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中华医学超声杂志(电子版) ›› 2025, Vol. 22 ›› Issue (06) : 504 -515. doi: 10.3877/cma.j.issn.1672-6448.2025.06.002

专家共识

颈动脉粥样硬化斑块超声规范化操作及报告专家共识(2025,上海)
上海市超声质量控制中心   
  1. 1. 200032 上海,复旦大学附属中山医院超声诊断科
  • 收稿日期:2025-02-25 出版日期:2025-06-01

Expert consensus on standardized operation and reporting of carotid ultrasound (2025, Shanghai)

Shanghai Municipal Center for Ultrasound Quality Control   

  • Received:2025-02-25 Published:2025-06-01
引用本文:

上海市超声质量控制中心. 颈动脉粥样硬化斑块超声规范化操作及报告专家共识(2025,上海)[J/OL]. 中华医学超声杂志(电子版), 2025, 22(06): 504-515.

Shanghai Municipal Center for Ultrasound Quality Control. Expert consensus on standardized operation and reporting of carotid ultrasound (2025, Shanghai)[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2025, 22(06): 504-515.

图1 颈动脉斑块超声扫查示意图。图a为斑块横断面超声扫查示意图;图b为斑块附着在血管侧壁,常规的超声纵断面扫查显示不明显;图c为转换探头角度进行横断面扫查,斑块显示清晰
图2 颈动脉斑块灰阶超声图像。图a为颈动脉斑块纵断面图像;图b为颈动脉斑块横断面图像;图c为多发斑块横断面图像(白色箭头为斑块)
图3 颈动脉斑块大小测量的超声图像及示意图。图a为颈动脉斑块纵断面长度测量灰阶超声图像;图b为纵断面测量颈动脉斑块长度示意图;图c为颈动脉斑块横断面厚度测量灰阶超声图像;图d为横断面测量颈动脉斑块厚度示意图
图4 颈动脉纵断面解剖示意图
图5 颈动脉斑块附着位置的灰阶超声图像及示意图。图a为颈动脉前壁斑块超声图像;图b为颈动脉后壁斑块的纵断面及横断面超声图像;图c为颈动脉侧壁斑块超声图像;图d~g分别为颈动脉斑块前壁、后壁及侧壁横断面示意图(图a~c红色圈出部分为斑块;图d~g黄色部分为斑块,红色部分为血管壁及斑块与血管腔交界面)
图6 不同回声类型颈动脉斑块的灰阶超声图像。图a示均匀回声斑块;图b示不均匀回声斑块(斑块内部回声不一致超过20%);图c示低回声斑块;图d示极低回声斑块;图e示高回声斑块;图f示强回声斑块后方伴声影(图中白色箭头所示为斑块,图b中箭头A所示为低回声区,箭头B所示为极低回声区,箭头C所示为高回声区)
图7 颈动脉斑块表面特征的灰阶超声图像及示意图。图a为超声图像示斑块表面连续光滑,回声连续;图b为超声纵断面图像示斑块表面不连续(白色箭头所示为斑块表面回声中断不连续,可见缺损);图c为超声横断面图像示斑块表面不连续(白色箭头所示为斑块表面回声中断不连续,可见缺损);图d~f分别为图a~c超声图像对应的示意图
图8 颈动脉狭窄程度超声评估方法。图a为北美症状性颈动脉内膜切除实验(NASCET)测量法(A为狭窄处管腔内径;B为狭窄处远端正常段管腔内径,狭窄率=(B-A)/B×100%);图b为欧洲颈动脉外科试验(ECST)测量法(A为狭窄处管腔内径;C为狭窄处正常内径,狭窄率=(C-A)/C×100%);图c为面积测量法(较大红圈内为原始管腔面积,较小红圈内为残余管腔面积);图d为超声图像示斑块致管腔轻度狭窄(狭窄率<50%);图e为超声图像示斑块致管腔中度狭窄(狭窄率50%~69%);图f为超声图像示斑块致管腔重度狭窄(狭窄率≥70%)
图9 斑块内新生血管的超声造影增强程度超声图像。图a示无新生血管:斑块内无明显微泡显影;图b为少量新生血管:斑块内少量微泡显影,微泡分布于斑块基底部;图c为新生血管丰富:斑块内见大量微泡显影,微泡分布于斑块表面及基底部
图10 正常颈动脉超声标准存图(单侧留存6张图像,双侧共须留存12张图像)。图a为颈总动脉近段至中段纵断面图;图b为颈总动脉远段至分叉处、颈内动脉起始段纵断面图;图c为放大测量内中膜厚度图;图d为颈总动脉彩色多普勒血流图;图e为颈内动脉彩色多普勒血流图;图f为颈外动脉彩色多普勒血流图
图11 动脉粥样硬化斑块超声标准存图。图a为最大斑块长度纵断面及最大斑块厚度横断面;图b为最大斑块管腔最窄处彩色血流图;图c为最大斑块管腔最窄处血流频谱图
表1 颈动脉超声检查的质量控制内容
质控项目 质控内容
检查前准备情况及仪器调节 考察操作者对仪器调节的熟练程度,对基本概念的了解程度:
1.灰阶图像调节:选择探头、频率、检查条件,调节图像深度、增益、时间增益补偿、聚焦点及动态范围等
2.彩色多普勒调节:频率、增益(彩色充盈程度调节)、彩色多普勒速度标尺、取样框大小及偏转、彩色滤波
3.脉冲多普勒调节:取样线位置及门宽、角度校正,标尺范围及基线位置
4.超声造影模式调节:在低机械指数条件下使用低声压,机械指数一般低于0.3
扫查流程 检查操作者扫查流程是否熟练及是否符合检查要求:
1.检查须包括纵断面及横断面,须显示颈总、颈内、颈外动脉并正确区分
2.血管内径应在灰阶图上测量,内中膜厚度的测量方法(部位及放大)
3.流速曲线相关参数(如血流速度、阻力指数等)测量方法;至少须测量颈总动脉流速、颈总动脉及颈内动脉的阻力指数
图像采集标准化 检查必存图像是否完整,在存图时必须标注左右或有体表标记
1.正常颈动脉必存图像(左右各6幅存图,共12幅存图):
①颈总动脉近段至中段纵断面图
②颈总动脉远段至分叉处、颈内动脉起始处纵断面
③放大测量内中膜厚度图
④颈总动脉彩色多普勒血流图
⑤颈内动脉彩色多普勒血流图
⑥颈外动脉彩色多普勒血流图
2.动脉粥样硬化斑块形成必存图像(共4幅):
①最大斑块纵断面,测量获得斑块长度
②最大斑块横断面
③最大斑块管腔最窄处彩色血流图
④最大斑块管腔最窄处血流频谱图
结构化报告 检查结构化报告是否完整
图12 颈动脉斑块影像报告和数据系统分类示意图注:CP-RADS为颈动脉斑块影像报告和数据系统;MWT为最大管壁厚度;LRNC为富含脂质的坏死核;IPH为斑块内出血
表2 颈动脉斑块影像报告和数据系统
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