超声造影与常规超声评估颈动脉粥样斑块不稳定性的价值

Value of contrast-enhanced ultrasound and conventional ultrasound in the evaluation of carotid atherosclerotic plaque instability

目的比较超声造影与常规超声对颈动脉粥样斑块不稳定性的评估价值。方法选取2016年9月至2019年8月在宜宾市第二人民医院经数字减影血管造影(DSA)检查为颈动脉不稳定性粥样斑块,拟行颈动脉内膜剥脱术(CEA)的80例患者(共122个斑块)作为研究对象,术前分别行常规超声及超声造影检查,以手术及病理证实为标准,比较两种检查方法的的诊断效能。结果超声造影与常规超声对斑块内部回声、表面形态、斑块内新血管形成的评估一致性均较差;超声造影对斑块内部回声检出不均匀型96个、均匀型26个,常规超声检出不均匀型22个,均匀型100个,差异有显著统计学意义(Kappa=0.263,P<0.01);超声造影对斑块表面形态检出表面不规则型及溃疡型102个、表面规则型20个,常规超声检出表面不规则型及溃疡型48个、表面规则型74个,差异有显著统计学意义(Kappa=0.311,P<0.01);超声造影对斑块内部新生血管形成检出1~3级血流119个、0级血流3个,常规超声检出1~3级血流36个、0级血流86个,差异有显著统计学意义(Kappa=0.006,P<0.01)。结论超声造影较常规超声对判断颈动脉粥样斑块内部出血、表面溃疡及新生血管形成情况存在明显优势,超声造影对颈动脉不稳定性粥样斑块的术前诊断及为临床治疗方案的选择具有明确的指导作用。

Objective To compare the value of contrast-enhanced ultrasound and conventional ultrasound in the evaluation of carotid atherosclerotic plaque instability.Methods Eighty patients(a total of 122 plaques)with unstable carotid atherosclerotic plaques examined by digital subtraction angiography(DSA)in the Second People's Hospital of Yibin from September 2016 to August 2019,who were scheduled to undergo carotid endarterectomy(CEA),were selected as subjects.Conventional ultrasound and contrast-enhanced ultrasonography were performed before operation,and the diagnostic efficacy of the two methods was compared according to the confirmation of operation and pathology.Results Contrast-enhanced ultrasound and conventional ultrasound examination revealed different results in the evaluation of echo within the plaque,plague surface morphology,and neovascularization in the plaque.Contrast enhanced ultrasound detected 96 plaques with heterogeneous type and 26 homogeneous type,while conventional ultrasound detected 22 plaques with heterogeneous type and 100 homogeneous type,with statistically significant difference(Kappa=0.263,P<0.01).Contrast-enhanced ultrasound detected 102 plaques with surface irregularity and ulceration and 20 smooth surface regularity,while conventional ultrasound detected 48 plaques with surface irregularity and ulceration and 74 smooth surface regularity,with statistically significant difference(Kappa=0.311,P<0.01).Contrast-enhanced ultrasound detected 119 plaques with level 1~3 blood flow and 3 level 0 blood flow,while conventional ultrasound detected 36 plaques with level 1~3 blood flow and 86 level 0 blood flow,with statistically significant difference(Kappa=0.006,P<0.01).Conclusion Contrast-enhanced ultrasound has obvious advantages over conventional ultrasound in judging internal bleeding,surface ulcer,and neovascularization of carotid atherosclerotic plaque.Contrast-enhanced ultrasound has high accuracy in the preoperative diagnosis of unstable carotid atherosclerotic plaque and plays a clear guiding role in the selection of clinical treatment.