超微血管成像技术检测颈动脉斑块新生血管的临床价值

Superb microvascular imaging in detecting neovascularization of carotid plaques

目的探讨超声超微血管成像(superb microvascular imaging, SMI)技术在评价颈动脉粥样硬化斑块内新生血管中的临床价值。方法 43例颈动脉粥样硬化斑块患者,均行SMI和超声造影(contrast-enhanced ultrasonography, CEUS)检查。以CEUS检查结果为标准,计算SMI检测斑块内新生血管的灵敏度、特异度和准确率,采用Kappa检验分析SMI和CEUS检出斑块内新生血管判断的一致性及对斑块内新生血管分级判断的一致性,采用Spearman秩相关分析SMI和CEUS检查斑块内新生血管分级与斑块厚度的相关性。结果 43例患者SMI共检出60个斑块,厚度1.5~5.6(3.4±1.0)mm,其中低回声斑块27个,低回声为主混合回声斑块33个;SMI检出斑块内新生血管的灵敏度为94.5%,特异度为80.0%,准确率为93.3%;SMI和CEUS检出斑块内新生血管的一致性及对斑块内新生血管分级判断的一致性均较好(Kappa=0.63,P<0.001;Kappa=0.65,P<0.001);SMI和CEUS检查斑块内新生血管分级分别与斑块厚度呈正相关(rs=0.68,P<0.001;rs=0.69,P<0.001)。结论 SMI可作为斑块内新生血管的可靠检测方法,在评价斑块内新生血管及评估斑块稳定性方面有一定价值。

Objective To explore the application of ultrasound superb microvascular imaging(SMI) in evaluating atherosclerotic plaque neovascularization. Methods Forty-three patients with carotid atherosclerotic plaque were examined by SMI and contrast-enhanced ultrasonography(CEUS) at the same time. The sensitivity, specificity and accuracy of SMI on detecting intraplaque neovascularization were calculated according to the results of CEUS. Kappa test was used to analyze the consistency of SMI and CEUS in evaluating intraplaque neovascularization and the consistency of classification of intraplaque neovascularization. Spearman rank correlation test was adopted to analyze the correlation between neovascularization degree and plaque thickness. Results SMI revealed 60 plaques in 43 patients, 1.5 to 5.6(3.4±1.0) mm in thickness, including 27 hypoechoic plaques and 33 hypoechoic mixed echo plaques. The sensitivity, specificity and accuracy of SMI for intraplaque neovascularization were 94.5%, 80.0% and 93.3%, respectively. SMI was quite consistent with CEUS in detecting intraplaque neovascularization(Kappa=0.63, P<0.001) and neovascularization degree(Kappa=0.65, P<0.001). The intraplaque neovascularization degrees detected by SMI and CEUS were positively correlated with the plaque thickness(rs=0.68, P<0.001;rs=0.69, P<0.001). Conclusion SMI can be used as a reliable detection method for intraplaque neovascularization. It has high a clinical value in evaluating intraplaque neovascularization and the plaque stability.