脑出血早期血肿扩大的CT影像学特点研究进展

doi:10.3969/j.issn.1673-5765.2018.11.018

摘要/Abstract

摘要：

自发性脑出血（intracranial hemorrhage，ICH）患者数量约占卒中患者的15%，是治愈率最低的卒中亚型。ICH患者可出现早期血肿扩大（hematoma expansion，HE），多预示临床不良预后。本文从计算机断层扫描（computed tomography，CT）影像学特点方面汇总预测早期HE发生及预后的最新进展，以期为预防HE的发生并提高患者的生存质量、改善预后提供参考。

文章导读： 本文从计算机断层扫描影像学特点方面阐述了其对脑出血患者早期血肿扩大及预后的预测价值，旨在指导临床早期发现血肿扩大、早期干预，提高脑出血患者的生存质量改善预后。

关键词: 脑出血; 血肿扩大; 计算机断层扫描; 预后

Abstract:

Intracranial hemorrhage (ICH) accounts for 15% of all stroke, and it has relatively worse prognosis. Early hematoma expansion (HE) may occur in ICH patients, which may predict poor clinical prognosis. This article reviewed the latest progress of predicting the occurrence and prognosis of early HE in terms of CT imaging features, to provide reference for preventing the occurrence of HE and improving the life quality and prognosis of ICH patients.

Key words: Intracranial hemorrhage; Hematoma expansion; Computed tomography; Prognosis

党慧, 钟镝, 李国忠. 脑出血早期血肿扩大的CT影像学特点研究进展[J]. 中国卒中杂志, 2018, 13(11): 1217-1222.

DANG Hui, ZHONG Di, LI Guo-Zhong. Advance in Computed Tomography Imaging Feature of Early Hematoma Expansion in Intracranial Hemorrhage Patients[J]. Chinese Journal of Stroke, 2018, 13(11): 1217-1222.

参考文献

[1] BRODERICK J P，BROTT T G，DULDNER J E，et

al. A powerful and easy-to-use predictor of 30-day

mortality[J]. Stroke，1993，24（7）：987-993.

[2] QURESHI A I，TUHRIM S，BRODERICK J P，et

al. Spontaneous intracerebral hemorrhage[J]. N Engl

J Med，2001，344（19）：1450-1460.

[3] VANASCH C J，LUITSE M J，RINKLE G J.

Incidence，case fatality，and functional outcome of

intracerebral haemorrhage over time，according to

age，sex，and ethnic origin：a systematic review and

meta-analysis[J]. Lancet Neurol，2010，9（2）：167-

176.

[4] KAZUI S，NARITOMI H，YAMAMOTO H，et

al. Enlargement of spontaneous intracerebral

hemorrhage. Incidence and time course[J]. Stroke，

1996，27（10）：1783-1787.

[5] SHENG C，BIN J Z，WEI W，et al. Predictors of

hematoma expansion predictors after intracerebral

hemorrhage[J]. Oncotarget，2017，8（51）：89 348-

89 363.

[6] CHEUNG R T F，ZOU L Y. Use of the original，

modified，or new intracerebral hemorrhage score to

predict mortality and morbidity after intracerebral

hemorrhage[J]. Stroke，2003，34（7）：1717-1722.

[7] DeLGADO A J E，YOO A J，STONE M J，et

al. Systematic characterization of the compuuted

tomography angiography spot sign in primary

intracerebral hemorrage identifies patients at highest

risk for hematoma expansion the spot sign score[J].

Stroke，2009，40（24）：2994-3000.

[8] DU F Z，JIANG R，GU M，et al. The accuracy of

spot sign in predicting hematoma expansion after

intracerebral hemorrhage：A systematic review

and meta-analysis[J/OL]. PLOS ONE，2014，9

（12）：e115777. https：//doi.org/10.1371/journal.

pone.0115777.

[9] KIM J，SMITH A，HEMPHILL J C，et al. Contrast

extravasation on CT predicts mortality in primary

intracerebral hemorrhage[J]. Am J neuroradiol，2008，

29（3）：520-525.

[10] JOSSER E D A，ALBERT J Y，MICHAEL J S，et

al. The spot sign score in primary intracerebral

hemorrhage identifies patients at highest risk of

in-hospital mortality and poor outcome among

survivors[J]. Stroke，2010，41（1）：54-60.

[11] DEMCHUK A M，DOWLATSHAHI D，

RODRIGUEZ-LUNA D，et al. Prediction of

haematoma growth and outcome in patients with

intracerebral haemorrhage using the CT-angiography

spot sign（PREDICT）：a prospective observational

study[J]. Lancet Neurol，2012，11（4）：307-314.

[12] BOULOUI G，MOROTTI A，BART B H，et al.

Association between hypodensities detected by

computed tomography and hematoma expansion in

patients with intracerebral hemorrhage[J]. JAMA

Neurol，2016，73（8）：961-968.

[13] BOULOUI G，MOROTTI A，BROUWERS H B.

Noncontrast computed tomography hypodensities

predict poor outcome in intracerebral hemorrage

patients[J]. Stroke，2016，47（10）：2511-2516.

[14] LI Q，ZHANG G，HUANG Y，et al. Blend Sign

on Computed Tomography：Novel and Reliable

Predictor for Early Hematoma Growth in Patients

With Intracerebral Hemorrhage[J]. Stroke，2015，46

（8）：2119-2123.

[15] NEW P F，ARONOW S. Attenuation measurements

of whole blood and blood fractions in computed

tomography[J]. Radiology，1976，121（3）：635-640.

[16] PIERCE J N，TABER K H，HAYMAN L A.

Acute intracranial hemorrhage secondary to

thrombocytopenia：CT appearances unaffected by

absence of clot retraction[J]. Am J neuroradiol，1994，

15（2）：213-215.

[17] YU Z，ZHENG J，GUO R，et al. Performance of

blend sign in predicting hematoma expansion in

intracerebral hemorrage：A meta-analysis[J/OL].

Clin Neurol Neurosurg，2017，163：84-89. https：//

doi.org/10.1016/j.clineuro.2017.10.017.

[18] PRUTHI N，BALASUBRAMANIAM A，

CHANDRAMOULI B A，et al. Mixed-density

extradural hematomas on computed tomographyprognostic

significance[J]. Surg Neurol，2009，71

（2）：202-206.

[19] SPORNS P B，SCHWAKE M，SCHMIDT R，et al.

Computed tomographic blend sign is associated with

computed tomographic angiography spot sign and

predicts secondary neurologic aldeterioration after

intracerebral hemorrhage[J]. Stroke，2017，48（1）：

131-135.

[20] LI Q，YANG W S，WANG X C，et al. Blend

sign predicts poor outcome in patirnts with

intracerebral hemorrhage[J/OL]. Plos One，2017，

12（8）：e0183082. https：//doi.org/10.1371/journal.

pone.0183082.

[21] AL-NAKSHABANDI N A. The swirl sign[J].

Radiology，2001，218（2）：433.

[22] SELARIU E，ZIA E，BRIZZI M，et al. Swirl sign

in intracranial hemorrhage：definition，prevalence，

reliability and prognostic value[J]. BMC Neurol，

2012，12（9）：1471-2377.

[23] NG D，CHURILOV L，MITCHELL P，et al. The CT

swirl sign is associated with hematoma expansion in

intracerebral hemorrage[J]. Am J Neuroradiol，2018，

39（2）：232-237.

[24] LI Q，ZHANG G，XIONG X，et al. Black Hole

Sign：Novel Imaging Marker That Predicts

Hematoma Growth in Patients With Intracerebral

Hemorrhage[J]. Stroke，2016，47（7）：1777-1781.

[25] XIN X，QI L，WEN S Y，et al. Comparison of

Swirl Sign and Black Hole Sign in Predicting Early

Hematoma Growth in Patients with Spontaneous

Intracerebral Hemorrhage[J]. Med Sci Monit，2018，

24（1）：567-573.

[26] GUI N H，HAO Z G，XIONG H，et al. Comparison

of CT black hole sign and other CT features in

predicting hematoma expansion in patients with

ICH[J]. J Neurology，2018，265（8）：1883-1890.

[27] ZHANG D F，CHEN J，XUE Q，et al. Heterogeneity

Signs on Noncontrast Computed Tomography

Predict Hematoma Expansion after Intracerebral

Hemorrhage[J/OL]. Biomed Res Int，2018：6038193.

https：//doi.org/10.1155/2018/6038193.

[28] SPORNS P B，SCHWAKE M，KEMMLING A，et

al. Comparison of spot sign，blend sign and black

hole sign for outcome prediction in patients with

intracerebral hemorrhage[J]. Stroke，2017，19（3）：

333-339.

[29] QI L，QING J L. Island Sign：An Imaging Predictor

for Hematoma Expansion and Poor Outcome in

Patients With Intracerebral Hemorrage[J]. Stroke，

2017，48（11）：3019-3025.

[30] ZHENG J，YU Z，XU Z，et al. The Accuracy of

the Spot Sign and the Blend Sign for Predicting

Hematoma Expansion in Patients with Spontaneous

Intracerebral Hemorrhage[J/OL]. Med Sci Monit，

2017，23：2250-2257. https：//www.ncbi.nlm.nih.gov/

pubmed/28498827.