颈部血管超声在粥样硬化斑块易损性评估中的应用价值

Clinical value of carotid Doppler ultrasonography in assessing vulnerability of atherosclerotic plaques

目的运用颈部血管超声(CDU)及高分辨率磁共振成像(HRMRI)评估颈动脉粥样硬化斑块性质,探究CDU对于评估粥样硬化斑块性质的应用价值。方法回顾性连续纳入2017年8月至2020年12月于苏州大学附属第一医院卒中中心因急性缺血性卒中或短暂性脑缺血发作等就诊,并分别经CDU及HRMRI检查确诊颈动脉存在责任斑块的患者85例。CDU根据颈动脉粥样硬化斑块形态、回声、纤维帽完整与否、有无溃疡等评估斑块性质,将其分为易损斑块和稳定斑块。HRMRI依据动脉粥样硬化斑块MRI分型标准评估斑块性质,亦分为易损斑块和稳定斑块。以HRMRI评估结果作为无创“金标准”,绘制CDU评估斑块易损性的ROC曲线,得出曲线下面积、敏感度、特异度、约登指数。并采用Kappa检验分析CDU与HRMRI评估斑块易损性的一致性。结果85个责任斑块中,HRMRI评估易损斑块49个(49/85,57.6%),CDU评估易损斑块46个(46/85,54.1%),根据ROC曲线得出CDU评估颈动脉易损斑块的ROC曲线下面积为0.921,敏感度为89.8%,特异度为94.4%,约登指数为0.842。Kappa检验结果显示,CDU与HRMRI评估颈动脉粥样硬化斑块性质的一致性强(Kappa值=0.833,P<0.05)。CDU与HRMRI评估颈动脉易损斑块有关特征:脂质坏死核/斑块内出血、钙化、溃疡型斑块、血栓形成、纤维帽状态的Kappa值分别为0.905、0.875、0.839、0.822、0.719。结论CDU为评估颈动脉粥样硬化斑块易损性的有效方法,能够为治疗方案的选择提供充分的依据。

Objective To investigate the nature of carotid atherosclerotic plaques by carotid Doppler ultrasonography(CDU)and high resolution magnetic resonance imaging(HRMRI),and to assess the value of CDU in evaluating the nature of atherosclerotic plaques.Methods We retrospectively and consecutively enrolled 85 patients who were admitted to the Stroke Center of the First Affiliated Hospital of Soochow University and diagnosed with responsible plaques in the carotid artery through CDU and HRMRI examinations for symptoms such as acute ischemic stroke or transient ischemic attack between August 2017 and December 2020.CDU was used to assess the nature of carotid atherosclerotic plaques according to their morphology,echo,integrity of fibrous cap,and presence or absence of ulcer,and divide them into vulnerable plaques and stable plaques.HRMRI was also performed to assess the nature of atherosclerotic plaques according to the MRI classification criteria for atherosclerotic plaques,and divide them into vulnerable plaques and stable plaques.Using the HRMRI evaluation results as the noninvasive"gold standard",the receiver operator characteristic(ROC)curve for CDU assessment of plaque vulnerability was plotted to calculate the area under the curve,sensitivity,specificity,and Youden index.Cohen's kappa values were used to calculate the agreement between CDU and HRMRI in assessing carotid atherosclerotic plaque vulnerability.Results Among the 85 responsible plaques,49 were assessed as vulnerable plaques by HRMRI(49/85,57.6%),and 46 were assessed as vulnerable plaques by CDU(46/85,54.1%).According to the ROC curve,the area under the ROC curve for CDU assessment of carotid vulnerable plaques was 0.921,with a sensitivity of 89.8%,specificity of 94.4%,and Youden index of 0.842.Kappa test results showed that the consistency between CDU and HRMRI in assessing the nature of carotid atherosclerotic plaque was strong(Kappa value=0.833,P<0.05).The Cohen's kappa values for CDU and HRMRI in assessing the following characteristics of vulnerable carotid plaques were 0.905,0.875,0.839,0.822,and 0.719 for lipid necrotic core/intraplaque hemorrhage,calcification,ulcerated plaques,thrombosis,and fibrous cap status,respectively.Conclusion CDU is an effective method for predicting carotid atherosclerotic plaque vulnerability and is able to accurately provide a sufficient basis for the selection of treatment options.