超声造影诊断颈动脉不稳定斑块破裂风险的效能  

Efficacy of Contrast-enhanced Ultrasound in Predicting the Risk of Rupture of Unstable Carotid Plaques

作　　者：黄雅萍 侯放 文晟[1] 丁旭[1] 刘晓刚[1] 孙心平[1] Huang Yaping;Hou Fang;Wen Sheng;Ding Xu;Liu Xiaogang;Sun Xinping(Department of Ultrasound,Chuiyangliu Hospital,Beijing 100022,China)

机构地区：[1]北京市垂杨柳医院超声科,北京市100022

出　　处：《中国超声医学杂志》2023年第1期5-8,共4页Chinese Journal of Ultrasound in Medicine

基　　金：首都卫生发展科研专项项目(No.2020-4-7035)。

摘　　要：目的 利用超声造影反映斑块内部的新生血管、斑块的形态和成分等,评价斑块不稳定特征性风险因素诊断斑块破裂风险的效能。方法 纳入超声筛查出颈动脉粥样硬化斑块、管腔面积狭窄50%~99%、临床表现为症状性缺血性脑卒中的患者共164例,均接受颈动脉超声造影,其中76例接受颈动脉内膜剥脱手术并获得病理结果。超声图像以斑块内新生血管、造影非强化区(包括脂质和斑块内出血)、斑块钙化向管腔面突出等作为斑块不稳定性的风险因素,以组织学发现斑块内出血作为最倾向斑块破裂的指标,将具有不稳定特征的各项风险指标分别与病理结果作对照,分析各项风险指标分别与斑块内出血的对应关系。造影新生血管分级为低风险组(0~1级)、中风险组(2~3级)、高风险组(4级),与病理斑块内出血结果作对照分析,对诊断不稳定斑块破裂的效能采用二元Logistic回归分析,以P<0.05差异具有统计学意义,以OR值反映危险度。结果 斑块内出血的发生率分别为:低或混合回声为77.6%,造影非强化区为81.8%,钙化向管腔面突出为90.2%,斑块内新生血管Ⅱ级以上为80.6%;新生血管分级与病理对照分析,P<0.01为差异具有统计学意义,说明新生血管分级是诊断不稳定斑块出血的风险因素,OR=15.556说明中风险组发生斑块内出血是低风险组的15.556倍,OR=59.5说明高风险组发生斑块内出血是低风险组的59.5倍,新生血管分级诊断不稳定斑块破裂出血的效能较高。结论 超声造影可以作为评价颈动脉斑块不稳定风险因素的一种可靠的技术,必要时需要联合二维超声共同评估;超声造影评价颈动脉斑块不稳定风险因素对诊断斑块破裂风险的效能较高。Objective To evaluate the diagnostic efficacy of the characteristic risk factors of plaque instability in diagnosing plaque rupture by contrast-enhanced ultrasound to reflect neovascularization,plaque morphology and composition.Methods A total of 164 patients with carotid plaques,luminal area stenosis of 50% to 99%,and symptomatic ischemic stroke were enrolled.All patients underwent CEUS,and 76 underwent carotid endarterectomy.Ultrasound inside neovascularization,and non-enhanced area(including lipid and intraplaque hemorrhage),plaque calcification prominent to the luminal as instability risk factors,such as histologically intraplaque hemorrhage as the tendency indicator of plaque rupture,unstable risk factors were compared respectively with pathologic results.The corresponding relationship between each risk indexes and intraplaque hemorrhage was analyzed.Neovascularization classification for low(0~1),medium(2~3) and high risk(4),pathological intraplaque hemorrhage results contrast analysis,using binary Logistic regression analysis,with P<0.05 differences statistically significant,OR eflects risk.Results The incidence of intraplaque hemorrhage was 77.6% with hypoechoic or mixed echo,81.8% with non-enhanced area,90.2% with calcification protruding into luminal,80.6% with neovascularization grade Ⅱ or higher.The difference between neovascularization grade and pathology was statistically significant(P<0.01),indicating that the neovascularization grade was a risk factor for the diagnosis of unstable plaque bleeding.OR=15.556 indicates that intraplaque bleeding in the middle-risk group was 15.556 times that in the low-risk group,likewise,OR=59.5 indicates that 59.5 times higher than that in the low-risk group,neovascularization classification has a higher efficacy in diagnosing unstable plaque rupture hemorrhage.Conclusions CEUS can be used as a reliable technique to evaluate the risk factors of carotid plaque instability.CEUS has high efficacy in evaluating the risk factors of plaque instability in diagnosing the r

关 键 词：颈动脉 不稳定斑块 超声造影 缺血性脑卒中 

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]