探讨高帧频超声造影（H-CEUS）评价颈动脉粥样硬化斑块内新生血管的价值。

回顾性分析2019年10月至2020年2月间在解放军总医院第一医学中心行颈动脉斑块超声造影的患者27例，共计33个斑块；对研究对象分别行常规超声造影及H-CEUS检查并留存图像资料，再由2位观察者（A和B）分别对超声造影和H-CEUS图像进行分析，给出评价结果和分级，观察指标包括斑块的厚度、回声、表面纤维帽是否完整，造影后斑块内有无新生血管和新生血管的结构。对超声造影和H-CEUS图像特征和分级结果进行统计分析，采用χ²检验比较2种造影模式下的差异，采用Kappa检验对2名观察者检查的一致性进行检验。

2名观察者对于斑块内有无新生血管的评价结果，2种造影模式下比较差异均无统计学意义（P>0.05）；H-CEUS对于新生血管结构的显示均优于常规造影，两者间差异具有统计学意义（观察者A：χ²=4.11，P=0.040，观察者B：χ²=4.20，P=0.040）；对于斑块内新生血管分级的评价中，2种造影模式比较差异均无统计学意义（P均>0.05）；超声造影模式下，2名观察者间的一致性检验Kappa系数为0.6716（95%可信区间：0.4737~0.8695）；H-CEUS模式下，2名观察者间的一致性检验Kappa系数为0.7500（95%可信区间：0.5681~0.9319）；与超声造影模式相比，采用H-CEUS观察2名观察者间的一致性有明显提高。

H-CEUS可以使斑块内的新生血管和血管结构的显示更加清楚，而且对不同观察者间评价结果的一致性上有着明显提高，H-CEUS对评价斑块内新生血管有一定临床应用价值。

To compare the value of high-frame-rate contrast-enhanced ultrasound (H-CEUS) in the evaluation of neovascularization in carotid atherosclerotic plaques compared with conventional contrast-enhanced ultrasound.

A retrospective analysis was performed on 27 patients with 33 carotid artery plaques at the First Medical Center of Chinese PLA General Hospital from October 2019 to February 2020. Both conventional contrast-enhanced ultrasound and H-CEUS were performed on all the subjects, and two observers analyzed the ultrasound images to give evaluation results and classification. Observation indicators includes plaque thickness, plaque echo, whether the surface fiber cap was complete or not, and whether there were new blood vessels and new blood vessel structures in the plaque post-contrast. Image characteristics and classification results of the two modalities were statistically analyzed. Count data were compared using the χ² test and the consistency was evaluated using the Kappa test.

The evaluation results of the two observers on the presence or absence of new blood vessels in the plaque between the two modalities were consistent, and there was no significant difference between them (P>0.05). H-CEUS was significantly better than conventional contrast-enhanced ultrasound in displaying neovascular structures (observer A: χ²=4.11, P=0.040; observer B: χ²=4.20, P=0.040), but there was no significant difference in the grading of neovascularization in the plaque (P>0.05). For conventional contrast-enhanced ultrasound, the Kappa coefficient of agreement between the two observers was 0.6716 (95% confidence interval: 0.4737~0.8695) for conventional contrast-enhanced ultrasound, and 0.7500 (95% confidence interval: 0.5681~0.9319) for H-CEUS; compared with conventional contrast-enhanced ultrasound, the consistency between two observers was significantly improved when using H-CEUS.

H-CEUS can make the neovascularization and vascular structure in plaque more clear, and the consistency of the evaluation results between different observers is obviously improved. H-CEUS has appreciated clinical application value in evaluating the neovascularization in plaque.