颈动脉易损斑块影像学评估与术后病理的临床队列研究  

Clinical cohort study of imaging evaluation and postoperative pathology of carotid vulnerable plaque

作　　者：赵克强[1] 谢霞 尹洪芳[3] 赵俊来[1] 曹战江[1] 杨宇[1] 蒋超[1] 朱融融[1] 吴巍巍[1] Zhao Keqiang;Xie Xia;Yin Hongfang;Zhao Junlai;Cao Zhanjiang;Yang Yu;Jiang Chao;Zhu Rongrong;Wu Weiwei(Department of Vascular Surgery,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102216,China)

机构地区：[1]清华大学附属北京清华长庚医院清华大学临床医学院血管外科,102216 [2]清华大学附属北京清华长庚医院清华大学临床医学院超声科,102216 [3]清华大学附属北京清华长庚医院清华大学临床医学院病理科,102216

出　　处：《中华医学杂志》2018年第30期2424-2428,共5页National Medical Journal of China

摘　　要：目的评估颈动脉超声造影对易损斑块识别的准确性。方法本研究为前瞻性临床队列研究。选择2016年1月至2017年12月清华大学附属北京清华长庚医院25例颈动脉狭窄并接受颈动脉内膜剥脱手术的患者。术前常规行颈动脉超声造影以及斑块高分辨核磁成像判断斑块性质是否稳定。所有患者行颈动脉内膜剥脱术，完整剥除斑块组织，并行连续病理切片，通过HE染色及CD31、CD34、SMA免疫组化，分析斑块性质，包括纤维帽厚度、完整性及斑块内是否存在新生血管、出血或炎症细胞浸润等。通过病理最终明确斑块性质，并与术前颈动脉斑块的影像学检查结果作对照，以判定术前颈动脉影像学检查对于易损斑块识别的准确率。结果25例患者中，术前超声造影判定不稳定斑块16例，稳定斑块9例；术后病理证实斑块标本中17例可检查出不稳定成分，超声造影对颈动脉易损斑块识别的敏感度为88.2%（15/17），特异度为87.5%（7/8），总体诊断符合率为88%（22/25）。高分辨率核磁对易损斑块识别的敏感度、特异度以及总体诊断符合率分别为83.3%（10/12）、71.4%（5/7）、78.9%（15/19），以术后病理作为金标准，两种检测易损斑块方法的准确性差异无统计学意义（χ2＝0.003，P〉0.05）。结论超声造影对颈动脉斑块稳定性评估的准确性较高，推荐作为颈动脉狭窄术前识别不稳定斑块的检查之一。To evaluate the accuracy of contrast-enhanced ultrasound（CEUS） scanning in identifying vulnerable plaque in carotid artery.MethodsThe study included a total of 25 patients who suffered from carotid artery stenosis and underwent carotid endarterectomy from January 2016 to December 2017 in Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University. Preoperative carotid artery contrast enhanced ultrasound and High-resolution MRI were performed to all patients to determine whether the plaques were stable. All patients then underwent carotid endarterectomy, during which, plaques were completely removed. Biopsies were performed using HE staining and CD31, CD34 and SMA immunohistochemistry was used to identify the plaques properties, including the thickness and integrity of the fiber cap, neovascular endothelium, hemorrhage, and inflammatory cells in the removed plaques.The results of these tests were compared with the diagnosis through the pre-operative imaging.ResultsAmong twenty-five cases, the pre-operative CEUS revealed sixteen with unstable plaques and nine with stable plaques. Meanwhile the post-operation pathology confirmed seventeen cases with unstable plaque components. The sensitivity of CEUS in the identification of carotid vulnerable plaque was 88.2%（15/17）, the specificity was 87.5%（7/8）, and the overall diagnostic accuracy was 88%（22/25）. The sensitivity, specificity and overall diagnostic accuracy of high resolution MR for vulnerable plaque identification were 83.3%（10/12）, 71.4%（5/7）, 78.9%（15/19）, respectively. There were no significant difference between two groups（χ2=0.003, P〉0.05）.ConclusionsThe sensitivity, specificity and overall diagnostic accuracy of the CEUS for vulnerable plaque identification are high.Therefore, CEUS is recommended as one of the pre-operative diagnostic method for unstable plaque in carotid stenosis.

关 键 词：颈动脉狭窄 斑块切除术 超声检查 磁共振成像 病理学 

分 类 号：R743.3[医药卫生—神经病学与精神病学]