超微血流成像技术评价颈动脉硬化斑块稳定性及预测脑卒中的应用价值  

Clinical value of SMI in evaluation of stability of carotid atherosclerotic plaque and prediction of stroke

作　　者：李丽[1] 张小红[1] 

机构地区：[1]山西省人民医院超声科,太原030012

出　　处：《中国药物与临床》2017年第8期1112-1115,共4页Chinese Remedies & Clinics

基　　金：山西省卫生计生委科研基金(2015021)

摘　　要：目的探讨超微血流成像技术(SMI)在评价颈动脉硬化斑块稳定性及预测脑卒中风险性中的应用价值。方法对经颈动脉常规超声检查发现有颈动脉粥样硬化斑块的78例患者(脑梗死患者38例,非脑梗死患者40例)进行SMI检查,并同时进行超声造影(CEUS)检查对比分析。结果常规颈动脉超声检查共发现141个斑块,其中低回声斑块38个,低回声为主的混合回声斑块40个,等回声斑块30个,强回声斑块33个。SMI和CEUS在不同性质斑块内新生血管显示率由高到低均为:低回声斑,低回声为主混合回声斑,等回声斑,强回声斑;低回声斑、混合回声斑与等回声斑、强回声斑比较差异均有统计学意义(P<0.05);低回声斑与混合回声斑比较差异无统计学意义(P>0.05)。所检斑块中137个斑块SMI与CEUS检测结果相同,其中80个斑块内均可见血流显像,多分布在近心端底部;57个斑块均未见血流显像;4个斑块CEUS可显示血流,而SMI未显示,经统计学检验差异无统计学意义(χ~2=0.233,P>0.05)。SMI与CEUS检测斑块内新生血管分级情况比较有较好的一致性(Kappa=0.736)。SMI技术显示斑块厚度≥3 mm斑块内新生血管数目较斑块厚度1.5~3.0 mm斑块内新生血管数目增多,差异有统计学意义(P<0.05)。受检者中脑梗死患者与非脑梗死患者斑块厚度比较差异无统计学意义(t=0.208,P>0.05),而脑梗死组SMI技术显示斑块内新生血管分级程度高于非脑梗组,差异有统计学意义(χ~2=10.44,P<0.01)。结论斑块中新生血管密度越高,发生脑卒中风险越大。Objective To investigate the clinical value of super microvascular imaging（SMI） in assessing the stability of carotid atherosclerotic plaque and predicting the risk of stroke. Methods Seventy-eight patients diagnosed with carotid atherosclerotic plaque（38 patients with cerebral infarction and 40 patients with non-cerebral infarction） by conventional carotid ultrasonography underwent SMI and contrast-enhanced ultrasonography（CEUS）. Results A total of 141 plaques were found in the conventional carotid ultrasonography, including 38 hypoechoic plaques, 40 hypoecho-dominant mixed-echoic plaques, 30 iso-echoic plaques and 33 hyperechoic plaques. The display rates of SMI and CEUS in different plaques of new blood vessels showed from high to low were hypoechoic plaques,hypoecho-dominant mixed-echoic plaques, iso-echoic plaques, and hyperechoic plaques. There were statistically significant differences between the hypoechoic plaques, mixed-echoic plaques and iso-echoic plaques, hyperechoic plaques（P〈0.05）. There were no significant difference between the hypoechoic plaques and mixed-echoic plaques（P〈0.05）. The findings of the 137 plaques detected by SMI and CEUS detection were the same, of which 80 plaques were observed with blood flow imaging, and multi-distribution at the bottom of the proximal end; 57 plaques were observed without blood flow imaging. Four plaques were observed with blood flow by CEUS, which were not observed by SMI.There was no statistically significant difference.（χ^2=0.233 P〈0.05）. There was a good consistence between SMI and CEUS in the examination of neovascularization in plaques（Kappa=0.736）. The SMI showed that the neovascularization number in the plaques with thickness ≥3 mm increased compared with that in the plaque with thickness of 1.5 mm-3.0 mm, and there was statistically significant difference（P〈0.05）. There was no statistically significant difference in the plaque thickness between the patients with cerebral infarction and non-cerebral infarction�

关 键 词：血管造影术 斑块 动脉粥样硬化 新生血管化 生理性 卒中 

分 类 号：R445.1[医药卫生—影像医学与核医学] R743.3[医药卫生—诊断学]