剪切波弹性成像鉴别不均质颈动脉斑块不同回声区域硬度差异的可行性研究

Feasibility Study of Using Shear Wave Elastography to Identify Stiffness Differences in Different Echogenic Regions of Heterogeneous Carotid Plaques

目的:探讨运用剪切波弹性成像(SWE)技术定量鉴别不均质性颈动脉粥样硬化斑块(HCAP)内部不同回声区域硬度差异的可行性。方法:通过二维灰阶超声筛选HCAP,依据回声强度将斑块内回声分为相对高回声、相对等回声和相对低回声3个区域。对斑块进行SWE检查,选取质量合格的图像进行定量分析,分别测量斑块内3个区域的硬度,保证每个区域测量感兴趣区面积相同,测量指标为剪切波弹性定量值(SWQ)。结果:定量分析HCAP37个,斑块内高回声区SWQ与等回声区差异有统计学意义(P<0.05),斑块内高回声区SWQ与低回声区差异有统计学意义(P<0.05),斑块内等回声区SWQ与低回声区差异有统计学意义(P<0.05)。结论:SWE可以定量区分HCAP内不同回声强度区的硬度差异,有望成为一项精准评估颈动脉斑块稳定性的临床新技术。

Purpose: To investigate the feasibility of using the shear wave elastography(SWE) technique to quantitatively identify differences in stiffness of different echogenic regions within heterogeneous carotid atherosclerotic plaques(HCAP). Methods: HCAP was screened by two-dimensional gray-scale ultrasound, and the intraplaque echogenicity was divided into three regions of relative high echogenicity, relative iso-echogenicity, and relative hypo-echogenicity based on echogenicity. The plaques were examined by SWE, and the images with qualified quality were selected for quantitative analysis. The stiffness of the three regions within the plaques was measured separately to ensure the same area of the region of interest for each region measurement, and the measurement index was the shear wave elasticity quantification value(SWQ). Results: Thirty-seven HCAPs were quantitatively analyzed in this study. After comparing the SWQ values respectively in different echoic areas within a plaque, we found that there was a statistically significant difference between SWQ in the high echogenic area and isoechoic area within the plaque(P<0.05), a statistically significant difference between SWQ in the high echogenic area and hypoechoic area within the plaque(P<0.05), and a statistically significant difference between SWQ in the isoechoic area and hypoechoic area within the plaque(P<0.05). Conclusion: SWE can be used to quantitatively distinguish the differences in stiffness of different echogenic intensity regions within HCAP, and is expected to be a new clinical technique for accurate localization and quantitative assessment of carotid plaque stiffness.