超声微血管成像在颈动脉受累的大动脉炎病变中的诊断价值

Diagnostic value of SMI technique in carotid artery involved Takayasu arteritis

目的探讨超声微血流成像(SMI)技术在颈动脉受累的大动脉炎(TA)病变中的诊断价值。方法选取我院收治的62例疑似颈动脉受累的TA患者,行常规超声检查和SMI检查,以超声血管造影(CEUS)检查为金标准,比较常规超声检查和SMI检查在颈动脉受累的TA患者中的诊断效能。结果常规超声检查阳性41例、阴性21例;SMI检查阳性44例、阴性18例;CEUS检查阳性46例、阴性16例;三种检查方式诊断情况对比差异无统计学意义(P>0.05)。SMI检查特异度、灵敏度、阳性预测值、阴性预测值和准确度均高于常规超声检查,差异有统计学意义(P<0.05)。经CEUS和SMI检查均确诊的42例TA患者中活动期患者32例、发现病变区域68处,非活动期患者10例,发现病变区域24处。活动期患者受累管壁厚度大于非活动期患者,CRP和ESR水平高于非活性期患者,差异有统计学意义(P<0.05)。结论SMI技术在颈动脉受累的TA患者中具有较高的诊断价值,可观察到微小、低速的血流,为临床诊断提供可靠依据。

Objective To investigate the value of superb microvasular imaging(SMI)in the diagnosis of carotid artery involved Takayasu arteritis(TA).Methods 62 TA patients with suspected carotid artery involvement treated in our hospital from May 2018 to December 2020 were selected as the research objects.Routine ultrasound and SMI were given successively.Taking contrast-enhanced ultrasonography(CEUS)as the gold standard,the diagnostic efficacy of routine ultrasound and SMI in Ta patients with carotid artery involvement was compared;For the confirmed patients,refered to the National Institutes of Health(NIH)score,we divided them into active phase and inactive phase,collected the measurement values of C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR),and compared the consistency between SMI technology and CEUS in judging the degree of neovascularization in the thickening wall of common carotid artery in patients with different active stages.Results Conventional ultrasonography was positive in 41 cases and negative in 21 cases,SMI was positive in 44 cases and negative in 18 cases,gold standard examination was positive in 46 cases and negative in 16 cases,there was no significant difference in the diagnosis of the three examination methods(P>0.05).The specificity,sensitivity,positive predictive value,negative predictive value and accuracy of SMI(87.5%,91.3%,95.45%,77.78%and 90.32%)were higher than those of conventional ultrasound(18.75%,60.87%,68.29%,14.29%and 50%),the difference was statistically significant(P<0.05).Among the 42 TA patients diagnosed by CEUS and SMI,32 patients in active phase and 68 lesion areas were found,and 10 patients in inactive phase and 24 lesion areas were found.The thickness of involved tube wall in active patients was greater than that in inactive patients,and the levels of CRP and ESR were higher than those in inactive patients(P<0.05).Conclusion SMI technology has high diagnostic value in Ta patients with carotid artery involvement.It can not only accurately capture the small and low-speed blood flow,improve the reliable basis for clinical diagnosis,but also clearly identify the disease activity of TA patients,provide reference for the establishment of clinical treatment plan,and has significant clinical application value.