摘要
目的:探讨双能CT多模态成像序列在缺血性脑卒中患者机械取栓(MT)术后对脑水肿的定量及可视化诊断价值。方法:纳入45例MT术后并进行双能量CT随访的患者。利用双能量CT数据重建120keV加权图像、虚拟平扫(VNC)及脑水肿图像(X-map),以净吸水率(NWU)作为不同图像序列间脑水肿的定量指标。采用4分李克特量表对水肿对比度与图像噪声进行主观评估,以评价影像可视化的定性诊断效能。术后随访DWI结果用于独立验证脑水肿区域及范围。采用Wilcoxon符号秩和检验比较主观评分之间的差异性,采用配对样本t检验比较NWU之间的差异。结果:X-map相较于VNC和120keV系列显示出更高的水肿对比度差异(均P<0.001),但同时也表现出最严重的图像噪声(均P<0.001)。通过ROC分析,X-map在检测水肿方面展现了最高敏感性(95.56%)和特异性(81.11%),X-map.VNC和120keV系列之间分类结果的诊断准确性(AUC)分别为0.889.0.733和0.693。与随访DWI结果进行比较,发现X-map与d-DWI相关性最强(r=-0.351;P<0.05),其次是VNC(r=0.252;P=0.095)和120 keV(r=0.181;P=0.235)。结论:在机械取栓后的复杂环境下,X-map对于脑水肿评估相比于120keV和VNC序列具有显著优势,对判断脑梗死的发展及预后具有重要临床意义。
Objective:To investigate the quantitative and visual diagnostic value of dual-energy CT multimodal imaging series in cerebral edema after mechanical thrombectomy(MT)in patients with ischemic stroke.Methods:Forty-five patients who underwent dual-energy CT follow-up after mechanical thrombectomy were included.Dual-energy CT data were used to reconstruct 120keV weighted images,virtual non-contrast(VNC)and brain edema images(X-map),and net water uptake(NWU)was used as a quantitative index of cerebral edema in different image series.The 4-point Likert scale was used to evaluate edema contrast and image noise to evaluate the qualitative diagnostic efficiency of image visualization.Postoperative follow-up DWI results were used to independently verify the area and extent of cerebral edema.Wilcoxon signed-rank test was used to evaluate the subjective scores.Paired-samples t-test was used to compare the differences between NWU.Results:The X-map demonstrated significantly greater edema contrast than VNC and 120keV series(P<0.001)but increased image noise(P<0.001).However,it also exhibited the highest level of image noise(P<0.001 for all).By ROC analysis,X-map showed the highest sensitivity(95.56%)and specificity(81.11%)in detecting edema,and the diagnosticaccuracy(AUC)of classification results between X-map,VNC,and 120 keV series were 0.889,0.733,0.693,respectively.Compared with the results of follow-up DWI,the X-map showed the strongest correlation with d-DWI(r=-0.351;P<0.05),followed by VNC(r=0.252;P=0.095)and 120 keV(r=0.181;P=0.235).Conclusion:In the complex environment following mechanical thrombectomy,X-map demonstrates a significant advantage in assessing cerebral edema when compared to 120keV and VNC series.This has important clinical implications for determining the development and prognosis of cerebral infarction.
作者
马超伟
彭瑞
杨旭
文娣娣
吴志斌
MA Chao-wei;PENG Rui;YANG Xu;WEN Di-di;WU Zhi-bin(Department of Radiology,First Affiliated Hospital,Air Force Military Medical University,Xi'an 710032,China)
出处
《中国临床医学影像杂志》
北大核心
2025年第11期765-770,共6页
Journal of China Clinic Medical Imaging
基金
陕西省重点研发计划项目(2023-YBSF-512)。
