颈动脉蹼的超声表现多样性与病理对照研究

A study on the diversity ultrasonographic manifestations of carotid web:compared with histopathology

目的与病理进行对照,观察并总结颈动脉蹼的长度、厚度、回声,凸向管腔内的走行方向及颈动脉蹼伴斑块或血栓形成的声像图特征等,减少漏诊及误诊。方法2018年6月至2019年5月,首都医科大学附属北京天坛医院拟行颈动脉内膜剥脱术的患者,术前行超声检查。常规超声观察并记录颈动脉狭窄处声像图表现,明确是否存在颈动脉蹼,如存在颈动脉蹼样结构,观察其周围是否合并斑块及血栓形成,测量并记录颈动脉蹼回声、长度、厚度及走行方向,有无飘动,术后进行病理对照。结果146例颈动脉内膜剥脱术患者,术后病理证实颈动脉蹼19例,其中17例颈动脉蹼底部伴斑块形成,2例颈动脉蹼伴血栓形成,其中1例血栓完全阻塞管腔,1例致管腔狭窄。与病理进行对照,术前超声正确诊断颈动脉蹼伴斑块形成16例,颈动脉蹼伴血栓形成1例,术前1例误诊为斑块表面溃疡形成,1例颈动脉蹼伴血栓形成并完全阻塞管腔漏诊,超声诊断为颈内动脉闭塞,未发现颈动脉蹼结构。结论超声检查颈动脉蹼合并斑块或血栓形成准确率高,但需要高度认识本病及充分了解本病的大体标本及组织病理情况方能做出正确诊断。

Objective To observe the features of carotid web with plaque or thrombosis by ultrasound,compared with histopathology,in order to reduce missed diagnosis and misdiagnosis.Methods From June 2018 to may 2019,146 patients were enrolled who underwent carotid endarterectomy and preoperatively ultrasound examination in our hospital.The image of carotid artery stenosis was scanned and observed carefully to confirm the carotid web.If a carotid web structure was confirmed,associated plaques or thrombosis around was verified and measured.The echo characteristics,length,thickness and direction in the lumen,and floating in the carotid artery were recorded.Postoperative pathological analysis was performed.Results Postoperative pathology confirmed 19 cases of carotid web,17 cases of which associated with atherosclerosis plaque and 2 cases with thrombosis.In these 2 cases,the lumen in one case was occluded,and the other case resulted in lumen stenosis.Compared with pathology,16 cases of carotid artery web with plaque formation and 1 case of carotid artery web with thrombosis were correctly diagnosed by ultrasound before surgery,1 case was misdiagnosed as plaque surface ulceration before surgery,and 1 case was missed diagnosed as the internal carotid artery occlusion due to the carotid web missed.Conclusion Ultrasound examination of carotid web with plaque or thrombosis has a high accuracy rate,but it is necessary to understand the disease,the gross specimen and histopathology before making a correct diagnosis.