目的观察和探讨增强CT扫描对 大面积脑梗死后出血性转化的预测价值分 析。方法 入选2013年1月-2014年6月我院 收治的大面积脑梗死的患者47例，入选患 者均在发病内12小时入院，且进行急诊头 CT平扫检查，于发病后24-48小时内进行 头部CT平扫和增强扫描检查，并在入院7d 后再次进行头部CT平扫检查，观察和分析 增强CT造影剂外渗和脑出血转化的相关 性。结果 47例患者中有17例出现陈旧性 脑梗死病灶，12例患者出现局灶性改变， 其余患者未见明显异常。发病24-48h对患 者再次进行头CT平扫检查结果发现，47例 患者均存在大面积脑梗死，其中2例发现 出血转化，剩余的45例进行增强CT扫描检 查，其中11例出现造影剂外渗情况加强。 针对进行增强CT扫描的患者在1周内复查 头CT平扫发现15例出血性转化，其中影像 学检查中出现点片状高密度影患者占绝对 优势，差异具有统计学意义，P<0.05。11 例增强CT扫描造影剂外渗在复查CT梗死灶 内均出现高密度改变。全部病例中发现出 血转化17例(36.17%)，其中经增强CT扫描 可预测的出血性转化11例，预测准确度 73.33%。结论 大面积脑梗死急性发作时 早期应用头CT平扫基础上的增强CT扫描检 查能够帮助临床早期发现脑出血转化，有 助于快速诊断和调整治疗方案，有利于患 者的疾病预后转归。

Objective To observe and explore the predictive value of enhanced CT scanning in the diagnosis of hemorrhagic transformation after large area cerebral infarction. Methods 47 cases with large area cerebral infarction from 2013 January to 2014 June in our hospital were selected. All patients were hospitalized within 12 hours and given emergency head CT scanning. Head plain CT scan and enhanced CT scan were performed within 24-48h, and plain CT scan was performed after 7days. The correlation between contrast agent extravasation and cerebral hemorrhage transformation was observed and analyzed. Results In 47 cases, 17 cases showed old cerebral infarction, 12 patients showed focal changes and other patients showed no obvious abnormalities. 24- 48h after onset of infarction, plain CT scan showed that all 47 patients were found large area of cerebral infarction, in which 2 cases were found hemorrhagic transformation and the remaining 45 cases underwent enhanced CT scan showed contrast agent extravasation in 11 cases. Patients who underwent enhanced CT scan were performed with plain CT scan within 1 week and found that 15 cases showed hemorrhagic transformation; 11 cases with contrast agent extravasation showed high density changes in infarction focus by reexamined plain CT scan. In all cases, 17 patients were found hemorrhagic transformation (36.17%), in which 11 cases were predicted by enhanced CT scans, and the predictive accuracy was73.33%. Conclusion The application of contrast enhanced CT scan on the basis of head plain CT scan on large area acute cerebral infarction patients could help the early discovery of cerebral hemorrhagic transformation, rapid diagnosis, treatment scheme adjustment and the prognosis and outcome of disease.