血管内超声在颈动脉粥样硬化研究中的应用——与血管造影和组织病理学的比较研究

Application of Intravascular Ultrasound in Carotid Atherosclerosis——Correlation with DSA and Histopathologic Findings

目的对离体颈动脉分别进行血管内超声(intravascular ultrasound,IVUS)与数字减影血管造影(digital subtractive angiography,DSA)以及组织病理学检查,将结果进行比对分析,探索IVUS在颈动脉狭窄诊断中的应用价值。方法采用国人尸体离体颅外段颈动脉共14根,连接于脉冲泵闭合环路循环系统,分别进行IVUS、DSA和组织病理学检查,测量血管管径、观察血管壁情况,并将结果进行比对分析。结果14根血管共42幅IVUS血管横断面图像和42张相对应部位血管的石蜡切片分析,IVUS共检测出15个粥样硬化斑块与组织病理检查相符合,1个IVUS怀疑为溃疡性斑块,病理检查为血栓附壁无明显斑块,IVUS检测斑块的灵敏度为88%,特异度为96%。而DSA诊断颈动脉轻度粥样硬化的灵敏度为47%。IVUS、DSA和组织病理学测量血管管径经相关分析,三者的测得值具有相关性。结论IVUS能清晰地显示颈动脉粥样硬化性质,精确地测量血管管径、狭窄程度和长度,特别是在病变早期,这在DSA影像中往往不易察觉,IVUS弥补了DSA的不足。

Objective To compare intravascular ultrasound(IVUS) with digital subtractive angiography(DSA) and histopathologic findings of the carotid artery in vitro, and evaluate the role of IVUS in the diagnosis and treatment of carotid atherosclerotic disease. Methods 14 cervical carotid arteries were obtained in 7 cadavers. The vessel specimen was connected to the closed tubing system and continuously infused by 40% glycerin. DSA and IVUS were performed during infusion. Pathological examination was done, and statistical analysis were ensued. Results In the 14 cadaver carotid artery specimen, 42 pictures of IVUS were obtained and at the same 42 location, pathological examination were also done. In IVUS, 15 cases of atherosclerosis were detected, which was compatible with pathological examination. Ulcerative plaque was suspected in one case during IVUS examination, but no obvious abnormality was detected by pathological examination. The sensitivity and specifi city of IVUS were 88% and 96% respectively. While in DSA examination, the sensitivity of mild atherosclerosis was only 47%. In the measurement of vascular diameter, there were no significantly statistical difference between DSA, IVUS and pathological examination. Conclusion IVUS can clearly show the characteristics of atherosclerosis of carotid artery, it can provide precise measurement of vascular diameter, severity and length of stenosis. As detecting early carotid atherosclerotic disease, IVUS is a very useful supplement while compared with DSA.