超声评价颈动脉斑块纤维帽的价值

Value of ultrasound in assessing carotid atherosclerotic plaque fibrous cap

目的探讨超声评价颈动脉斑块纤维帽的价值。方法选取2010年11月至2012年10月首都医科大学附属北京安贞医院和中日友好医院行颈动脉内膜切除术（CEA）患者19例，回顾性分析患者的超声图像资料，与CEA术后病理结果进行对照分析。结果病理见斑块纤维帽完整11例，无纤维帽4例，纤维帽不完整4例。灰阶超声显示7例斑块表面纤维帽清晰，为细线样高回声弧形结构，超声对完整斑块纤维帽的识别率为63．6％（7／11）；4例斑块纤维帽结构不清晰，但未见明确破裂征象；8例斑块无明显纤维帽或纤维帽破裂（4例斑块纤维帽连续性中断，其中1例灰阶超声显示斑块内低无回声自中断处流入血管腔内，3例灰阶超声显示斑块表面可见凹陷，彩色多普勒超声见彩色血流通过破裂口进入斑块内）。结论超声检查可准确判断是否形成溃疡斑，可大致判断颈动脉斑块是否存在纤维帽，但对斑块纤维帽较薄或无纤维帽但斑块仍完整者不能准确分辨。

Objective To discuss the value of ultrasound in assessing carotid atherosclerotic plaque fibrous cap. Methods The ultrasonographic data of 19 cases with carotid atheroselerotic plaque from November 2010 to October 2012 were retrospectively analyzed and compared with the pathologic findings after carotid endarterectomy. Results Pathological results showed that the atherosclerotic plaque fibrous cap was intact in 11 cases and was incomplete in 4 cases, no atherosclerotic plaque fibrous cap was shown in the other 4 cases. Gray-scale ultrasound data was as followed： the atherosclerotic plaque fibrous cap was clearly shown in 7 cases, being line like homogeneous high echo with arc shape, the detected rate was 63.6% （7/11） ; the atherosclerotie plaque fibrous cap were unsharp in 4 cases, without clear broken signs; the atherosclerotic plaque fibrous cap was not observed or was local ruptured in 8 cases （the cap was discontinuoas in 4 cases, among them the low or non echo inside the plaque flowed into the vessel from the rupture in 1 case; the blood flowed into the plaques from the broken crack in 3 cases）. Conclusion Ultrasound can accurately identify the ulcer spots of atherosclerotic plaque or generally assess the atherosclerotic plaque fibrous cap; but it cannot accurately identify the atherosclerotic plaque with thin fibrous cap or complete atherosclerotic plaque without fibrous cap.