颈动脉超声定量参数结合MRI对急性脑梗死患者的诊断价值  

Diagnostic Value of Quantitative Parameters of Carotid Ultrasound Combined with MRI in Patients with Acute Cerebral Infarction

作　　者：童陶然[1] 周菁菁 曹昌权[1] TONG Tao-ran;ZHOU Jing-jing;CAO Chang-quan(Department of Ultrasound,Tongling People' s Hospital, Tongling 244000, Anhui Province, China)

机构地区：[1]安徽省铜陵市人民医院超声医学科

出　　处：《中国CT和MRI杂志》2019年第7期29-31,49,共4页Chinese Journal of CT and MRI

摘　　要：目的探讨颈动脉超声定量参数结合MRI在急性脑梗死(ACI)诊断中的价值。方法病例源于2016年12月至2018年9月106例ACI患者,颈动脉超声检查ACI患者颈动脉狭窄程度、颈动脉内膜中层厚度(IMT)、颈内动脉收缩期峰值血流速度(PSV)、舒张末期流速(EDV)及斑块情况,MRI扫描检查颈动脉狭窄程度及颈动脉斑块性质和分布情况。结果中重度组IMT较轻度组明显高,PSV、EDV较轻度组明显低,差异显著(P<0.05);经ROC曲线分析,IMT+PSV+EDV联合检测对ACI患者颈动脉狭窄程度诊断的曲线下面积为0.821;MRI检出颈动脉粥样硬化斑块阳性者102例,检出率96.23%(102/106),79块位于颈总动脉分叉(50.00%),易损斑块107块(67.72%),斑块脂质成分在2D-TOF像呈等信号,在T1WI呈等或稍低信号,在T2WI呈稍低信号,而完整纤维帽2D-TOF上呈带状低信号,T1WI、T2WI上呈等或较高信号;超声检出颈动脉粥样硬化斑块阳性者86例,检出率81.13%(86/106);超声联合MRI对ACI患者颈动脉狭窄程度的总体检出率98.11%明显高于两者单一检查的(超声70.75%、MRI 84.91%)(P<0.05)。结论颈动脉超声定量参数结合MRI在ACI诊断中,可对患者颈动脉斑块情况进行准确地定性、定位诊断,且明显地提高了对颈动脉狭窄程度的检出率。Objective To investigate the value of quantitative parameters of carotid ultrasound combined with MRI in the diagnosis of acute cerebral infarction(ACI).Methods The cases were from 106 patients with ACI from December 2016 to September2018. Carotid ultrasound was performed to examine carotid stenosis, carotid intima-media thickness(IMT), internal carotid peak systolic velocity(PSV), end diastolic velocity(EDV)and plaques in ACI patients. MRI scan was performed to examine carotid stenosis, and the nature and distribution of carotid plaques. Results The IMT in moderate to severe group was significantly higher than that in mild group, while PSV and EDV were significantly lower than those in mild group(P<0.05). The ROC curve analysis showed that the area under the curve of IMT with PSV and EDV for the diagnosis of carotid stenosis degree in ACI patients was 0.821. There were 102 cases with positive carotid atherosclerotic plaques detected by MRI, the detection rate was 96.23%(102/106). 79 of plaques were located in the common carotid bifurcation(50.00%), and there were 107(67.72%) vulnerable plaques. The plaque lipid component showed equal signal in 2 D-TOF image, equal or slightly lower signal on T1 WI, slightly lower signal on T2 WI. The complete fiber cap showed banded low signal on 2 D-TOF, equal or higher signal on T1 WI and T2 WI. There were 86 cases with positive carotid atherosclerotic plaques detected by ultrasound, the detection rate was 81.13%(86/106). The overall detection rate of ultrasound combined with MRI(98.11%) for carotid stenosis degree in ACI patients was significantly higher than that of either of the two examination methods(ultrasound 70.75%, MRI 84.91%)(P<0.05). Conclusion The application of quantitative parameters of carotid ultrasound combined with MRI in the diagnosis of ACI can help accurately qualitative and locating diagnosis for carotid plaques, which significantly improve the detection rate of carotid stenosis.

关 键 词：急性脑梗死 颈动脉超声 MRI 颈动脉狭窄 

分 类 号：R742[医药卫生—神经病学与精神病学]