实时超声弹性成像联合超声造影在颈动脉斑块稳定性评估中的临床应用  

Clinical application of real-time ultrasound elastography combined with contrast-enhanced ultrasound in the assessment of carotid plaque stability

作　　者：范洁[1] 李延皎[1] 李丽丽 郑桂霞[1] 于士芳 FAN Jie;LI Yan-jiao;LI Li-li(Ultrasound Department,Heilongjiang Provincial Hospital,Harbin 150036,China)

机构地区：[1]黑龙江省医院超声科,150036 [2]中国人民解放军总医院海南医院超声科,572000

出　　处：《中国现代药物应用》2023年第11期62-65,共4页Chinese Journal of Modern Drug Application

基　　金：黑龙江省卫生健康委科研课题(项目编号:20210909020117);黑龙江省卫生健康委科研课题(项目编号:20210909010231)。

摘　　要：目的 分析实时超声弹性成像联合超声造影在颈动脉斑块稳定性评估中的价值。方法 140例颈动脉粥样硬化斑块患者,均实施颈动脉剥脱术治疗,手术证实颈动脉斑块176个,其中病理学检查结果显示易损斑块131个,稳定斑块45个。患者术前均采取实时超声弹性成像联合超声造影检查。比较实时超声弹性成像联合超声造影检查中不同性质斑块回声特征、弹性成像评分、新生血管强化程度分级情况,评估超声造影、实时超声弹性成像单独检查及两者联合检查对不同性质颈动脉斑块的诊断效能。结果 实时超声弹性成像联合超声造影诊断中,颈动脉易损斑块检出低回声比例51.1%高于稳定斑块的22.2%,检出强回声比例32.8%低于稳定斑块的64.4%,差异有统计学意义(P<0.05);颈动脉易损斑块检出混合回声比例16.0%与稳定斑块的13.3%对比,差异无统计学意义(P>0.05)。颈动脉易损斑块弹性成像评分(2.3±0.6)分低于稳定斑块的(4.4±0.8)分,差异有统计学意义(P<0.05);易损斑块新生血管强化程度Ⅰ~Ⅱ级比例17.6%低于稳定斑块的84.4%,Ⅲ~Ⅳ级比例82.4%高于稳定斑块的15.6%,差异有统计学意义(P<0.05)。实时超声弹性成像联合超声造影诊断的敏感度、特异度、准确度分别为91.6%、93.3%、92.0%,实时超声弹性成像诊断分别为77.1%、66.7%、74.4%,超声造影诊断分别为81.7%、73.3%、79.5%。实时超声弹性成像联合超声造影诊断的敏感度、特异度、准确度均高于实时超声弹性成像、超声造影单独诊断,差异有统计学意义(P<0.05);实时超声弹性成像诊断的敏感度、特异度、准确度与超声造影比较,差异无统计学意义(P>0.05)。结论 实时超声弹性成像联合超声造影联合诊断颈动脉斑块,可通过斑块内部回声、弹性成像评分及新生血管强化程度等指标对比,提升易损斑块及稳定斑块检出的敏感度、特异度、准确度,评估颈动脉斑�Objective To analyze the value of real-time ultrasound elastography combined with contrast-enhanced ultrasound in the assessment of carotid plaque stability.Methods All 140 patients with carotid atherosclerotic plaque underwent carotid artery dissection,and 176 carotid plaques were confirmed by surgery,among which 131 plaques were vulnerable and 45 plaques were stable.All patients underwent real-time ultrasound elastography combined with contrast-enhanced ultrasound before surgery.The echo characteristics,elastography score,and grading of neovascularization of different plaques in real-time ultrasound elastography combined with contrast-enhanced ultrasound were compared,and the diagnostic efficiency of the contrast-enhanced ultrasound,the real-time ultrasound elastography alone and in combination for carotid plaque of different properties was evaluated.Results In the diagnosis of realtime ultrasound elastography combined with contrast-enhanced ultrasound,the proportion of low echo detected in vulnerable carotid plaques was 51.1%,which was higher than that of 22.2%in stable plaques;the proportion of strong echo detected in vulnerable carotid plaques was 32.8%lower than that of 64.4%in stable plaques;the differences were statistically significant(P<0.05).The proportion of mixed echo detected in vulnerable carotid plaques was 16.0%,and the difference was not statistically significant compared with 13.3%in stable plaques(P>0.05).The elastography score of vulnerable carotid plaques was(2.3±0.6)points,which was lower than that of(4.4±0.8)points of stable plaques,and the difference was statistically significant(P<0.05).The proportion of gradeⅠ-Ⅱneovascularization was 17.6%in vulnerable carotid plaques,which was lower than that of 84.4%in stable plaques,and the proportion of gradeⅢ-Ⅳneovascularization was 82.4%,which was higher than that of 82.4%in stable plaques;the differences were statistically significant(P<0.05).The sensitivity,specificity and accuracy were 91.6%,93.3%and 92.0%for real-time ultrasound elas

关 键 词：颈动脉斑块 稳定性 实时超声弹性成像 超声造影 诊断效能 

分 类 号：R445.1[医药卫生—影像医学与核医学] R543.4[医药卫生—诊断学]