Metallic Hyperdensity Sign on Noncontrast CT Immediately after Mechanical Thrombectomy Predicts Parenchymal Hemorrhage in Patients with Acute Large-Artery Occlusion
Metallic Hyperdensity Sign on Noncontrast CT Immediately after Mechanical Thrombectomy Predicts Parenchymal Hemorrhage in Patients with Acute Large-Artery Occlusion
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DOI：
10.3174/ajnr.a6008
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发表时间：
2019-04-01
影响因子：
3.5
通讯作者：
Lou, M.
中科院分区：
文献类型：
--
作者：
Xu, C.;Zhou, Y.;Lou, M.
作者评价了2014年1月至2018年9月期间在机械血栓切除术后立即接受非造影CT的198例急性缺血性卒中伴大血管闭塞的连续患者。金属高密度征定义为基底节区无点状高密度病变，最大CT密度>90 HU。59例（29.7%）患者出现金属高密度征，51例（25.7%）患者在24小时内出现脑实质出血。有金属高密度征的患者比无金属高密度征的患者更容易发生脑实质出血。背景和目的：脑实质出血是急性缺血性卒中伴大血管闭塞患者机械再通后的严重并发症。本研究旨在评估机械血栓切除术后立即进行的非造影CT上的金属高密度征是否可以预测24 hours.MATERIALS和METHODS实质hemorrhage：我们纳入了2014年1月至2018年9月期间机械血栓切除术后立即进行非造影CT的急性缺血性卒中伴大血管闭塞的连续患者。金属高密度征定义为基底节区无点状脑内高密度病变（直径1 cm），最大CT密度>90 HU。计算金属高密度征预测脑实质出血的敏感性、特异性、阳性预测值和阴性预测值。59例（29.7%）患者出现金属高密度征，51例（25.7%）患者在24小时内出现脑实质出血。有金属高密度征的患者比无金属高密度征的患者更容易发生脑实质出血（76.3%比4.3%，P <0.001）。金属高密度征预测脑实质出血的敏感性、特异性、阳性预测值和阴性预测值分别为88.2%、90.5%、76.3%和95.7%。在机械性血栓切除术后立即进行的非增强CT上金属高密度征的存在，血管闭塞可预测24 h内脑实质出血的发生，对机械取栓术后24 h内的介入治疗有一定的指导意义。
The authors evaluated 198 consecutive patients with acute ischemic stroke with large-vessel occlusion who underwent noncontrast CT immediately after mechanical thrombectomy between January 2014 and September 2018. The metallic hyperdensity sign was defined as a nonpetechial intracerebral hyperdense lesion in the basal ganglia and a maximum CT density of >90 HU. The metallic hyperdensity sign was found in 59 (29.7%) patients, and 51 (25.7%) patients had parenchymal hemorrhage at 24 hours. Patients with the metallic hyperdensity sign are more likely to have parenchymal hemorrhage than those without it.BACKGROUND AND PURPOSE: Parenchymal hemorrhage is a severe complication following mechanical recanalization in patients with acute ischemic stroke with large-vessel occlusion. This study aimed to assess whether the metallic hyperdensity sign on noncontrast CT performed immediately after mechanical thrombectomy can predict parenchymal hemorrhage at 24 hours.MATERIALS AND METHODS: We included consecutive patients with acute ischemic stroke with large-vessel occlusion who underwent noncontrast CT immediately after mechanical thrombectomy between January 2014 and September 2018. The metallic hyperdensity sign was defined as a nonpetechial intracerebral hyperdense lesion (diameter, 1 cm) in the basal ganglia and a maximum CT density of >90 HU. The sensitivity, specificity, and positive and negative predictive values of the metallic hyperdensity sign in predicting parenchymal hemorrhage were calculated.RESULTS: A total of 198 patients were included. The metallic hyperdensity sign was found in 59 (29.7%) patients, and 51 (25.7%) patients had parenchymal hemorrhage at 24 hours. Patients with the metallic hyperdensity sign are more likely to have parenchymal hemorrhage than those without it (76.3% versus 4.3%, P < .001). The sensitivity, specificity, positive predictive value, and negative predictive value of the metallic hyperdensity sign in predicting parenchymal hemorrhage were 88.2%, 90.5%, 76.3%, and 95.7%, respectively.CONCLUSIONS: The presence of the metallic hyperdensity sign on noncontrast CT performed immediately after mechanical thrombectomy in patients with large-vessel occlusion could predict the occurrence of parenchymal hemorrhage at 24 hours, which might be helpful in postinterventional management within 24 hours after mechanical thrombectomy.