颈动脉硬化斑块及其新生血管的超声造影研究

Study on feature of neovascularization within carotid atherosclerotic plaques with contrast-enhanced ultrasonography

目的探讨实时超声造影技术检测颈动脉硬化斑块及其内部新生血管的超声造影特征。方法 53例颈动脉粥样硬化患者行颈动脉、椎动脉常规检查及超声造影检查,其中对49个粥样硬化斑块行超声造影,观察超声造影时管腔狭窄程度及斑块造影增强模式,分析斑块内新生血管的超声造影表现与斑块回声之间的关系。结果在超声造影过程中清晰显示中内膜厚度并显示出常规超声未发现的9个斑块;对于诊断颈动脉、椎动脉重度狭窄和闭塞,常规超声与超声造影间、常规超声与DSA间均有统计学差异(P<0.05)。49个斑块中有35个超声造影表现为弱增强,增强模式以自外膜向中心增强为主,占54%(19/35),其中低回声斑块占53%(10/19);其次是自内膜及外膜向中心增强,占31%(11/35);自内膜向中心增强最少,占14%(5/35)。低回声斑块、等回声斑块、混合回声斑块组增强率分别为93%、71%、81%,明显高于高回声斑块组27%(P<0.05)。结论超声造影提高了颈动脉斑块显示率,有助于判断颈动脉狭窄程度,可敏感地显示斑块动态增强形式,并能够显示斑块内新生血管特征,评估斑块的稳定性,为临床治疗及评价预后提供了有效方法。

Objective To explore the feature of neovascularization within carotid atherosclerotic plaques by real-time contrast-enhanced ultrasonography .Methods 53 patients with carotid arterial angiosclerosis were examined by routine ultrasonography.Then 49 carotid atherosclerotic plaques with contrast-enhanced ultrasonography（CEUS）. Imaging performance of the degree of carotid arterial stenosis and contrast enhancement mode were observed and evaluated.To analyze the relationships of the neovascularization enhancement feature with plaque echogenicity . Results 9 plaques were found and the intima-media thickness was displayed more clearly after injection contrast agent.There were significantly different between routine ultrasonography with CEUS and DSA to diagnose severe stenosis and obliteration （ P 〈0.05 ） .35 of 49 carotid atherosclerotic plaques were enhanced poorly in contrast-enhanced ultrasonography ,19 plaques of them enhanced from periphery to the center of plaques about 54%.Low level echo plaques to occupy 53% in them.31% were enhanced from intima and extima to the center of plaques .Only 14%plaques enhanced from intima to the center .The enhancement rate of low ,equal ,mixed echo group were 93%, 71%,81%, which enhanced intensity more than high echo group （ P 〈0.05 ） .Conclusion Contrast-enhanced ultrasound imaging can increase the presentation rate of carotid plaques and revealed the feature of neovascularization ,which is help for appraising the carotid artery stenosis .To provide valuable informations of plaque risk stratification and modus operandi to clinical .