Research On The Expansion And Perfusion Of Cerebral Hemorrhage With CTPI And CTA

Study onePurpose: With CTA original image "spot sign" and " nine points method”, to investigate the effect of the nine points method in predicting the enlargement of hematoma and judging the prognosis of the clinic.Method: Select 79 patients with spontaneous intracerebral hemorrhage from the Tianjin beach people’s Hospital from January to July in 2014.Combined with the original image of CTA "spot sign", according to the " nine points method " we grade these patients. The patients were divided into two groups:there are 55 patients in group of 0~3 scores, the group of 4~9 scores has 24 patients.1. To compared the baseline data between the two groups;2.To compared the 30 d NIHSS, hematoma enlargement ratio,surgical intervention ratio and the difference of the proportion of death between the two groups.3.To predict the positive predictive value(PPV), negative predictive value(NPV), sensiivity, specificity of the expansion of hematoma by nine points method.Result: 1、Compared with the 0~3 groups,the hospitalization blood pressure,positive rate of ”spot sign”,hematoma enlargement,30 d NIHSS scores,surgical intervention,90 d mortality of 4~9 groups was significantly increased, the difference was statistically significant(P<0.05, P<0.01). 2、The "nine points method" predicts hematoma expansion in the positive predictive value(PPV) was 50%, the negative predictive value(NPV) was 96.4%, sensitivity 85.7%, specificity 81.5%.Study twoPurpose: Using CT perfusion imaging(CTPI) combined with CT angiography(CTA) imaging,to investigate the hemodynamic changes of the brain tissue around the hematoma.Method:The people’s Hospital of Tianjin seaside 2014.1~2014.12 85 cases confirmed by CT for supratentorial cerebral hemorrhage patients in the incidence of 1 h our to 2 weeks underwent CTP and CTA examination.To reduce the effect of arterial stenosis on cerebral perfusion, the patients(3 cases) with large arterial stenosis were excluded by CT angiography(CTA),The other 82 cases obtain r CBF;,r CBV;MTT;TTP parameter map. The 1cm range from the edge of the hematoma was placed 4 ROI(four directions respectively). Symmetrical mirror with the midline of the brain, to get the contralateral hemisphere mirror ROI.1. MTT, r CBF, TTP and r CBV in the area of the peripheral hematoma were compared with the image region and the ipsilateral hematoma outer zone.2. Further subgroup analysis: hematoma surrounding r CBV and contralateral contrast is higher in subgroup analysis, namely decreased r CBV group an d r CBV increased group. Two groups were within group comparison hematoma surrounding area and image area, area around the hematoma and ipsilateral distant outer regions of r CBF, MTT and TTP comparisonResult: 1. The changes of r CBV and r CBF were significantly decreased, and the changes of TTP and MTT were not statistically significant.(T=3.49, P<0.01; T=4.31, P<0.01; T=1.05,P<0.05; T=0.65, P>0.05). In the area around the hematoma and ipsilateral outer zone of the comparative r CBV, r CBF decreased significantly, MTT and TTP changes without statistical significance.(T=3.61,P<0.01; T=4.59,P<0.01;T=1.54,P>0.05;T=1.68,P>0.05). 2. Subgroup analysis:(1) r CBV reduced group with hematoma surrouding area①The r CBF of hematoma surrouding area was significantly decreased, and the TTP and MTT were significantly prolonged(T=11.38,P<0.01;T=2.53,P<0.05;T=2.09,P<0.05)②The r CBF of hematoma surrouding area was significantly d ecreased compared with the outer area of the same side, significantly the TTP and MTT were significantly prolonged.(T=9.72,P<0.01;T=3.54,P<0.01;T=3.71,P<0.01) ③The r CBF of before and after ROI in the periphery of the hematoma was significantly decreased compared with the internal and external ROI. MTT and TTP had no statistical significance.(T=4.13,P<0.01;T=0.804,P>0.05;T=1.44,P>0.05)(2) r CBV increased group with hematoma surrouding area① The r CBF of hematoma surrouding area was significantly higher, and the TTP and MTT had no statistical significance(T=2.017,P<0.05;T=1.371,P>0.05;T=0.317,P>0.05) ②The r CBF of hematoma surrouding area was significantly higher compared with the outer area of the same side, significantly the TTP and MT T were significantly prolonged(T=2.085,P<0.05;T=1.374,P>0.05;T=2.008,P<0.05) ③The r CBF of before and after ROI in the periphery of the hematoma was significantly decreased compared with the internal and external ROI. MTTand TTP had no statistical significance.(T=2.202,P<0.05;T=0.073,P>0.05;T=0.802,P>0.05)Conclusion: 1.Combined with imaging CTA original image "spot sign" and risk factors of formation of "Nine points method" can effectively predict hematoma enlarge ment and judge clinical adverse clinical outcomes.4~9 group was significantly elevated in hematoma enlargement, 30 d NIHSS score, surgical intervention, and mortality of 90 days, compared with 0~3group. 2. The local appearance of cerebral hemorrhage was significantly lower in the hematoma around hematoma.Tips for local ischemia and semi- dark bands, consistent with domestic and international literature reports. 3.Cerebral hemorrhage perihematomal perfusion state may include two types, namely reducing perfusion and perfusion increased. Around the hematoma also has increased r CBV, r CBF was significantly higher than that of the local high blood flow perfusion, and blood vessels around the hematoma abnormally dilated. 4.The two perfusion types around hematoma the internal and external ROI were higher than that in the before and after ROI of the hematoma, and it was considered to be related to the cerebral anatomic structures. 5.Because cerebral hemorrhage in perihematomal perfusion were increased in a small number,possible statistical deviation.Need to continue to expand the cases,and analyzed the related factors and clinical outcome of the perfusion.