多层螺旋CT和彩色多普勒超声评价脑梗死患者颈动脉斑块

Multi-slice spiral CT and CDFI evaluation of carotid artery atherosclerostic plaques in patients with cerebral infarction

目的探讨多层螺旋CT血管成像(MSCTA)与彩色多普勒血流显像(CDFI)在评价脑梗死患者颈动脉粥样硬化病变中的价值。方法对195例脑梗死患者在7天内行颈动脉CDFI和MSCTA检查。分别对颈动脉分叉部内-中膜厚度(IMT)/管壁厚度(CAWT)、斑块表面形态学特征、密度、体积进行分析,将病变分为管壁增厚、稳定斑块和易损斑块。结果 195例患者390处颈动脉分叉部血管纳入分析。MSCTA:正常血管71处(18.21%);CAWT增厚87处(22.31%);斑块232处(59.49%),其中稳定斑块140处(35.90%),易损斑块92处(23.59%)(包括溃疡型斑块5处)。CDFI:正常血管80处(20.51%);IMT增厚86处(22.05%);斑块224处(57.44%),其中稳定斑块136处(34.87%),易损斑块88处(22.56%)(包括溃疡型斑块4处)。MSCTA与CDFI对脑梗死患者颈动脉粥样硬化病变评价的一致性为72.60%(Kappa=0.63,P<0.05)。结论 MSCTA与CDFI对评价脑梗死患者颈动脉粥样硬化病变具有较好的一致性。颈动脉CDFI应作为首选检查,经CDFI检查存在血管病变者应常规接受MSCTA检查。

Objective To explore the value of multi-slice spiral computed tomography angiography （MSCTA） and color Doppler flow imaging （CDFI） in evaluation of carotid artery atherosclerostic plaques in patients with cerebral infarction. Methods Totally 195 consecutive patients with cerebral infarction were enrolled. All patients underwent examinations of carotid artery with both MSCTA and CDFI within 7 days. Intima-media thickness （IMT）/carotid artery wall thickness （CAWT）,and the surface morphology,density,volume of the atherosclerotic plaques were analyzed. The results were divided into 4 types including normal,IMT/CAWT thickening,stable plaque and vulnerable plaque. Results A total of 390 carotid arteries were analyzed. MSCTA showed 71 （18.21%） normal,87 （22.31%） CAWT thickeningm 232 （59.49%） plaques including 140 （35.90%） stable plaques and 92 （23.59%） vulnerable plaques （ulcerated of 5）. CDFI showed 80 （20.51%） normal,86 （22.05%） IMT thickening,224 （57.44%） plaques including 136 （34.87%） stable plaques and 88 （22.56%） vulnerable plaques （ulcerated of 4）. The overall concordance of morphology characteristic of carotid artery between both MSCTA and CDFI was 72.60% （Kappa=0.63,P0.05）. Conclusion MSCTA has good agreement with CDFI in assessing carotid atherosclerosis in patients with cerebral infarction. CDFI can be used as the first choice of the carotid artery imaging,while MSCTA should be routine examination in patients with vascular lesion found with CDFI.