多模态超声检查结合临床预测颈动脉粥样硬化患者缺血性脑卒中或短暂性脑缺血复发  

Multimodal ultrasonography combined with clinical data for predicting ischemic stroke or recurrence of transient ischemic attack in patients with carotid atherosclerosis

作　　者：孙飞一[1] 潘晓芳[1] 贾晓东[1] 刘琳[1] 张博[1] SUN Feiyi;PAN Xiaofang;JIA Xiaodong;LIU Lin;ZHANG Bo(Department of Ultrasound Imaging,Dalian Municipal Central Hospital,Dalian 116033,China)

机构地区：[1]大连市中心医院超声影像科,辽宁大连116033

出　　处：《中国医学影像技术》2022年第1期53-58,共6页Chinese Journal of Medical Imaging Technology

基　　金：大连市医学科学研究计划(1811020)。

摘　　要：目的观察常规超声、超声造影(CEUS)和剪切波弹性成像(SWE)结合临床预测颈动脉粥样硬化患者缺血性脑卒中或短暂性脑缺血发作(TIA)复发的价值。方法纳入87例因TIA就诊的颈动脉粥样硬化伴单发斑块患者,根据随访期间是否发生缺血性脑卒中或复发TIA分为复发组(n=35)和未复发组(n=52),比较组间常规超声、CEUS和SWE所示斑块特征及一般临床资料,将差异有统计学意义的因素纳入logistic回归分析,建立多因素联合预测模型,评价其预测缺血性脑卒中或TIA复发的效能。结果复发组与未复发组患者高血压、糖尿病、高脂血症、吸烟史、脑卒中家族史占比及药物依从性差异均有统计学意义(P均<0.05)。复发组斑块内出血、斑块溃疡及薄纤维帽占比均高于未复发组(P均<0.05),且其常规超声所示易损斑块、SWE示软斑块或混合斑块及CEUS 2~3级斑块数目均大于未复发组(P均<0.05)。高血压、吸烟史、脑卒中家族史、药物依从性、部分常规超声指征(溃疡、斑块内出血、薄纤维帽)、SWE指征(软斑块或混合斑块)及CEUS指征(2~3级斑块)均为颈动脉粥样硬化患者发生缺血性脑卒中或TIA复发的独立危险因素(P均<0.05),据以预测缺血性脑卒中或TIA复发的曲线下面积(AUC)为0.93(95%CI 0.85~1.00)(P<0.05)。结论联合应用常规超声、CEUS及SWE指征并结合临床预测颈动脉粥样硬化患者发生缺血性脑卒中或复发TIA具有一定准确性,可为临床处置提供参考。Objective To observe the value of conventional ultrasound,contrast-enhanced ultrasound(CEUS)and shear wave elastography(SWE)combined with clinical data for predicting ischemic stroke or recurrence of transient ischemic attack(TIA)in patients with carotid atherosclerosis.Methods A total of 87 TIA patients with carotid atherosclerosis and single carotid plaque were enrolled and divided into recurrence group(n=35)and non-recurrence group(n=52)according to ischemic stroke or recurrence of TIA occurred or not during the follow-up periods.Clinical data and plaque characteristics depicted with conventional ultrasound,CEUS and SWE were compared between groups.The factors being statistically different between groups were included in logistic regression analysis.Then a multi factor combining prediction model was established,and the value for predicting ischemic stroke or recurrence of TIA was analyzed.Results There were significant differences of the ratios of hypertension,diabetes,hyperlipidemia,smoking history,family history of stroke,also of drug compliance between groups(all P<0.05).The numbers of intra plaque hemorrhage,ulcer and thin fibrous cap of plaque in recurrence group were larger than those in non-recurrence group(all P<0.05),while of vulnerable plaque shown with conventional ultrasound,soft plaque or mixed plaque shown with SWE and plaque with CEUS grade 2—3 in recurrence group were all larger than those in non-recurrence group(all P<0.05).Hypertension,smoking history,family history of stroke,drug compliance,some conventional ultrasound indications(ulcer,intra plaque hemorrhage,thin fibrous cap),SWE indications(soft plaque or mixed plaque)and CEUS indications(grade 2—3 plaque)were independent risk factors for ischemic stroke and recurrence of TIA in patients with carotid atherosclerosis(all P<0.05),and the area under the curve(AUC)of combining model for predicting ischemic stroke or recurrence of TIA was 0.93(95%CI 0.85—1.00)(P<0.05).Conclusion Combination of conventional ultrasound,CEUS and SWE with cl

关 键 词：颈动脉 动脉硬化 脑卒中 脑缺血发作 短暂性 超声检查 弹性成像技术 

分 类 号：R543.4[医药卫生—心血管疾病] R445.1[医药卫生—内科学]