超声造影与磁共振增强血管成像在诊断颈动脉斑块特性方面的价值比较

Application of contrast enhanced ultrasound in the diagnosis of carotid plaque characteristics：comparison with magnetic resonance angiography

目的分别应用超声造影（cEuS）和磁共振增强血管成像（CEMRA）评价颈动脉斑块的特性，并对其价值进行比较。方法对46例（48个斑块）行颈动脉内膜剥脱术的患者术前行颈动脉CEUS和CEMRA检查，观察斑块的表面光滑情况、有无钙化、内部成分是否均一，测定直径狭窄率，分别以病理结果和数字减影血管造影（DSA）检查为金标准，比较CEUS参数和CEMRA检查在判断斑块特性方面的价值。结果48个斑块中有42个易损斑块，6个稳定斑块，CEUS和CEMRA正确诊断47个颈动脉斑块的特性，误诊1个，两者在整体评价斑块易损性方面的敏感性、特异性、准确性方面差异均无统计学意义（P〉0．05）；以病理结果为金标准，CEUS和CEMRA在诊断斑块表面光滑情况的敏感性、特异性、准确性差异均无统计学意义（P〉0．05）；CEUS诊断斑块表面有无钙化的敏感性、特异性和准确性高于CEMRA，差异均有统计学意义（P均〈0．05）；CEUS和CEMRA在诊断斑块内部成分均匀性方面的特异性和准确性差异有统计学意义（P〈0．05），而敏感性方面差异无统计学意义（P〉0．05）。以DsA检查结果为金标准，CEUs诊断颈动脉管腔狭窄程度方面的准确性为97．92％（47／48），CEMRA检查的准确性为100％（48／48），两组间比较差异无统计学意义（P〉0．05）。结论CEUS和CEMRA在评价颈动脉斑块特性方面各有优势，两者互补性强，两种方法结合有利于对斑块特性进行系统性评估。

Objective To compare the application value of contrast enhanced ultrasound （CEUS） and contrast enhanced magnetic resonance angiography （CEMRA） in the diagnosis of carotid plaque characteristics. Methods Fourty-six patients （48 carotid plaques） were performed with carotid CEUS and CEMRA examination prior to carotid endarterectomy. The following characteristics of plaque including the surface of the plaque, the presence of calcification, the internal composition and the diameter stenosis were observed and measured, which were compared with pathologic and digital subtraction angiography（DSA） results. Results There were 42 vulnerable plaques and 6 stable plaques in the 48 plaques. Fourty-seven carotid plaques had been correctly diagnosed by CEUS and CEMRA, and one plaque had been misdiagnosed. The sensitivity, specificity and accuracy between CEUS and CEMRA had no obvious differences in terms of the overall evaluation of plaque vulnerability （ P 〉 0.05） ; CEUS and CEMRA in the diagnosion of the plaque surface situation had no statistical difference in terms of sensitivity, specificity and accuracy compared with pathological results（ P〉0.05） ;There was no significant difference in diagnostic accuracy rate between two modalities （ P 〈0.05） ; In the diagnosis of plaque internal composition, they had statistically differences in terms of specificity and accuracy （ P 〈0.05）, while sensitivity had no obvious difference （ P 〉0.05）. With DSA examination results as the gold standard, the accuracy of CEUS in the diagnosis of the diameter stenosis was 97. 92%（47/48）, CEMRA was 100% （48/48）, they had no significant difference between two groups （ P 〉 0.05）. Conclusions CEUS and CEMRA in carotid plaques characteristic evaluation haverespective advantages, are highly complementary, and combining two methods can systematically evaluate for plaque characteristics.