超声造影评价颈动脉粥样硬化斑块稳定性价值  

Contrast-enhanced Ultrasonic imaging evaluation carotid atherosclerotic plaque stability

作　　者：孙晓峰[1] 李妍[1] 白洋[1] 邢英琦[2] 周杨杨[2] 于慧[1] 祝英乔[1] 

机构地区：[1]吉林大学白求恩第一医院腹部超声,吉林长春130021 [2]吉林大学白求恩第一医院神经内科,吉林长春130021

出　　处：《中风与神经疾病杂志》2013年第10期924-927,共4页Journal of Apoplexy and Nervous Diseases

基　　金：吉林省科技厅项目(No.2011Z065)

摘　　要：目的超声造影（contrastenhancedultrasound，CEUS）评价颈动脉粥样硬化斑块（carotidatheroscle—roticplaque，CAP）的稳定性。方法选取2011年6月-2012年6月44例有临床症状于我院就诊患者，CEUS观察CAP新生血管。并选取24例颈内动脉强回声斑块患者做对照。同时每个患者均采用经颅多普勒（transcranialdoppler，TCD）微栓子（microembolisignal，MES）监测技术监测是否存在微栓子脱落。二者检测均阳性者，回顾分析其CT或MRI是否存在新鲜梗死灶，予以验证是否为不稳定斑块。回顾TCD结果除外大脑中动脉狭窄。结果（1）44例患者行超声造影检查，CEUS阳性者34例，其中以低回声／等回声组（20例，占58．8％）和以低回声／等回声为主混合回声组（16例，占47．1％）增强为著。对照组24例患者造影均为阴性。（2）44例患者中，TCD监测MES阳性者16例，其中包括2例CEUS阴性者。（3）2级、3级CEUS增强者，MES阳性检出率高。4、2级、3级CEUS增强者共23例，经回顾CT及MRI检查结果，7例门诊患者未查CT或MRI，余16例患者中，1例为阴性，15例均提示见新鲜梗死灶。TCD结果除外大脑中动脉狭窄。结论CEUS观察CAP，2级或3级CEUS增强者疑为不稳定斑块。Objective To value stability of carotid atherosclerotic plaque. Method Forty-four symptomic patients in our hospital from June 2011 to June 2012 were selected as candidates. Intraplaque neovascularization of their plaques were studied on contrast-enhanced ultrasonic （CEUS） imaging. All these patients were monitered on Transcranial Doppler to find micro embolus signal （MES） , in order to confirm whether there is micro embolus dropping. Those patients who were positive on both CEUS and MES,were reviewed their previous results of the CT or MRI scanning to find whether there were some fresh infarcts. Then those patients with fresh infarcts were verified with unstable plaques. Twenty-four patients with hy- perecho plaque were matched group. In addition, the TCD results had been reviewed to exclude middle cerebral artery steno- sis. Results （ 1 ） Among the 44 patients on ECUS, 34 patients imaging showed neovascularization, including 20 （58.8%） neovasculariztion patients showing hypoecho or isoecho plaque,and 16（47.1% ） neovasculariztion patients showing mixed echo with dominant hypoecho or isoecho plaque,while matched group showed negative. The results of CEUS in two groups were significantly different. The matched group were negative. （2） Sixteen cases among 44 cases were positive on MES, in- eluding 2 cases of CEUS imaging were negative. （ 3 ） Those patients with intraplaque neovascularization were grade 2 and grade 3 on ECUS, whose MES positive rate were higher than else groups. （4）These patients MRI results were reviewed to confirm fresh infarction. And their TCD results were also reviewed to excluded middle cerebral artery stenosis. Conclusion Iutraplaque neovascularization grade 2 and grade 3 on CEUS may indicate vulnerable plaque.

关 键 词：颈动脉粥样斑块 超声造影 斑块内新生血管 经颅多普勒 微栓子监测 

分 类 号：R743.3[医药卫生—神经病学与精神病学]