超声实时组织弹性成像诊断颈动脉易损斑块

Real-time tissue elastography in diagnosis of carotid vulnerable plaque

目的探讨超声实时组织弹性成像(RTE)技术对颈动脉易损斑块的诊断价值。方法选取缺血性脑血管病患者60例,对颈动脉斑块进行超声弹性成像;采用Itoh 5分法对斑块RTE图像进行评分,并与颈动脉内膜切除术(CEA)术后病理学检查进行对照分析。结果超声弹性图彩色编码显示斑块脂质坏死核心为绿色,纤维为蓝色,钙化为蓝白色,出血/血栓为绿色、红绿色相间、蓝绿色相间。60例中,纤维斑块12例,粥样斑块24例,斑块内出血/血栓9例,复杂斑块15例。弹性成像诊断易损斑块的敏感度、特异度、准确率分别为93.75%(45/48)、83.33%(10/12)、91.67%(55/60),阳性预测值、阴性预测值分别为95.74%(45/47)、76.92%(10/13),阳性似然比、阴性似然比分别为5.62、0.075。结论超声弹性成像技术对颈动脉易损斑块有较好的诊断价值。

Objective To observe the value of real-time tissue elastography （RTE） in diagnosis of carotid vulnerable plaque. Methods Sixty patients with ischemic cerebrovascular diseases were enrolled. RTE images of plaque were esti- mated according Itob＇s 5-point scale. After carotid endarterectomy （CEA）, the plaques were examinated pathologically, and the results of RTE were compared with those of pathological examination. Results On ultrasonic efastogram, lipid necrotic core of plaque were green, fibers were blue, calcifications were blue and white, hemorrhage/thrombi were green, red green alternating or blue green alternating. Fibrous plaque, atheromatous plaque, plaque hemorrhage/thrombus and complicated plaque were in 12, 24, 9 and 15 cases, respectively. The sensitivity, specificity and accuracy of elastographic diagnosis for vulnerable plaques was 93.75% （45/48）, 83.33% （10/12）, 91.67% （55/60）, positive predictive value and negative pre- dictive value was 95.74% （45/47） and 76.92% （10/la）, while positive likelihood ratio and negatiive likelihood ratios was 5.62 and 0.07S, respectively. Conclusion RTE technique has good diagnostic value for carotid vulnerable plaques.