摘要目的:初步探讨颅脑创伤患者伤后早期CT影像特征与颅内压的相关性，及其对颅内压的评估作用。方法:回顾性分析上海交通大学医学院附属仁济医院神经外科2018年1月至2019年12月采用手术治疗的单侧颅脑创伤患者的临床资料，共21例。采用患者术前的最后一次CT影像，测量中线移位程度、获取中线两侧的CT值；记录患者术中颅内压监测初始值。采用Pearson相关性分析法分析中线移位程度、中线两侧平均CT值比值与颅内压值的相关性，通过受试者工作特征曲线(ROC)判断其评估颅内压增高(>22 mmHg，1 mmHg＝0.133 kPa)的准确性。结果:21例患者术前CT显示中线移位距离为0.2～1.6(中位数1.0，四分位数间距：0.9)cm、中线两侧CT均值比值为1.0～1.4(1.1±0.1)，术中颅内压初始值为11.0～45.0(24.3±8.3)mmHg。相关性分析显示，中线移位距离和中线两侧CT均值比值均与颅内压呈现正相关( r＝0.44， r＝0.58 ；均 P<0.05)。采用中线两侧CT均值比值评估颅内压增高的曲线下面积(AUC)为0.65，采用中线移位距离评估颅内压增高的AUC为0.64。 结论:初步研究显示，颅脑创伤患者的CT影像特征与颅内压水平相关。采用中线两侧CT均值比值评估颅内压增高的准确性不低于利用中线移位距离评估的准确性。

abstractsObjective:To investigate the relationship between early Computed Tomography (CT) features and intracranial pressure (ICP) in patients with traumatic brain injury (TBI), and to evaluate the predictive value of CT features.Methods:We retrospectively analyzed the clinical data of 21 patients with unilateral craniocerebral trauma who underwent surgical treatment from January 2018 to December 2019 at Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine. The last CT image before the operation was used to measure the degree of midline shift and obtain the CT values on both sides of the midline; the initial value of ICP during the operation was recorded. Pearson correlation analysis was used to analyze the correlation between the degree of midline shift, the ratio of the mean CT value on both hemispheres and the ICP. The area under the receiver operating curve (ROC) was used to determine the accuracy of prediction in intracranial hypertension (>22 mmHg, 1 mmHg=0.133 kPa).Results:The preoperative CT of 21 patients showed that the range of midline shift was 0.2-1.6 (median: 1.0, IQR: 0.9) cm; the range of ratio of mean CT value between both hemispheres was 1.0-1.4 (1.1±0.1), and the range of initial ICP during operation was 11.0-45.0 (24.3±8.3) mmHg. Correlation analysis showed that the degree of midline shift and the ratio of mean CT value between both hemispheres were significantly positively correlated with ICP ( r=0.44, r=0.58, both P<0.05). The AUC (area under curve) of the ICP increasing evaluation using the ratio of the mean CT value was 0.65, and the AUC of the ICP increasing evaluation using the degree of midline shift was 0.64. Conclusions:Preliminary studies have shown that the CT features of patients with craniocerebral trauma are related to the level of ICP. The evaluation accuracy of the ratio of the mean CT value on both hemispheres is not lower than the traditional evaluation using the degree of midline shift.