能谱CT血管成像评价颈动脉粥样硬化斑块成分的临床分析

Clinical study on evaluation of carotid atherosclerotic plaque type by energy spectral CT angiography

目的探讨能谱CT血管成像(能谱CTA)多参数分析对颈动脉粥样斑块成分界定的应用价值。方法收集44例经超声筛查拟行颈动脉内膜剥脱术的颈动脉粥样硬化患者,术前行颈动脉CT能谱成像扫描。将数据传输至图像后处理工作站,记录颈动脉斑块的位置和数量,并使用GSI Viewer(Gemstone Spectral Imaging Viewer)平台综合分析颈动脉斑块的组织成分。获取各斑块主要成分的能谱曲线及有效原子序数,计算出各成分的能谱曲线斜率。采用方差分析比较上述斑块成分的能谱参数。采用Kappa检验能谱CTA与病理诊断结果的一致性。结果44例患者中能谱CTA共检出49处斑块,与超声检出斑块数量相符,其中纤维斑块24处,脂质斑块18处,斑块内出血7处。3种斑块组织成分的曲线斜率及有效原子序数均具有统计学差异。能谱CTA对颈动脉斑块类型的诊断结果与病理学切片的诊断结果一致性较高(kappa值分别为0.796、0.824、0.764)。结论能谱CTA能够准确分析颈动脉粥样斑块的组织成分,进而判断斑块的类型,对颈动脉斑块的临床治疗具有一定参考价值。

Objective To explore the application value of energy spectral CTA multi-parameter data in defining the composition of carotid atherosclerotic plaque.Methods 44 patients with carotid atherosclerosis undergoing carotid endarterectomy were screened out by carotid ultrasound examination.Preoperative carotid spectral CTA were performed by spectral CT for all patients.The image data were transmitted to the image post-processing work station for evaluation,with the location and the number of carotid plaques being recorded.Then the carotid plaque composition was analyzed by Gemstone Spectral Imaging(GSI)Viewer platform.The energy spectral curve and the effective atomic number of main tissue components of each plaque were obtained,and the slope of energy spectral curve was calculated.The variance analysis was used to compare the above GSI parameters of various plaque components,and the Kappa analysis was used to evaluate the diagnostic consistency between spectral CTA and pathological sections.Results In 44 patients,49 plaques were detected by spectral CTA,which was consistent with the number of plaques detected by ultrasound,including 24 fibrous plaques,18 lipid plaques and 7 plaques with significant intra-plaque hemorrhage.The curve slope and effective atomic number of the three differentplaque components were statistically different.The diagnostic results of carotid artery plaque components by spectral CTA were wellconsistent with those of pathological results(The kappa values are 0.796,0.824,0.764,respectively).Conclusion Spectral CTA can analyze the tissue composition of the carotid atherosclerotic plaque accurately,and then define the plaque type accordingly,which provide reference value for clinical treatment of carotid plaques.