超微血管成像背景下超声造影检测颈动脉斑块内新生血管的应用价值

Application of contrast-enhanced ultrasound combined with superb micro-vascular imaging for detecting neovascularization in carotid artery plaques

目的评估超微血管成像(SMI)背景下超声造影(CEUS)检测颈动脉斑块内新生血管的应用价值。方法随机抽取2017年9月至2018年9月于郑州大学第一附属医院就诊的颈动脉粥样硬化患者135例(斑块230个),其中低回声斑块190个,以低回声为主的混合回声斑块40个。应用常规超声观察颈动脉,记录目标斑块的位置、厚度,并根据斑块厚度分类:1.5~2.4 mm,2.5~3.4 mm,≥3.5 mm。然后对斑块行单用SMI、CEUS及SMI背景下CEUS(CEUS联合SMI模式)检查,记录斑块内新生血管的血流信息并保存图像。评估三种方法检测不同厚度颈动脉斑块内新生血管结果的一致性。结果230个斑块中,厚度1.5~2.4 mm斑块73个,2.5~3.4 mm斑块77个,≥3.5 mm斑块80个。单用SMI、CEUS及CEUS联合SMI模式检测斑块内新生血管分级结果Kappa值均>0,但单用SMI与CEUS联合SMI模式检测1.5~2.4 mm斑块内新生血管暂不能确定具有一致性(P>0.05)。CEUS与SMI检测斑块内新生血管分级结果一致性,Kappa值=0.314(>0,但<0.5);单用CEUS与CEUS联合SMI模式检测斑块内新生血管分级结果一致性,Kappa值=0.664(>0,且>0.5)。CEUS联合SMI模式较单用SMI或CEUS可以检测到斑块内更多的新生血管,差异有统计学意义(χ2=102.058,P<0.001;χ2=8.363,P=0.039)。结论单用CEUS与CEUS联合SMI模式检测颈动脉斑块内新生血管的一致性较好,且CEUS联合SMI模式相比单用SMI或CEUS,可提高斑块内新生血管的检出率。

Objective To evaluate the application value of contrast-enhanced ultrasound (CEUS) combined with superb micro-vascular imaging (SMI) for detecting neovascularization in carotid artery plaques.Methods A total of 135 patients with carotid arteries arteriosclerosis (230 plaques) were collected from the First Affiliated Hospital of Zhengzhou University from September 2017 to September 2018, which including 190 hypoechoic plaques and 40 mainly hypoechoic-oriented heterogeneous plaques. The carotid artery was observed by conventional ultrasound, and the position and thickness of the target plaque were recorded and classified according to the plaque thickness: 1.5 to 2.4 mm, 2.5 to 3.4 mm, and ≥3.5 mm. Then, the plaques was examined with SMI, CEUS and combination of two methods, and the blood flow information of the new blood vessels in the plaque was recorded and the image was saved. The consistencies of the three methods in dectecting neovascularization in carotid plaques of different thicknesses were evaluated.Results Of the 230 plaques, 73 were 1.5 to 2.4 mm thick, 77 were 2.5 to 3.4 mm, and 80 were ≥3.5 mm. The Kappa values for consistencies of SMI, CEUS, and CEUS combined with SMI mode in detecting angiographic grading in plaques were all >0. While there was no certainty of consistency in 1.5 to 2.4 mm group between SMI and CEUS combined with SMI(P>0.05). Kappa value for consistency of CEUS and SMI in the detection of angiographic grading results in plaques was 0.314 (>0, but <0.5);the Kappa value for the consistency of CEUS and CEUS combined with SMI mode in detecting angiographic results in plaques was 0.664 (>0, and >0.5). CEUS combined with SMI mode could detect more neovascularization in plaque than SMI or CEUS alone, the difference was significant (χ2=102.058, P<0.001;χ2=8.363, P=0.03).Conclusions CEUS and CEUS combined with SMI have good consistency in detecting neovascularization in carotid artery plaques. Furthermore, CEUS combined with SMI can obviously improve the detection rate of neovascularization in plaques which compared with SMI or CEUS.