超声造影时间强度曲线技术预测颈动脉粥样硬化斑块新生血管的可行性分析

Analysis of the Feasibility of Forecasting the Neovascularization in Carotid Atherosclerosis Plaque by Time Gain Curve Technology of Ultrasonography Angiography

目的 通过超声造影检测颈动脉粥样硬化斑块,并利用时间强度曲线（TIC）预测斑块内新生血管.方法 回顾性分析笔者医院2011年1月～2014年1月内临床确诊为缺血性脑卒中的患者（由颅脑MRI确诊）,且颈动脉超声检查存在颈动脉斑块者47例作为脑卒中组（斑块为软斑,最厚达2.5mm,符合造影条件）,对其造影动态图进行TIC曲线分析.另采集临床无缺血性脑卒中的患者50例作为对照组,也进行TIC曲线分析.结果 筛选出47个斑块的完整造影资料作为研究对象,其中1例保留了病理资料,该患者颈动脉斑块造影显示斑块内部呈斑片状增强,以肩部为主.TIC曲线显示有一明显的波峰区段,峰值强度（peak）、曲线下面积（AUC）较高,达峰时间（TP）较短,病理结果提示该患者斑块内血管CD34染色阳性.再比较脑卒中组和对照组患者超声造影TIC曲线,发现脑卒中组的Peak（68.74±7.81）和AUC（2573.53±420.82）显著高于对照组（55.02±7.08 vs1799.03±393.89）,而TP值（16.85±2.23）显著低于对照组（20.04±2.52）,差异均有统计学意义（P＜0.05）.结论 颈动脉斑块超声造影TIC曲线有望成为预测颈动脉粥样硬化斑块稳定性的有效工具.

Objective To detect the carotid atherosclerotie plaque by ultrasonography angiography, and to forecast the neovascular- ization in carotid atherosclerotic plaque by time gain curve. Methods Retrospective analysis was performed with 47 patients diagnosed as stroke in clinical in our hospital from January 2011 to January 2014. Patients with plaque rupture and 50 patients with no plaque rupture were analyzed by the TIC. Results Forty - seven CEUS recordings were collected in this study, and the pathological data of one case was preserved. The ultrasound contrast of the plaque showed that patchy enhancement was occurred inside the plaque （in the shoulder area mainly）. The TIC showed that there was a distinct peak section. Meanwhile, the peak intensity and area under the curve （AUC） was higher, but the peak time （TP） was short. Pathology result suggested that the vascular plaque was positive by CD34. Compared with the control group, the peak value （68.74 ± 7.81 ） and AUC （2573.53 ± 420.82） of TIC was much higher （ control group： peak value 55.02±7.08, 1799.03 ± 393.89） in patients of the stroke group and the peak time（ 16.85 ± 2.23 ）were much lower （control group： 20.04± 2.52）. The differences were statistically significant （P 〈 0.05）. Conclusion The TIC of ultrasonography angiography is expec- ted to be an effective tool to predict the stability of the carotid atheroselerotic plaque.