多模态影像学对颈动脉斑块易损性的诊断价值  

Diagnostic value of multimodal imaging for the vulnerability of carotid artery plaque

作　　者：曾宇琪 郑进 霍桂军 曹俊杰 姚志超 沈利明[1] 周大勇[1] Zeng Yuqi;Zheng Jin;Huo Guijun;Cao Junjie;Yao Zhichao;Shen Liming;Zhou Dayong(Department of Vascular Surgery,Gusu School of Nanjing Medical University/Affiliated Suzhou Hospital of Nanjing Medical University/Suzhou Municipal Hospital(Headquarters),Suzhou 215002,Jiangsu,China)

机构地区：[1]南京医科大学姑苏学院/南京医科大学附属苏州医院/苏州市立医院(本部)血管外科,江苏苏州215002

出　　处：《血管与腔内血管外科杂志》2024年第3期270-274,共5页Journal of Vascular and Endovascular Surgery

基　　金：江苏省卫生健康委科研项目(H2023146);南京医科大学姑苏学院科研项目(GSKY20210223)。

摘　　要：目的 探讨计算机断层扫描血管成像(CTA)、磁共振成像(MRI)、超声及CTA+超声对颈动脉斑块易损性的诊断效能。方法 收集2020年10月至2023年5月南京医科大学姑苏学院/南京医科大学附属苏州医院/苏州市立医院(本部)行颈动脉血管重建术的26例患者的临床资料,将其手术所得颈动脉斑块行苏木精-伊红(HE)染色、Masson三色染色及CD34抗体染色,分析斑块成分,判断斑块稳定性。以病理结果为金标准,比较不同影像学方法的诊断效能。结果 以病理结果为金标准,CTA+超声评估易损斑块的灵敏度最高,MRI评估易损斑块的特异度、准确度、阳性预测值、阴性预测值均较高。MRI对斑块的脂质核心、薄纤维帽、溃疡、钙化、斑块内出血检出率与病理结果比较,差异均无统计学意义(P﹥0.05),MRI检测斑块薄纤维帽的灵敏度最高,检测斑块脂质核心的特异度最高,检测斑块薄纤维帽、脂质核心的准确度均较高。结论 MRI仍是评估颈动脉粥样硬化斑块的金标准,但CTA+超声评估颈动脉粥样硬化斑块的灵敏度、准确度与MRI相当,且其更加快速、便捷和经济,更利于在基层医院推广应用。Objective To investigate the diagnostic efficacy of computed tomography angiography(CTA),magnetic resonance imaging(MRI),ultrasound and CTA+ultrasound in the vulnerability of carotid artery plaques.Method Clinical data of 26 patients undergoing carotid artery revascularization in Gusu School of Nanjing Medical University/Affiliated Suzhou Hospital of Nanjing Medical University/Suzhou Municipal Hospital(Headquarters)from October 2020 to May 2023 were collected.Hematoxylin-eosin(HE)staining,Masson trichromatic staining and CD34 antibody staining were performed to analyze plaque components and determine plaque stability.The pathological results was the gold standard,the diagnostic efficacy of different imaging methods was compared.Result With pathological results as the gold standard,CTA+ultrasound had the highest sensitivity in the evaluation of vulnerable plaque,while MRI had higher specificity,accuracy,positive predictive value and negative predictive value in the evaluation of vulnerable plaque.There were no statistical significances in the detection rates of MRI for plaque lipid core,thin fiber cap,ulcer,calcification,and hemorrhage in plaque compared with the pathological results(P>0.05).MRI showed the highest sensitivity and specificity in detecting plaque lipid core,the highest accuracy in detecting plaque thin fiber cap and lipid core.Conclusion MRI is still the gold standard for evaluating carotid atherosclerotic plaques,but CTA+ultrasound has the same sensitivity and accuracy as MRI in evaluating carotid atherosclerotic plaques,it is more rapid,convenient and economical,which is more conducive to the promotion and application in primary hospitals.

关 键 词：颈动脉狭窄 易损斑块 磁共振成像 计算机断层扫描血管成像 B超 

分 类 号：R543[医药卫生—心血管疾病]