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中华医学超声杂志(电子版) ›› 2017, Vol. 14 ›› Issue (07) : 494 -499. doi: 10.3877/cma.j.issn.1672-6448.2017.07.004

所属专题: 文献

头颈部超声影像学

三维超声评估颈动脉斑块易损性的可行性
杨甲1, 惠品晶1,(), 颜燕红1, 张白1, 石伟强2, 黄亚波3, 方琪4   
  1. 1. 215006 苏州大学附属第一医院颈脑血管超声科
    2. 215006 苏州大学附属第一医院病理科
    3. 215006 苏州大学附属第一医院神经外科
    4. 215006 苏州大学附属第一医院神经内科
  • 收稿日期:2017-06-01 出版日期:2017-07-01
  • 通信作者: 惠品晶
  • 基金资助:
    苏州市临床重点病种诊疗技术专项项目(LCZX201403); 江苏省第十批"六大人才高峰"高层次人才选拔培养项目(2013-WSW-045); 苏州市科技发展计划资助项目(SYS201326); 江苏省科技厅社会发展项目—重点病种规范化诊疗项目(BE2016670); 江苏省医学创新团队(领军人才)(CXTDA2017026); 苏州市民生科技示范工程项目(SS201714)

A feasibility study of three-dimensional ultrasonography in assessing the carotid plaque vulnerability

Jia Yang1, Pinjing Hui1,(), Yanhong Yan1, Bai Zhang1, Weiqiang Shi2, Yabo Huang3, Qi Fang4   

  1. 1. Department of Carotid and Cerebralvascular Ultrasonography, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
    2. Department of Pathology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
    3. Department of Neurology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
    4. Department of Neurosurgery, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
  • Received:2017-06-01 Published:2017-07-01
  • Corresponding author: Pinjing Hui
  • About author:
    Corresponding author: Hui Pinjing, Email:
引用本文:

杨甲, 惠品晶, 颜燕红, 张白, 石伟强, 黄亚波, 方琪. 三维超声评估颈动脉斑块易损性的可行性[J/OL]. 中华医学超声杂志(电子版), 2017, 14(07): 494-499.

Jia Yang, Pinjing Hui, Yanhong Yan, Bai Zhang, Weiqiang Shi, Yabo Huang, Qi Fang. A feasibility study of three-dimensional ultrasonography in assessing the carotid plaque vulnerability[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2017, 14(07): 494-499.

目的

采用斑块评分研究三维超声评估颈动脉易损斑块的可行性及可靠性。

方法

选取2016年2月至2017年3月在苏州大学附属第一医院神经外科行颈动脉内膜剥脱术(CEA)的患者41例(45例次,其中4例双侧),术前均行常规颈部血管超声、三维超声(3D-US)、CT血管造影(CTA)、CT灌注成像(CTP)和(或)数字减影血管造影(DSA)检查,术后观察粥样斑块大体形态并行HE染色。在二维超声基础上,依据3D-US图像示斑块形态、均质性、回声特征及血管狭窄程度设定斑块评分标准,计算责任斑块综合评分,并与术后相应层面病理学结果对照。根据病理结果,将责任斑块分为易损斑块组(35块)及稳定斑块组(10块),采用独立样本t检验比较2组斑块评分。根据术前6个月内患者是否首发缺血性卒中分为缺血组(27例)与非缺血组(14例),采用Pearson χ2比较缺血性事件与易损斑块发生率。

结果

易损斑块组与稳定斑块组的斑块评分比较(5.3±0.2 vs 3.4±0.3),差异有统计学意义(t=5.339,P<0.05);斑块评分诊断易损斑块的准确性较高,ROC曲线下面积为0.907,诊断的最佳界值为4.5分(最大Youden指数为0.671,敏感度为77%,特异度为90%);缺血性事件的发生与斑块易损性有显著相关关系(r=0.858,P<0.05)。

结论

三维超声可准确、定量评估颈动脉斑块的易损性,颈动脉易损斑块与缺血性卒中呈相关关系,为临床准确评估及个体化治疗提供依据。

Objective

To investigate the feasibility and reliability of three-dimensional ultrasound in evaluating carotid artery vulnerable plaques with the method of prospective plaque scoring.

Methods

From February 2016 to March 2017, 41 patients who performed carotid endarterectomy (CEA) in the department of neurosurgery at the First Affiliated Hospital of Soochow University were scheduled for conventional cervical vascular ultrasonography, three-dimensional ultrasonography (3D-US), CT angiography (CTA), CT perfusion imaging (CTP) and / or digital subtraction angiography (DSA) examinations before surgery. On pathology, the atherosclerotic plaque morphology and HE staining findings were evaluated after surgery. The results of preoperative 3D-US were compared with the corresponding postoperative pathologic findings. Each plaque was scored based on the plaque morphology, homogeneity, echo characteristics and degree of vascular stenosis in 3D-US. According to the pathological results, the plaques were divided into vulnerable plaque group (n=35) and stable plaque group (n=10). The plaque score difference between groups was compared using independent sample t test. Patients were classified into ischemic stroke group (n=27) and non-ischemic stroke group (n=14) according to whether ischemic stroke symptoms occurred during the last 6 months. Pearson χ2 test was used to analyze the correlation between ischemic events and the vulnerable plaques.

Results

Plaque scores were significantly different between vulnerable plaque group and stable plaque group (5.3±0.2 vs 3.4±0.3, t=5.339, P<0.05). The accuracy of identifying vulnerable plaque by plaque score is high, while the area under the ROC curve is 0.907 with a cutoff 4.5 (the maximum Youden index is 0.671, the sensitivity is 77%, the specificity is 90%). There is a significant positive correlation between the occurrence of ischemic events and plaque vulnerability (r=0.858, P<0.05).

Conclusion

3D-US can accurately and quantitatively assess vulnerability of carotid plaques, carotid artery vulnerable plaque was significantly associated with ischemic stroke, which can provide the basis for clinical individualized treatment.

图1 颈动脉斑块评分诊断易损斑块的受试者工作特征曲线
图8~13 左侧颈动脉球部前后外侧壁上斑块(致左侧颈动脉球部重度狭窄)。图8为粥样斑块二维超声纵断切面彩色血流图;图9为粥样斑块二维超声横断切面图;图10~11为斑块三维超声图像(斑块评分为6分,易损斑块)。图10为三维超声纵断切面斑块定位图;图11为三维超声定位图第4层面的斑块横断切面图,超声示斑块内低-无回声(箭头所示)不规则斑块;图12为CEA术后大体标本(与超声相应层面的横断面):见新鲜出血与陈旧性出血(箭头所示);图13为CEA术后与超声相应层面标本(HE ×2):新鲜血栓和陈旧性血栓(箭头所示),即易损斑块
表1 缺血组与非缺血组易损斑块与稳定斑块的分布情况[块(%)]
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