I.
背景和目的：最近的研究建议早期和晚期成像以增加斑点征检测。然而，斑点检测的最佳采集时机和对结果预测的影响是不确定的。我们的目的是评估实用程序的CTP在现场的迹象检测和表征，强调其对急性原发性ICH.MATERIALS和METHODS患者的预后预测的影响：28例患者在6小时内出现ICH，研究CTA，CTP，和postcontrast CT，进行了回顾性分析。根据预定义的放射学标准记录CTA、CTP和造影后CT斑点征特征。使用血肿扩大或临床结局不良的联合主要结局，定义为血肿扩大≥ 6 mL或≥ 30%，需要手术引流或住院死亡。对照基线临床、实验室和影像学变量，检查主要结局和斑点体征存在的相关性。CTA，CTP和增强后CT斑点特征的预测能力进行了比较models.RESULTS：18例患者（61%）符合主要结局标准。CTP斑点征是血肿扩大或预后不良的独立预测因素（P = 0.040），其敏感性（78%）高于CTA斑点征（44%，P = 0.034）和增强CT斑点征（50%，P = 0.025）。斑点征的特异性和阳性预测值在所有模式上都很高（100%）。CTP检测到最大数量的斑点（80%），在造影剂团注后50秒（范围，34-63秒）的中位（四分位距）时间处显示出峰值斑点衰减。CTP斑点出现晚于CTA检测斑点（P = 0.002），早于增强后CT斑点（P <0.001）。结论：与CTA或增强后CT检测斑点相比，CTP斑点检测提高了预测结果的敏感性。
BACKGROUND AND PURPOSE: Recent studies have recommended both early and late imaging to increase spot sign detection. However optimal acquisition timing for spot detection and impact on outcome prediction is uncertain. Our aim was to assess the utility of CTP in spot sign detection and characterization with emphasis on its impact on the prediction of outcome in patients with acute primary ICH.MATERIALS AND METHODS: A retrospective review of 28 patients presenting within 6 hours of ICH, studied with CTA, CTP, and postcontrast CT, was performed. CTA, CTP, and postcontrast CT spot sign characteristics were recorded according to predefined radiologic criteria. A combined primary outcome of hematoma expansion or poor clinical outcome was used and defined as hematoma expansion >= 6 mL or >= 30%, need for surgical drainage, or in-hospital mortality. Associations with the primary outcome and spot sign presence were examined against baseline clinical, laboratory, and radiographic variables. Predictive ability of CTA, CTP, and postcontrast CT spot characteristics were compared among modalities.RESULTS: Primary outcome criteria were met in 18 patients (61%). CTP spot sign presence was an independent predictor of hematoma expansion or poor outcome (P = .040) and demonstrated greater sensitivity (78%) than spots detected on CTA (44%, P = .034) and postcontrast CT (50%, P = .025). Specificity and positive predictive value of the spot sign was high (100%) on all modalities. CTP detected the greatest number of spots (80%) with peak spot attenuation demonstrated at a median (interquartile range) time of 50 seconds (range, 34-63 seconds) after contrast bolus injection. CTP spot appearance was later than CTA-detected spots (P = .002) and earlier than postcontrast CT spots (P < .001).CONCLUSIONS: CTP spot sign detection improves the sensitivity for prediction of outcome compared with CTA or postcontrast CT-detected spots.