基于病理特征评价术前超声造影与高分率磁共振对颈动脉易损斑块的诊断价值  

Evaluation of the diagnostic value of preoperative contrast-enhanced ultrasound and high-resolution magnetic resonance imaging in carotid artery vulnerable plaques based on pathological features

作　　者：张丽丽[1] 曾宇琪 王佑玲 陈科岐 周大勇[2] 张逸莎 Zhang Lili;Zeng Yuqi;Wang Youling;Chen Keqi;Zhou Dayong;Zhang Yisha(Ultrasound Center,Affiliated Suzhou Hospital of Nanjing Medical University/Suzhou Municipal Hospital(Headquarters),Suzhou 215002,Jiangsu,China;Department of Vascular Surgery,Affiliated Suzhou Hospital of Nanjing Medical University/Suzhou Municipal Hospital(Headquarters),Suzhou 215002,Jiangsu,China)

机构地区：[1]南京医科大学附属苏州医院/苏州市立医院(本部)超声中心,江苏苏州215002 [2]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》2025年第1期17-21,25,共6页Journal of Vascular and Endovascular Surgery

基　　金：苏州市科技计划项目(SKY2022187)。

摘　　要：目的 通过术后斑块病理检查结果验证术前超声造影(CEUS)和高分辨率磁共振成像(HR-MRI)对颈动脉易损斑块的诊断价值。方法 选取2021年1月至2024年6月于南京医科大学附属苏州医院/苏州市立医院(本部)由颈动脉粥样硬化斑块导致中度、重度颈动脉狭窄并接受颈动脉内膜剥脱术治疗的32例患者,将手术所得的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。以术后病理检查结果为金标准,比较术前CEUS与HR-MRI对颈动脉易损斑块的诊断效能,评估两种影像学检查方法之间的一致性及其与病理检查结果的一致性,分析CEUS增强强度与每斑块面积的微血管密度(MVD)的相关性。结果 病理组织学切片结果显示,易损斑块25个,稳定斑块7个。以术后病理检查结果为金标准,CEUS诊断颈动脉易损斑块的灵敏度为92.0%(23/25),特异度为57.1%(4/7),准确度为84.4%(27/32),阳性预测值为88.5%(23/26),阴性预测值为66.7%(4/6)。HR-MRI诊断颈动脉易损斑块的灵敏度为92.0%(23/25),特异度为71.4%(5/7),准确度为87.5%(28/32),阳性预测值为92.0%(23/25),阴性预测值为71.4%(5/7)。CEUS检查与病理检查诊断颈动脉易损斑块的一致性中等,HR-MRI检查与病理检查结果的一致性较好,Kappa值分别为0.518和0.634(P<0.01)。CEUS与HR-MRI诊断颈动脉易损斑块的一致性中等,Kappa值为0.518(P<0.01)。CEUS分级的增加与每斑块面积的MVD呈正相关(P<0.01)。结论 CEUS和HR-MRI评估颈动脉斑块易损性具有较高的准确性,两种影像学方法在诊断效能方面具有良好的一致性。CEUS可有效检测斑块内新生血管,识别潜在的脑卒中风险,可以成为颈动脉斑块初步筛选评估有价值的临床工具。Objective To verify the accuracy of preoperative contrast-enhanced ultrasound(CEUS)and high-resolution magnetic resonance imaging(HR-MRI)in the diagnosis of carotid artery vulnerable plaques through postoperative plaque pathological results.Method A total of 32 patients with moderate or severe carotid artery stenosis caused by carotid atherosclerotic plaque in Affiliated Suzhou Hospital of Nanjing Medical University/Suzhou Municipal Hospital(Headquarters)from January 2021 to June 2024 who underwent carotid endarterectomy were selected,and the carotid artery plaques obtained from surgery were stained with hematoxylin-eosin(HE),Masson three-color staining and CD34 antibody staining,and the plaque components were analyzed to determine the stability of the plaque.Taking the postoperative plaque pathological results as the gold standard,the diagnostic efficacy of preoperative CEUS and HR-MRI for carotid artery vulnerable plaques was compared,and the consistency between two imaging examination methods and their consistency with pathological examination results were evaluated,and the correlation between CEUS enhancement intensity and total number of microvessel density(MVD)was analyzed.Result The histopathological section results showed 25 vulnerable plaques and 7 stable plaques.With postoperative plaque pathological results as the gold standard,the sensitivity of CEUS in diagnosing vulnerable carotid plaques was 92.0%(23/25),specificity was 57.1%(4/7),accuracy was 84.4%(27/32),positive predictive value was 88.5%(23/26),and negative predictive value was 66.7%(4/6).The sensitivity of HR-MRI in diagnosing vulnerable carotid plaques was 92.0%(23/25),specificity was 71.4%(5/7),accuracy was 87.5%(28/32),positive predictive value was 92.0%(23/25),and negative predictive value was 71.4%(5/7).The consistency between CEUS examination and pathological examination in diagnosing carotid artery vulnerable plaques is moderate,while the consistency between HR-MRI examination and pathological examination results is good,with Kappa valu

关 键 词：颈动脉狭窄 易损斑块 超声造影 高分辨率磁共振成像 斑块内新生血管 

分 类 号：R543[医药卫生—心血管疾病]