超声高精细血流联合弹性成像评估颈动脉斑块稳定性预测缺血性脑卒中发生的价值  

The value of Fine-Flow imaging combined with ultrasound elastography to assess carotid plaqu estability in predicting ischemic stroke

作　　者：张洪江 贾贤达 牛亚军[2] 赵鹏[3] 胡晓敏 ZHANG Hong-jiang;JIA Xian-da;NIU Ya-jun;ZHAO Peng;HU Xiao-min(Department of Ultrasound,the Second Affiliated Hospital of Hebei North University,Zhangjiakou 075100,China;Department of Ultrasound,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China;Department of Neurology,the Second Affiliated Hospital of Hebei North University,Zhangjiakou 075100,China)

机构地区：[1]河北北方学院附属第二医院超声科,河北张家口075100 [2]河北北方学院附属第一医院超声科,河北张家口075000 [3]河北北方学院附属第二医院神经内科,河北张家口075100

出　　处：《河北医科大学学报》2024年第6期654-660,共7页Journal of Hebei Medical University

基　　金：河北省医学科学研究课题计划(20231470)。

摘　　要：目的探讨超声高精细血流成像(fine-flow imaging,FFI)技术联合超声弹性成像技术对于脑卒中患者颈动脉斑块稳定性的诊断价值。方法以缺血性脑卒中患者200例作为观察组,有颈动脉斑块患者200例作为对照组。常规灰阶超声观察所有患者颈动脉斑块特征。采用超声FFI技术检测颈动脉斑块内新生血管情况,进行血流分级,弹性成像技术测量斑块弹性参数。分析比较2组颈动脉斑块特点与缺血性脑卒中相关性。Logistic回归分析研究相关指标与缺血性脑卒中相关性,为患者早期预防提供诊断依据。绘制受试者工作特征(receiver operating characteristic,ROC)曲线分析超声FFI联合弹性成像技术预测缺血性脑卒中发生的临床价值。结果观察组和对照组在年龄、糖尿病史、心血管病史、吸烟史、体重指数(body mass index,BMI)、三酰甘油、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、肌酐、不稳定斑块方面的比较差异有统计学意义(P<0.05)。利用超声弹性成像技术测得观察组B/A比值、组织弹性评分低于对照组(P<0.05)。不稳定斑块组B/A值和组织弹性评分低于稳定斑块组(P<0.05)。观察组和对照组的斑块内新生血管分级比较差异有统计学意义(P<0.05),不稳定斑块组和稳定斑块组的斑块内新生血管分级比较差异有统计学意义(P<0.05)。B/A值(r=0.791,P<0.001)、弹性评分(r=0.773,P<0.001)与斑块稳定性呈正相关。斑块内新生血管分级(r=-0.270,P<0.001)与斑块的稳定性呈负相关。新生血管分级曲线下面积(area under curve,AUC)为0.674,敏感度为51.6%,特异度为75.9%;B/A值AUC为0.822,敏感度为77.4%,特异度为86.2%。两者联合后AUC为0.864,敏感度为80.6%,特异度为86.2%。结论超声高精细血流技术联合弹性成像技术通过评估斑块的稳定性可用于早期预测缺血性脑卒中发生风险,为临床医生早期采取干预措施提供诊断依据,减少缺血Objective To investigate the diagnostic value of Fine-Flow imaging(FFI)combined with ultrasound elastography(UE)for carotid plaque stability in stroke patients.Methods In total,200 patients with ischemic stroke were selected as the observation group,and 200 patients with carotid artery plaques were selected as the control group.Routine grayscale ultrasound was used to observe the characteristics of carotid artery plaques in all patients.FFI technology was used to detect neovascularization in carotid artery plaques,followed by grading of blood flow,and measurement of plaque elasticity parameters using elastography technology.The correlation between the characteristics of carotid artery plaques and ischemic stroke was analyzed and compared between the two groups.Logistic regression analysis was used to study the correlation between relevant indicators and ischemic stroke,providing diagnostic basis for early prevention of patients.Receiver operating characteristic(ROC)curve was drawn to analyze the clinical value of FFI combined with elastography in predicting the occurrence of ischemic stroke.Results There were significant differences between the observation group and the control group with respect to age,history of diabetes,history of cardiovascular disease,history of smoking,body mass index(BMI),triacylglycerol(TG),low-density lipoprotein cholesterol(LDL-C),creatinine(Cre),and unstable plaques(P<0.05).The ratio of region of interest B to region of interest A(B/A ratio)and tissue elasticity score of the observation group measured using ultrasound elastography technology were lower than those of the control group(P<0.05).The B/A ratio and tissue elasticity score in the unstable plaque group were lower than those in the stable plaque group(P<0.05).The difference in grading of intraplaque neovascularization between the observation group and the control group was statistically significant(P<0.05),while the difference in grading of intraplaque neovascularization between the unstable plaque group and the stable plaque g

关 键 词：缺血性卒中 高精细血流 颈动脉斑块 

分 类 号：R743.3[医药卫生—神经病学与精神病学]