超微血管成像和超声造影评估多发性大动脉炎活动性

Superb microvascular imaging and contrast-enhanced ultrasonography for assessment of activity of Takayasu arteritis

目的评价超声造影(CEUS)及超微血管成像(SMI)评估多发性大动脉炎(TA)活动性的价值。方法纳入47例TA患者、共87支受累颈动脉,根据TA活动性将其分为活动期组和稳定期组,分别包括21例、38支受累颈动脉和26例、49支受累颈动脉。比较组间实验室检查结果和常规超声参数差异,以Pearson相关性分析评价CEUS与SMI增厚颈动脉管壁分级的相关性;绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评价超声指标评估TA活动性的效能。结果活动期组与稳定期组受累颈动脉管壁厚度、管壁厚度变化值、管腔内径及内外径比值差异均有统计学意义(P均<0.05)。SMI与CEUS分级标准呈中度相关(r=0.702,P<0.001)。以颈动脉管壁厚度评估TA活动性的AUC为0.680,截断值取2.75 mm时,敏感度为46.67%,特异度为87.23%;以颈动脉管壁增厚幅度评估活动性的AUC为0.680,截断值取0.15 mm时,敏感度为63.33%,特异度为89.36%。以CEUS分级评估TA活动性的AUC为0.773,根据颈动脉CEUSⅡ级判断活动期TA的敏感度为60.52%、特异度为95.92%,以CEUS 0级判断TA稳定期的敏感度为28.57%、特异度为86.84%。以SMI分级评估TA活动性的AUC为0.712,SMIⅡ级判断活动期TA的敏感度为23.68%、特异度为100%,SMI 0级判断稳定期的TA敏感度为53.06%、特异度为78.95%。结论CEUS及SMI均可用于评估TA活动性;SMI更为便捷且价廉,适用范围更广。

Objective To observe the value of superb microvascular imaging(SMI)and contrast-enhanced ultrasonography(CEUS)for assessment of the activity of Takayasu arteritis(TA).Methods Totally 47 TA patients with 87 involved carotid arteries were enrolled and divided into active group(21 patients with 38 involved carotid arteries)and stable group(26 patients with 49 involved carotid arteries)according to activity of TA.The results of laboratory examinations and conventional ultrasound parameters were compared between groups.Pearson correlation analysis was used to evaluate the correlations of CEUS parameters and SMI thickened carotid artery wall grades.Then receiver operating characteristic(ROC)curve was plotted,and the area under the curve(AUC)was calculated to evaluate the effectiveness of ultrasound for assessing TA activity.Results Statistically significant differences of the wall thickness,the change value of wall thickness,the inner lumen diameter and ratio of inside and outside diameter of the involved carotid arteries were found between groups(all P<0.05).SMI grading standards were moderately correlated with CEUS grading standards(r=0.702,P<0.001).The AUC of assessing TA activity based on the wall thickness was 0.680,and taken 2.75 mm as the cut-off value of wall thickness,the sensitivity and specificity was 46.67%and 87.23%,respectively.The AUC of assessing TA activity based on the increased value of wall thickness was 0.680,and taken 0.15 mm as the cut-off value,the sensitivity and specificity was 63.33%and 89.36%,respectively.The AUC of activity assessment based on CEUS was 0.773,the sensitivity and specificity of CEUS gradeⅡfor judging active phase TA was 60.52%and 95.92%,of grade 0 for judging stable phase TA was 28.57%and 86.84%,respectively.The AUC of assessing TA activity based on SMI was 0.712,the sensitivity and specificity of SMIⅡwas 23.68%and 100%,of SMI 0 for judging stable phase TA was 53.06%and 78.95%,respectively.Conclusion Both SMI and CEUS could be used to assess TA.SMI was convenient and cheap,with wider applications.