声触诊组织成像与量化技术联合超声造影评级与缺血性脑梗死的相关性

The Correlation between Virtual Touch Tissue Imaging Quantification Combined with Contrast-enhanced Ultrasound and the Diagnosis of Ischemic Cerebral Infarction

目的研究声触诊组织成像与量化技术联合超声造影评级与缺血性脑梗死发生的相关性。方法选取本院神经内科住院的缺血性脑梗死患者97例和非脑梗死患者55例,进行颈动脉斑块声触诊组织成像与量化和超声造影检查,收集声触诊组织成像与量化的最大剪切波速度(SWVmax)、最小SWV(SWVmin)、平均SWV(SWVmean),超声造影结果分为0~4级,分别对声触诊组织成像与量化、超声造影及两者联合检查的结果进行分析,得出其与缺血性脑梗死的相关性。结果 (1)缺血性脑梗死组与非脑梗死组间比较,年龄、性别、颈动脉内-中膜厚度、斑块厚度及斑块回声差异均无统计学意义(均P>0.05)。(2)两组间SWVmax、SWVmin、SWVmean差异均有统计学意义(均P<0.01)。以临床诊断为金标准,绘制SWVmax、SWVmin、SWVmean的ROC曲线,曲线下面积分别为0.78、0.81、0.81。以SWVmean≤3.68m/s作为预测缺血性脑梗死的截断值,其敏感度为76.38%,特异度为55.71%,准确度66.44%。(3)超声造影评级在两组间比较有统计学意义(Z=-5.48,P<0.01)。以超声造影评级≥3为预测缺血性脑梗死的标准,其敏感度为84.12%,特异度为60.03%,准确度为73.04%。(4)以SWVmean≤3.68m/s及超声造影评级≥3为预测缺血性脑梗死的标准,其敏感度为92.51%,特异度为71.32%,准确度为79.78%。SWVmean、超声造影评级和缺血性脑梗死间存在高度线性相关(r=-0.78、0.82,均P<0.01)。结论声触诊组织成像与量化技术联合超声造影可以较全面地评价颈动脉斑块的易损性,为临床预测缺血性脑梗死提供了新的手段。

Objective To study the correlation between virtual touch tissue imaging quantification（ VTIQ） combined with contrast-enhanced ultrasound（ CEUS） and the diagnosis of ischemic cerebral infarction. Methods 97 cases with ischemic cerebral infarction and 55 cases with non-cerebral infarction were selected. All patients were under the examination of virtual touch tissue imaging quantification and contrast-enhanced ultrasound. The maximum Shear wave velocity（ SWVmax）,minimum SWV（ SWVmin）,mean SWV（ SWVmean） were collected,and the results of contrast-enhanced ultrasound were divided into 0 ~ 4 grade. The results of VTIQ,CEUS and the combined examination were analyzed respectively to obtain the correlation between it and ischemic cerebral infarction. Results（ 1） The age,gender,carotid intima-media thickness,plaque thickness and the echo between the ischemic cerebral infarction and cerebral infarction group were no significant difference（ P 0. 05）.（ 2） The differences of SWVmax,SWVmin,SWVmeanbetween the two groups had statistical significance（ P 0. 01）. With clinical diagnosis as the gold standard,the ROC curve of area under the SWVmax,SWVmin,SWVmeanwere 0. 78,0. 81,0. 81 respectively. With SWVmean≤3. 68 m/s as diagnostic criteria to predict the occurrence of ischemic cerebral infarction,the sensitivity was 76.38%,the specificity was 55. 71%,the accuracy was 66. 44%.（ 3） Contrast-enhanced ultrasound grade between the two groups had significant differences（ Z = 5. 48,P 0. 01）. Using the criterion of contrast-enhanced ultrasound grade ≥3 to predict the occurrence of ischemic cerebral infarction,its sensitivity,specificity and accuracy were 84. 12%,60. 03%,73. 04%.（ 4） Using the diagnostic criteria of SWVmean≤3. 68 m/s or the contrast-enhanced ultrasound grade ≥3 to predict the occurrence of ischemic cerebral infarction,its sensitivity,specificity and accuracy were 92. 51%,71. 32%,79. 78%. There was remarkable linear correlation between SWVmean,contrast-enhanced ultrasound grade and ischemic cerebral infarction（ r =-0. 78,0. 82,P 0. 01）. Conclusions The combined application of VTIQ and CEUS can comprehensively evaluate the vulnerability of carotid plaque,and provide a new means for clinical prediction of ischemic cerebral infarction.