摘要
目的基于CT灌注成像(CTPI)参数量化评估颅脑损伤(TBI)患者早期损伤严重程度的价值。方法回顾性选取2019年1月至2022年12月衡水市第四人民医院收治的TBI患者220例,所有患者均在入院时行CT及CTPI检查,根据入院格拉斯哥昏迷评分分为轻中度组(9~15分,138例)和重度组(≤8分,82例)。比较两组病灶出血核心区、病灶周围低密度区、对侧镜像区CTPI参数;采用多因素Logistic回归分析TBI患者早期损伤严重程度的影响因素,构建TBI患者早期损伤严重程度预测模型,并采用ROC曲线分析该模型的预测价值。结果两组病灶出血核心区脑血流量(CBV)、脑血容量(CBF)均低于病灶周围低密度区、对侧镜像区,病灶周围低密度区CBV、CBF均低于对侧镜像区(P<0.05);两组病灶出血核心区MTT长于病灶周围低密度区、对侧镜像区,病灶周围低密度区平均通过时间(MTT)长于对侧镜像区(P<0.05)。重度组病灶出血核心区、病灶周围低密度区CBV、CBF均低于轻中度组,病灶出血核心区、病灶周围低密度区MTT长于轻中度组(P<0.05)。多因素Logistic回归分析显示,病灶出血核心区和周围低密度区高CBV、CBF、GCS为TBI患者早期损伤严重程度的独立保护因素,病灶出血核心区和周围低密度区长MTT为TBI患者早期损伤严重程度的独立危险因素(OR=0.592,95%CI:0.429~0.783,P=0.008;OR=0.826,95%CI:0.608~0.955,P=0.038;OR=0.616,95%CI:0.427~0.806,P=0.009;OR=0.842,95%CI:0.507~0.895,P=0.041;OR=0.848,95%CI:0.686~0.963,P=0.009;OR=2.007,95%CI:1.615~3.790,P=0.004;OR=1.487,95%CI:1.273~1.890,P=0.038)。ROC曲线分析显示,预测模型预测TBI患者早期损伤严重程度的曲线下面积为0.795(95%CI:0.684~0.853),敏感度为0.753,特异度为0.775。结论基于CTPI参数量化模型在预测TBI患者早期损伤严重程度上有较高的价值。
Objective To evaluate the value of quantitative assessment of early injury severity in patients with traumatic brain injury(TBI)based on computed tomography perfusion imaging(CTPI)parameters.Methods A total of 220 patients with TBI admitted to the Fourth People's Hospital of Hengshui from January 2019 to December 2022 were retrospectively enrolled.All patients underwent CT and CTPI upon admission,and were divided into a mild-to-moderate group[Glasgow Coma Scale(GCS)score:9–15,n=138]and a severe group(GCS score:≤8,n=82)according to their admission GCS scores.The CTPI parameters of the hemorrhagic core area of the lesion,perilesional hypodense area and contralateral mirror area were compared between the two groups.Multivariate Logistic regression analysis was performed to identify the influencing factors of early injury severity in TBI patients;a predictive model for early injury severity in TBI patients was constructed,and the receiver operating characteristic(ROC)curve was used to analyze the predictive value of this model.Results In both groups,the cerebral blood volume(CBV)and cerebral blood flow(CBF)in the hemorrhagic core area were lower than those in the perilesional hypodense area and contralateral mirror area,and the CBV and CBF in the perilesional hypodense area were lower than those in the contralateral mirror area(P<0.05).The mean transit time(MTT)in the hemorrhagic core area was longer than that in the perilesional hypodense area and contralateral mirror area,and the MTT in the perilesional hypodense area was longer than that in the contralateral mirror area(P<0.05).Compared with the mild-to-moderate group,the severe group had lower CBV and CBF and longer MTT in the hemorrhagic core area and perilesional hypodense area(P<0.05).Multivariate Logistic regression analysis showed that higher CBV and CBF in both the hemorrhagic core area and perilesional hypodense area,as well as a higher GCS score,were independent protective factors for early injury severity in TBI patients.In contrast,prolonged MTT in both the hemorrhagic core area and perilesional hypodense area were independent risk factors for early injury severity in TBI patients(OR=0.592,95%CI:0.429–0.783,P=0.008;OR=0.826,95%CI:0.608–0.955,P=0.038;OR=0.616,95%CI:0.427–0.806,P=0.009;OR=0.842,95%CI:0.507–0.895,P=0.041;OR=0.848,95%CI:0.686–0.963,P=0.009;OR=2.007,95%CI:1.615–3.790,P=0.004;OR=1.487,95%CI:1.273–1.890,P=0.038).ROC curve analysis indicated that the area under the curve of the predictive model for evaluating early injury severity in TBI patients was 0.795(95%CI:0.684–0.853),with a sensitivity of 0.753 and a specificity of 0.775.Conclusion The quantitative model based on CTPI parameters has a high value in predicting the severity of early injury in TBI patients.
作者
吴婷
史佩佩
王芬
吴淅铭
陈祥云
WU Ting;SHI Peipei;WANG Fen;WU Ximing;CHEN Xiangyun(CT room,The Fourth People's Hospital of Hengshui City,Hengshui,Hebei 053000,China;Department of Public Health,The People's Hospital of Wuqiang County,Hengshui,Hebei 053301,China;Department of Orthopedic Joint,The Fourth People's Hospital of Hengshui City,Hengshui,Hebei 053000,China)
出处
《转化医学杂志》
2026年第3期393-397,共5页
Translational Medicine Journal
基金
衡水市科技计划项目(2022014002Z)。
关键词
CT灌注成像参数
颅脑损伤
损伤程度
computed tomography perfusion imaging
traumatic brain injury
injury severity
