超声联合多层螺旋CT血管成像对颈部动脉溃疡斑块的诊断价值

Value of Ultrasound and Multi-slice Spiral CT in the Detection of Carotid Plaque Ulceration

目的探讨超声及多层螺旋CT血管成像（MSCTA）对颈部动脉溃疡斑块的诊断价值。方法选择2010~2014年于我院进行颈部超声检查和MSCTA检查的400例颈动脉斑块患者,比较溃疡斑块的发生率、颈动脉狭窄程度、不同部位溃疡斑块的检出情况及颈动脉斑块与脑缺血的关系。结果超声和MSCTA分别发现85处及142处溃疡斑块,两种检查方法对颈部溃疡斑块的检出率具统计学差异（P〈0.05）;超声和MSCTA分别发现707及719处非溃疡斑块,两种检查对非溃疡斑块的检出率无统计学差异。两种检查方法对颈动脉狭窄程度（轻度、中度、重度）的检出率无统计学差异（P〉0.05）,对3个不同部位（颈总动脉、颈总动脉分叉处、颈内动脉颅外段）溃疡斑块的检出率有统计学差异（P〈0.01）;溃疡斑块与脑缺血症状存在统计学关联（P〈0.05）。结论溃疡斑块是引起缺血性脑卒中的危险因素,MSCTA显示溃疡斑块较超声好,超声应作为颈动脉血管的首选检查手段,如有血管病变应进一步行MSCTA检查。

Objective To explore the diagnostic value of ultrasonography（US） and multi-slice spiral computed tomography angiography（MSCTA） in the evaluation of carotid plaque ulceration. Methods A total of 400 patients underwent CDFI and MSCTA examination during 2010 and 2014 were analyzed. The incidence rate of ulceration was compared. The carotid artery narrowing degree was observed. The positional distribution and composition of the carotid plaque, as well as the correlation between plaque ulceration in carotid arteries and the symptoms of cerebral ischemia, were studied. Results US and MSCTA respectively detected 85 and 142 plaques, the difference of plaque ulceration detection rates between US and MSCTA was statistically significant（P〈0.05）. US and MSCTA respectively detected 707 and 719 plaques without ulceration, the difference of non-ulcerous plaque detection rate between US and MSCTA was not statistically significant. Ultrasound and MSCTA has a good consistency for the evaluation of carotid artery stenosis（mild, moderate, and severe） and was not statistically significant（P〈0.05）. The plaque ulceration detection rates of the two methods in the examination of the three positional distribution have statistical difference（P〈0.01）.Plaque ulceration was statistically associated with symptomatic ischemic events（P〈0.05）. Conclusion Plaque ulceration is a risk factor of the development of cerebral ischemia. MSCTA can display carotid plaque ulceration more clearly than US. US can be used as the first choice of the carotid artery imaging, whereas MSCTA should be followed if vascular lesion found with US.