颈动脉蹼的影像学特征与病理对照研究  

Imaging features and pathological comparison of carotid web

作　　者：宁彬[1] 张东[1] 于腾飞[1] 宋海曼[1] 王福民 何文[1] Ning Bin;Zhang Dong;Yu Tengfei;Song Haiman;Wang Fumin;He Wen(Department of Ultrasound,Beijing Tian Tan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院超声科,100070

出　　处：《中华超声影像学杂志》2020年第1期37-42,共6页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金(81730050)。

摘　　要：目的观察颈动脉蹼的超声及计算机断层血管成像(computed tomography angiography,CTA)特征,与颈动脉内膜剥脱术后病理进行对照,比较两种检查方法的诊断效能。方法选择2018年6月至2019年7月于首都医科大学附属北京天坛医院拟行颈动脉内膜剥脱术的患者159例,术前行超声检查、主动脉弓上CTA,明确有无颈动脉蹼以及是否合并血栓或动脉粥样硬化斑块。超声检查记录颈动脉蹼的位置、长度、厚度、伸入管腔的方向、回声、有无合并斑块或血栓等,与术前CTA检查结果对比。术后大体标本观察,行组织病理学检查。结果159例颈动脉内膜剥脱术患者中22例经病理证实有颈动脉蹼结构,HE染色为广泛的内膜肌纤维增生及黏液样变性,其中18例颈动脉蹼底部合并斑块形成,4例合并血栓形成。术前超声诊断术侧存在颈动脉蹼结构17例,5例误诊及漏诊,超声诊断颈动脉蹼的敏感性为77%(17/22),特异性为98%(135/137),准确性为75%。术前CTA诊断术侧颈动脉蹼11例,11例误诊及漏诊,CTA诊断颈动脉蹼的敏感性为50%(11/22),特异性为97%(134/137),准确性为47%。结论超声诊断颈动脉蹼的敏感性及准确性高于CTA,能更好地显示颈动脉蹼结构及是否合并斑块或血栓形成。Objective To analyze the ultrasound examination and computed tomography angiography(CTA)features of carotid web(CAW),and compare with the pathology after carotid endarterectomy,and then compare diagnostic efficacies of the two methods.Methods From June 2018 to July 2019,159 patients underwent carotid endarterectomy(CEA)in Beijing Tian Tan Hospital were collected,ultrasound examination and CTA were performed preoperatively.The presence or absence of CAW and whether there were thrombosis or atherosclerotic plaques associated with it were identified.The location length,thickness,direction in the lumen,echo characteristics of CAW,and complicated with or without thrombosis or atherosclerotic plaques were recorded.The postoperative specimens were observed,and the pathological analysis was performed.Results Among the 159 cases of CEA,22 cases were confirmed to have CAW structure by pathology,and HE staining showed extensive intimal fibrohyperplasia and mucoid degeneration,among which 18 cases had plaque formation at the bottom of the carotid web,and 4 cases associated with thrombosis.There were 17 cases of CAW structure diagnosed by ultrasound,5 cases were misdiagnosed or missed,the sensitivity and specificity of ultrasound in the diagnosis of CAW were 77%(17/22)and 98%(135/137),and the accuracy was 75%.Eleven cases of CAW were diagnosed by preoperative CTA,and 11 cases were misdiagnosed and missed diagnosis,the sensitivity and specificity of CTA in the diagnosis of CAW were 50%(11/22)and 97%(134/137),and the accuracy was 47%.Conclusions The sensitivity of ultrasound in the diagnosis of CAW is higher than that of CTA,which can better display the structure of CAW and whether it is associated with plaque or thrombosis.

关 键 词：超声检查 颈动脉蹼 粥样硬化斑块 血栓 计算机断层血管成像 

分 类 号：R74[医药卫生—神经病学与精神病学]