超声造影在颈动脉不同性质斑块评价中的应用价值

The value of contrast-enhanced ultrasound in the evaluation of different nature of carotid artery plaques

目的利用超声造影评估颈动脉不同性质斑块中新生血管形成的密度,探讨其应用价值。方法回顾性分析2016年1月至2018年12月南京中医药大学附属医院87例颈动脉斑块患者的临床资料,常规超声检测后超声造影(CEUS)检测,对斑块内新生血管进行分级和定量评估。结果 87例颈动脉粥样硬化患者,共102个斑块,其中46例为软斑块,42例为混合斑块,14例为硬斑块,超声造影能明确显示斑块纤维帽连续性,并且发现常规超声易漏诊的斑块溃疡。软斑、混合斑和硬斑造影增强比例分别为95.7%、88.1%和50.0%,斑块回声越低,超声造影增强越明显,不同性质颈动脉斑块超声造影增强分级的分布差异有统计学意义(Z=13.657,P=0.001)。超声造影增强定量分析软斑与混合斑测值相较,软斑达峰时间更短[(21.84±7.85) s vs (29.71±13.75) s],造影峰值强度更高[(5.81±2.43) d B vs (4.01±2.54) d B],差异均有统计学意义(P<0.05)。结论超声造影可定量评估颈动脉斑块内新生血管的形成情况,用于临床评估脑血管的潜在风险,也为临床疗效评价提供了准确可重复的检测方法。

Objective To investigate the value of contrast-enhanced ultrasonography(CEUS) in the evaluation of neovascular density in plaques with different carotid atherosclerosis.Methods Patients with carotid plaques were observed by conventional ultrasound from January 2016 to December 2018.The CEUS test was used to grade and quantify the new blood vessels in the plaque.Results Among 87 patients with a total of 102 plaques,46,42,and 14 cases were soft plaques,mixed plaques,and hard plaques,respectively.CEUS clearly showed the continuity of plaque fibrous caps and found plaque ulcers that were easily missed by conventional ultrasound.The enhancement percentages of soft plaques,mixed plaques and hard plaques were 95.7%,88.1% and 50.0%,respectively.The lower the echo of the plaque,the more obvious contrast was enhanced in the plaques.The difference of hierarchical distribution of the contrast-enhanced carotid plaque was statistically significant(Z=13.657,P=0.001).Quantitative analysis of CEUS showed the peak time of soft plaques was shorter [(21.84±7.85) s vs(29.71±13.75) s]and the peak intensity of soft plaques was higher[(5.81±2.43) d Bvs(4.01±2.54) d B],compared with mixed plaques.The difference were statistically significant(P<0.05).Conclusion Contrast-enhanced ultrasonography can quantitatively evaluate the formation of neovascularization in plaque.It can be used for clinical evaluation of potential cerebrovascular risk and also provides an accurate and reproducible detection method for clinical efficacy evaluation.