颈动脉斑块易损性的超声造影评估及与缺血性卒中的相关性研究  

Carotid contrast-enhanced ultrasound assessment of plaque vulnerability and its correlation with ischemic stroke

作　　者：吕琦[1] 惠品晶[1] 丁亚芳[1] 颜燕红[1] Lyu Qi;Hui Pinjing;Ding Yafang;Yan Yanhong(Department of Carotid and Cerebrovascular Ultrasonography,the First Affiliated Hospital of Soochow University,Suzhou,215006,China)

机构地区：[1]苏州大学附属第一医院卒中中心颈脑血管超声科,215006

出　　处：《中华医学超声杂志（电子版）》2023年第10期1040-1045,共6页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：苏州市民生科技项目(SS202061);苏州大学技术合作项目(H211064)。

摘　　要：目的应用超声造影评估颈动脉斑块易损特征及与缺血性卒中的相关性,以明确与缺血性卒中发生密切相关的“高危”斑块易损特征。方法连续纳入2019年1月至2019年12月在苏州大学附属第一医院卒中中心进行颈动脉内膜切除术(CEA)的患者51例。患者于术前行超声造影评估斑块易损性。根据造影剂在斑块内的不同扩散方式,分为“由内向外”灌注模式(造影剂从颈动脉管腔向斑块内扩散)和“由外向内”灌注模式(造影剂从颈动脉外膜向斑块内扩散)。根据斑块内造影增强程度分为无增强、中等增强以及广泛增强。根据是否发生缺血性卒中分为有症状组及无症状组。根据斑块的组织病理学结果,对不同造影灌注模式斑块的病理特征及斑块纤维帽破裂的独立危险因素进行分析,并对有症状患者与无症状患者的斑块造影灌注模式及造影增强程度进行比较分析。结果51个斑块中,超声造影“由内向外”灌注模式23个(23/51,45.1%),其中18个为典型溃疡型,5个斑块为裂隙型。超声造影“由内向外”灌注模式的斑块中,纤维帽破裂的发生率高于“由外向内”灌注模式(73.9%vs 25.0%,P<0.001)。多因素回归分析显示,造影剂“由内向外”灌注模式是斑块纤维帽破裂的独立危险因素(OR值:8.5,95%CI:2.4~30.1,P=0.001)。51例患者中,有症状患者42例,无症状患者9例。缺血性卒中有症状的患者中斑块造影剂“由内向外”灌注模式的发生率高于无症状患者(52.4%vs 11.1%,P=0.024)。缺血性卒中有症状患者与无症状患者在超声造影增强级别程度上差异无统计学意义(P=0.649)。结论造影剂在颈动脉斑块内“由内向外”的灌注模式可为诊断斑块纤维帽破裂提供重要的形态学标志,是与缺血性卒中发生密切相关的“高危”斑块易损特征。Objective To evaluate the correlation between plaque vulnerability assessed by contrast-enhanced ultrasound(CEUS)and ischemic stroke so as to identify"high-risk"vulnerability characteristics that are closely related to the occurrence of ischemic stroke.Methods Fifty-one patients who underwent carotid endarterectomy(CEA)at the Stroke Center of the First Affiliated Hospital of Suzhou University from January 2019 to December 2019 were evaluated for plaque vulnerability by CEUS before operation.Based on the direction of the contrast agent that diffused within the plaques,the plaques were divided into"inside-outside"direction(contrast agent diffused from the artery lumen towards the inside of the plaque)and"outside-inside"direction(contrast agent diffused from the adventitia towards the inside of the plaque).Plaque enhancement degree were divided into no enhancement,moderate enhancement,and extensive enhancement.According to the occurrence of ischemic stroke,the patients were divided into a symptomatic group and an asymptomatic group.The correlation between CEUS perfusion pattern and enhancement degree and ischemic stroke symptoms was analyzed according to histopathological gold standard.Results Among the 51 plaques,23(23/51,45.1%)had"inside-out"perfusion mode,of which 18 were typical ulcerative and 5 were fissured plaques.The incidence of cap rupture was significantly higher in plaques with the"inside to outside"direction perfusion pattern than in those with the"outside to inside"direction perfusion pattern(neovascularization)(73.9%vs 25.0%,P<0.001).Multivariate analysis showed that the"inside to outside"perfusion pattern was an independent risk factor for plaque fibrous cap rupture(odds ratio=8.5,95%confidence interval:2.4-30.1).Among the 51 patients,42 were symptomatic and 9 were asymptomatic.The incidence of"inside to outside"perfusion pattern plaques was significantly higher in patients with ischemic stroke symptoms than in asymptomatic patients(52.4%vs 11.1%,P=0.024).There was no significant difference in plaque

关 键 词：易损斑块 超声造影 灌注模式 纤维帽破裂 

分 类 号：R540.4[医药卫生—心血管疾病]