超声造影对症状性缺血性脑卒中颈动脉不稳定斑块破裂的诊断价值

Diagnostic value of contrast-enhanced ultrasound in the rupture of unstable carotid plaque in symptomatic ischemic stroke

目的探究超声造影对症状性缺血性脑卒中颈动脉不稳定斑块破裂的诊断价值。方法选择2021年3月至2022年12月于我院接受诊治的92例(111个斑块)症状性缺血性脑卒中患者为研究对象,均接受颈动脉常规超声及超声造影检查,并行颈动脉内膜剥脱手术取得病理结果。比较常规超声与超声造影对斑块内部回声、表面形态、新生血管形成分级的检查情况;以病理诊断结果为金标准,分析超声造影对颈动脉不稳定斑块破裂的诊断效能。结果超声造影检出斑块内部回声均匀24个,不均匀87个,超声造影对斑块内部回声的检查优于常规超声(P<0.001)。超声造影检出表面规则型18个、表面不规则型和溃疡斑块型93个,超声造影对斑块表面形态的检查优于常规超声(P<0.001)。超声造影检出斑块内新生血管0级4个、1-3级107个,超声造影对斑块内新生血管形成分级的检查优于常规超声(P<0.001)。病理检出不稳定斑块破裂85例,超声造影检出不稳定斑块破裂81例,与病理结果一致性较好(Kappa=0.826);超声造影诊断不稳定斑块破裂的受试者工作特征(ROC)曲线下面积(AUC)为0.899,灵敏度、特异度分别为78.95%、86.75%。结论超声造影对症状性缺血性脑卒中患者颈动脉不稳定斑块破裂的诊断效能较高。

Objective To explore the diagnostic value of contrast-enhanced ultrasound in the rupture of unstable carotid plaque in symptomatic ischemic stroke.Methods A total of 92 patients(111 plaques)with symptomatic ischemic stroke who were diagnosed and treated in our hospital from March 2021 to December 2022 were selected as the research objects.All patients underwent routine carotid ultrasound and contrast-enhanced ultrasound examination,and carotid endarterectomy was performed to obtain pathological results.The internal echo,surface morphology and neovascularization grading of plaques were compared between routine carotid ultrasound and contrast-enhanced ultrasound;the diagnostic efficacy of contrast-enhanced ultrasound in the diagnosis of unstable plaque rupture of carotid artery was analyzed with pathological diagnosis as the gold standard.Results A total of 24 uniform echoes and 87 uneven echoes in the plaques were detected by contrast-enhanced ultrasound,contrast-enhanced ultrasound was superior to routine carotid ultrasound in detecting the internal echoes of plaques(P<0.001).Eighteen regular surface types,93 irregular surface types and ulcer plaque types were detected by contrast-enhanced ultrasound,contrast-enhanced ultrasound was superior to routine carotid ultrasound in the examination of plaque surface morphology(P<0.001).Four neovascularizations of grade 0 and 107 neovascularizations of grade 1-3 in plaques were detected by contrast-enhanced ultrasound,contrast-enhanced ultrasound was superior to routine carotid ultrasound in detecting the grade of neovascularization in plaques(P<0.001).Eighty-five cases of unstable plaque rupture were detected by pathology,and 81 cases of unstable plaque rupture were detected by contrast-enhanced ultrasound,which were in good agreement with pathological results(Kappa=0.826);the receiver operating characteristic(ROC)areas under curve(AUC)of contrast-enhanced ultrasound in the diagnosis of unstable plaque rupture was 0.899,and the sensitivity and specificity were 78.95%and 86.75%,respectively.Conclusion Contrast-enhanced ultrasound has a high diagnostic efficiency for unstable carotid plaque rupture in patients with symptomatic ischemic stroke.