颈动脉粥样硬化斑块二维超声特征与斑块标本结构一致性的研究  

The consistency between two-dimensional sonographic feature of carotid atherosclerosis plaque and morphological characteristics of endarterectomy specimen

作　　者：刘蓓蓓[1] 华扬[1] 刘玉梅[1] 李景植[1] 孟秀峰[1] 周瑛华[1] 

机构地区：[1]首都医科大学宣武医院血管超声诊断科,北京100053

出　　处：《中华医学超声杂志（电子版）》2015年第8期628-634,共7页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的探讨颈动脉粥样硬化斑块术前二维超声基本形态及内部回声特征与颈动脉内膜剥脱术（CEA）后斑块大体标本高倍相机影像结构的一致性,以二维超声方法评估斑块易损性的特征。方法连续纳入2014年1月至2015年5月因颈动脉狭窄70%~99%收入首都医科大学宣武医院行颈动脉内膜剥脱术治疗、术前颈动脉超声纵、横切面动脉粥样硬化斑块成像清晰的患者160例,根据二维超声斑块形态特征分为规则型（32例）与不规则型（128例）,其中溃疡型斑块91例,与CEA术后即刻斑块的外观形态结构进行比较;根据二维超声回声特征分为均质等回声斑块组（64例）、低至无回声斑块组（44例）、不均质强回声斑块组（52例）,分别与CEA术后即刻斑块的纵断解剖切面高倍相机成像显示内部结构特征进行对比。将超声回声均质的斑块（108例）按CEA术后斑块内部结构特征进行分类为均质性非粥样物质（64例）、粥样物质（10例）、新鲜出血（10例）及陈旧性出血坏死（5例）,测量不同性质斑块在二维超声图像上的平均灰阶中值（GSM）并进行比较。结果 160例颈动脉粥样硬化患者超声显示斑块形态与术中标本检查结果：（1）二维超声显示斑块形态与大体标本斑块形态特征的准确率93.1%（149/160）,对不规则斑块诊断的敏感度为95.3%,特异度83.9%;对溃疡性斑块诊断的敏感度84.8%,特异度88.5%,两种类型斑块的总准确率86.2%（138/160）。（2）二维超声回声特征为均质等回声斑块64例,标本内解剖结构显示为结构均匀一致非粥样物质者占95.3%（61/64）;低至无回声斑块44例,标本内结构显示为粥样物质和斑块内新鲜出血占86.3%（38/44）。术中标本显示为非粥样物质成分的斑块GSM值平均为55±19,显著高于粥样物质斑块39±11（P〈0.001）和新鲜出血性斑块29±10（P〈0.001）,而新鲜出血性斑块平均GSM值低于粥Objective The aim of this study was to assess the consistency between the echogenicity and morphology of two-dimensional ultrasonography for the carotid atherosclerosis plaque and the morphological characteristics from the endarterectomy（CEA） specimen in same patient. Methods A total of 160 consecutive patients with severe carotid stenosis were enrolled into this study from January 2014 to May 2015. Each patient underwent ultrasonography in 0-48 hours before CEA. The longitudinal and cross-sectional images of carotid plaque in stenosis lumen were detected and recorded. The echogenicity, plaque surface morphology and the gray scale median（GSM） were recorded. After endareterectomy, the homogeneity and appearance characteristics of multi sections of the specimen were detected and images were stored by high resolution camera. Results（1） The consistency of plaque morphology（regular or irregular） between two-dimensional sonogram and images obtained by high resolution camera was 93.1%（149/160）. The sensitivity of the surface irregularity plaque diagnosed by two-dimensional sonography was 95.3%. The sensitivity and specificity of ulcer plaque diagnosed by two-dimensional sonography was 84.8% and 88.5%, retrospectively, and the overall accuracy was 86.2%（138/160）.（2） Sixtyone of 64 isoechoic plaques（95.3%） were homogeneous tissue without large lipid core and necrosis. Thirtyeight of 44 hypoechoic plaques（86.3%, 38/44） had necrosis and hemorrhage in section images of specimen. The GSM of homogeneous plaques（55±19） was higher than those of the lipid core plaques（39±11, P〈0.001） and hemorrhage plaques（29±10, P〈0.001）.（3） Eight of 17 plaques with calcification near arterial wall had necrosis（47.1%, 8/17） and the incidence of intra-plaque hemorrhage was 52.9%（9/17）. Twentynine plaques with mixed hypoechogenicity and isoechogenicity had micro-calcification and large necrosis（29, 100%）. Conclusions Two-dimensional ultrasonography correlated well with specimen

关 键 词：超声检查 动脉粥样硬化 斑块 颈动脉内膜切除术 

分 类 号：R445.1[医药卫生—影像医学与核医学] R543.4[医药卫生—诊断学]