CDFI评估颈动脉粥样硬化斑块易损性  

Evaluation of carotid atherosclerotic plaque vulnerability with CDFI

作　　者：吕琦[1] 惠品晶[1] 陈剑华[2] 黄亚波[3] 顔燕红 张白[1] 胡春洪[2] 郭亮[2] 惠国祯[3] 

机构地区：[1]苏州大学附属第一医院颈脑血管超声,江苏苏州215006 [2]苏州大学附属第一医院影像科,江苏苏州215006 [3]苏州大学附属第一医院神经外科,江苏苏州215006

出　　处：《中风与神经疾病杂志》2015年第3期243-247,共5页Journal of Apoplexy and Nervous Diseases

基　　金：国家重点基础研究发展计划(973计划)资助项目(No.2012CB518106);江苏省第十批"六大人才高峰"高层次人才选拔培养项目资助(No.WSW-045);苏州市科技发展计划资助项目(No.SYS201326);苏州市临床重点病种诊疗技术专项项目(No.LCZX201403)

摘　　要：目的前瞻性研究彩色多普勒血流显像(CDFI)评估颈动脉粥样硬化斑块易损性的可行性。方法33例(36例次)行颈动脉内膜剥脱术(CEA)患者术前均行CDFI、高分辨率核磁共振成像(HRMRI)、CT血管造影(CTA)、CT灌注成像(CTP)和(或)数字减影血管造影(DSA)检查,术后观察粥样硬化斑块形态并行HE染色。将术前CDFI结果分别与相应层面HRMRI及术后病理学结果对照,CDFI设定易损斑块标准:低回声、中等偏低回声不均质斑块;斑块形态不规则、纤维帽不完整或斑块内见血流信号。CDFI设定稳定斑块标准:斑块表面光滑、纤维帽完整、中等回声及强回声均质斑块。结果 CDFI与病理学比较评估易损斑块的敏感性为93.3%,特异性为83.3%,阳性预测值为96.6%,阴性预测值为71.4%;HRMRI与病理学比较评估易损斑块的敏感性为90%,特异性为83.3%,阳性预测值为96.4%,阴性预测值为62.5%。CDFI与HRMRI评估斑块易损性具有良好的一致性(Kappa=0.915,P<0.01)。结论 CDFI可以准确识别易损斑块,为临床诊断及治疗提供可靠依据。Objective To prospectively investigate the feasibility of color Doppler flow imaging（ CDFI） in evaluating the vulnerability of carotid atherosclerosis plaques. Methods 33 patients（ 36 plaques） performed carotid endarterectomy were scheduled for CDFI,High-resolution MRI（ HRMRI）,CT angiography（ CTA）,CT perfusion imaging（ CTP）and / or digital subtraction angiography（ DSA） examinations respectively pre-operation. Observation of plaques and HE staining were employed post-operation. Compare the corresponding level results of CDFI with that of HRMRI and pathological results respectively. The standard of CDFI setting vulnerable plaques： heterogeneity plaques characterized by low echo with irregular shape,fibrous cap rupture,blood flow filling. The standard of CDFI setting stable plaques： homogeneous plaques characterized by medium and strong echo with smooth surface,complete fibrous cap. Results The sensitivity and specificity of CDFI compared with pathological results were respectively 93. 3% and 83. 3%,positive predictive value and negative predictive value were respectively 96. 6% and 71. 4%. The sensitivity and specificity of HRMRI compared with pathological results were respectively 90% and 83. 3%,and positive predictive value and negative predictive value were respectively96. 4% and 62. 5%. The results of CDFI were well accordant with that of HRMRI（ Kappa = 0. 915,P〈0. 01）. Conclusion CDFI is a reliable test for clinical diagnosis and treatment for it can accurately identify the vulnerable plaques.

关 键 词：粥样硬化斑块 彩色多普勒血流显像 高分辨率核磁共振 斑块易损性 

分 类 号：R743[医药卫生—神经病学与精神病学]