超声造影评价颈动脉斑块易损性预测脑卒中的应用价值  

Value of contrast-enhanced ultrasound in evaluating carotid plaque vulnerability and predicting stroke

作　　者：张小航 金惠红 ZHANG Xiaohang;JIN Huihong(Department of Ultrasound,The First Hospital of Jiaxing City,Jiaxing 314001,Zhejiang,China)

机构地区：[1]嘉兴市第一医院超声科,浙江嘉兴314001

出　　处：《中国现代医生》2023年第32期40-44,共5页China Modern Doctor

摘　　要：目的探讨超声造影(contrast-enhancedultrasound,CEUS)评价颈动脉斑块易损性对脑卒中的预测价值。方法纳嘉兴市第一医院2020年5月至2022年5月收治的颈动脉斑块患者108例进行回顾性研究,均行CEUS检查,评估斑块易损性。根据患者是否发生脑卒中,分成卒中组(n=51)、非卒中组(n=57),比较两组颈动脉斑块的CEUS特征,包括新生血管分级、灌注方向、主要增强部位。绘制受试者工作特征(receiver operating characteristic,ROC)曲线分析颈动脉斑块常规超声特征、CEUS特征对脑卒中的预测价值。结果卒中组平均斑块长度、厚度高于非卒中组,斑块狭窄程度≥50%、低回声为主的混合回声、斑块表面溃疡占比高于非卒中组(P<0.05)。卒中组0级、1级占比低于非卒中组,2级、3级占比高于非卒中组,且2级+3级总数占比高于非卒中组(P<0.05)。两组斑块内新生血管的灌注方向比较,差异无统计学意义(P>0.05)。卒中组斑块肩部增强占比高于非卒中组(P<0.05)。常规超声评估斑块易损预测脑卒中的曲线下面积(area under curve,AUC)为0.612,敏感度为62.75%,特异性为59.65%。CEUS评估斑块易损预测脑卒中的AUC为0.788,敏感度为80.39%,特异性为77.19%。结论CEUS可以通过评估患者的颈动脉斑块易损情况,对脑卒中发生风险进行预测,敏感度与特异性较理想。Objective To evaluate the value of contrast-enhanced ultrasound(CEUS)in the prediction of carotid plaque vulnerability in stroke.Methods Totally 108 patients with carotid artery plaque admitted to our hospital from May 2020 to May 2022 were included in the retrospective study.All patients underwent CEUS examination to evaluate the plaque vulnerability.Patients were divided into stroke group(n=51)and non-stroke group(n=57)according to whether or not they had had stroke.CEUS characteristics of carotid plaque in the two groups were compared,including the grade of neovascularization,perfusion direction,and main enhancement site.Receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of conventional ultrasound features and CEUS features of carotid plaque in stroke.Results The average plaque length and thickness in the stroke group were higher than those in the non-stroke group,the degree of plaque stenosis was more than 50%,the proportion of mixed echo with low echo and plaque surface ulcer was higher than that in the non-stroke group(P<0.05).The proportion of grade 0 and grade 1 in stroke group was lower than that in non-stroke group,the proportion of grade 2 and grade 3 was higher than that in non-stroke group,and the total proportion of grade 2 and grade 3 was higher than that in non-stroke group(P<0.05).There was no difference in the perfusion direction of neovascularization between the two groups(P>0.05).The proportion of plaque shoulder enhancement in stroke group was higher than that in non-stroke group(P<0.05).The area under the curve(AUC),sensitivity(62.75%),and specificity(59.65%)for predicting stroke of plaque vulnerability assessed by conventional ultrasound were 0.612.The AUC of CEUS for plaque vulnerability prediction of stroke was 0.788,sensitivity was 80.39%,and specificity was 77.19%.Conclusion CEUS can predict the risk of stroke by evaluating the vulnerability of patients with carotid artery plaque,with ideal sensitivity and specificity.

关 键 词：颈动脉斑块易损性 超声造影 脑卒中 预测价值 

分 类 号：R445[医药卫生—影像医学与核医学]