无创超声弹性成像与MRI诊断颈动脉易损斑块的价值分析

Clinical value of noninvasive ultrasound elastography and MRI in the diagnosis of carotid vulnerable plaque

目的探讨无创超声弹性成像与MRI诊断颈动脉易损斑块的临床价值。方法选取2017年1月至2018年6月诊断为颈动脉斑块并拟行颈动脉内膜剥脱术的患者60例为研究对象,依据检查方案分为对照组(行无创超声弹性成像检查)和观察组(行MRI检查),每组30例,以术后病理检查结果为金标准,比较两组颈动脉易损斑块的诊断效能、检测费用、效益、成本效益比、成本-增加的效果比。结果以病理检查结果为金标准,无创超声弹性成像诊断颈动脉易损斑块的敏感性为81.25%、特异性为71.43%、准确性为76.67%、阳性预测值为76.47%、阴性预测值为76.92%、Kappa值为0.767;MRI诊断颈动脉易损斑块的敏感性为93.75%、特异性为85.71%、准确性为90.00%、阳性预测值为88.24%、阴性预测值为92.31%、Kappa值为0.900;观察组检测费用显著高于对照组高,效益显著高于对照组(P均<0.05);观察组成本效益比显著高于对照组(P<0.05),无创超声弹性成像与MRI诊断颈动脉易损斑块的成本-增加的效果比>1。结论 MRI诊断颈动脉易损斑块的效能较无创超声弹性成像更高,但后者的操作更简便且经济性更高,无创超声弹性成像可作为基层医院患者诊断颈动脉易损斑块的经济有效手段。

Objective To investigate the clinical value of noninvasive ultrasound elastography and MRI in the diagnosis of carotid vulnerable plaque.Methods Sixty patients with carotid plaqueundergoing carotid endarterectomy from January 2017 to June 2018 were selected as research objects,they were divided into the control group(with non-invasive ultrasound elastography examination)and observation group(with MRI examination),with 30 patients in each group.Taking postoperative pathological examination results as the gold standard,the diagnostic efficacy,testing cost,benefit,cost-benefit ratios,cost-increased effect ratio of carotid vulnerable plaque in the two groups were compared.Results Taking pathological examination results as the gold standard,the sensitivity of noninvasive ultrasound elastography in the diagnosis of carotid vulnerable plaque was 81.25%,the specificity was 71.43%,the accuracy was 76.67%,the positive predictive value was 76.47%,the negative predictive value was 76.92%and the Kappa value was 0.767.The sensitivity of MRI in the diagnosis of carotid vulnerable plaque was 93.75%,the specificity was 85.71%,the accuracy was 90.00%,the positive predictive value was 88.24%,and the negative predictive value was 92.31%.The Kappa value was 0.900.The detection cost of the observation group was significantly higher than that of the control group,the benefit was significantly higher than that of the control group(P<0.05).The cost-benefit ratio of the observation group was significantly higher than that of the control group(P<0.05).The cost-increasing effect ratio for the diagnosis of carotid vulnerable plaque bynoninvasive ultrasound elastography and MRI was greater than 1.Conclusions MRI is more effective in the diagnosis of carotid vulnerable plaque than non-invasive ultrasound elastography,but the latter is easier to operate and more economical.Noninvasive ultrasound elastography can be used as aneconomically effective means for the diagnosis of carotid vulnerable plaque in primary hospital.