超声与高分辨磁共振成像检查评价颈动脉斑块易损性的对比研究

Comparative study of ultrasound and high-resolution magnetic resonance imaging in evaluating carotid artery plaque vulnerability

目的探讨在高分辨磁共振成像(MRI)评估的基础上采用超声评估颈动脉斑块易损性的价值。方法收集2023年3月至2023年5月于茂名市人民医院同时进行超声、高分辨MRI检查的16例颈动脉斑块患者的临床资料,共检出27个颈动脉易损性斑块(含极低回声或低回声斑块,厚度≥3.5 mm)。基于高分辨动态对比增强MRI序列(DCEMRI)和超声造影,分析斑块内新生血管(IPN)的检出率。在采用高分辨MRI对颈动脉易损性斑块进行分析的基础上,通过解剖定位匹配,观察易损性成分在超声的主要表现,并测量极低回声区的超声灰阶强度(即超声回声强度),通过超声灰阶值分析超声对于区分易损性斑块成分[斑块内出血(IPH)和脂质坏死核心]的潜在价值。结果在27个颈动脉易损性斑块中,超声造影显示24个斑块内部出现超声造影剂微气泡灌注,DCE-MRI显示24个斑块出现强化。DCEMRI和超声造影对颈动脉IPN的诊断符合率为78%(21/27)。通过对18个易损性斑块极低回声区代表的成分进行分析发现18个斑块均在解剖定位上匹配成功,其中,高分辨MRI诊断7个斑块内的极低回声区为IPH,为亚急性出血,T1加权成像(T1WI)和时间飞跃(TOF)序列对亚急性出血敏感,表现为稍高或高信号;11个斑块内的极低回声区是脂质坏死核心。IPH的超声回声强度明显低于脂质坏死核心的超声回声强度,差异有统计学意义(P﹤0.05)。结论超声检查具有潜在区分易损性斑块成分的价值,有助于对颈动脉易损性斑块的早期诊断与干预,从而减少其对患者健康带来的危害。

Objective The value of ultrasound in assessing the vulnerability of carotid artery plaques based on highresolution magnetic resonance imaging(MRI)evaluation.Method Collect clinical data of 16 patients with carotid artery plaques who underwent ultrasound and high-resolution MRI examinations simultaneously at Maoming People's Hospital from March 2023 to May 2023,a total of 27 vulnerable carotid artery plaques(including extremely low echogenic areas or low echogenic plaques with a thickness of≥3.5 mm)were detected.Based on high-resolution dynamic contrast enhanced magnetic resonance imaging(DCE-MRI)and contrast-enhanced ultrasound,the detection rate of intraplaque neovascularization(IPN)was analyzed.Based on the analysis of vulnerable plaques in the carotid artery using highresolution MRI imaging,the main manifestations of vulnerable components in ultrasound were observed through anatomical localization matching,and the ultrasound gray scale intensity(i.e.ultrasound echo intensity)in the extremely low echo area was measured.The potential value of ultrasound in distinguishing vulnerable plaque components[intraplaque hemorrhage(IPH)and lipid necrosis core]was analyzed through ultrasound gray scale value analysis.Result Among 27 vulnerable carotid artery plaques,contrast-enhanced ultrasound showed microbubble perfusion of ultrasound contrast agent inside 24 plaques,and DCE-MRI showed enhancement in 24 plaques.The diagnostic accuracy of DCE-MRI and contrast-enhanced ultrasound for carotid artery IPN was 78%(21/27).By analyzing the components represented by the extremely low echo areas of 18 vulnerable plaques,it was found that all 18 plaques were successfully matched in anatomical localization,among them,high-resolution MRI diagnosis of the extremely low echo area within 7 plaques was IPH,which is subacute bleeding.T1WI and TOF sequences are sensitive to subacute bleeding and exhibit slightly high or high signal intensity;the extremely low echo area within 11 plaques is the core of lipid necrosis.The ultrasound echo intensity of IPH was significantly lower than that of lipid necrosis core,with a statistically significant difference(P<0.05).Conclusion Ultrasound examination has potential value of distinguishing vulnerable plaque components,which can help physicians diagnose carotid artery vulnerable plaques in the early stage and provide early intervention,thereby reducing the harm it poses to patient health.