摘要
目的应用微血管成像技术(SMI)、超声造影(CEUS)观察斑块表面形态及斑块内新生血管,以临床诊断为症状性颈动脉斑块为标准,比较两种技术的相关性及一致性。方法选择2016年8月至2017年10月在首都医科大学附属北京天坛医院超声科行颈动脉超声检查的患者92例,其中男61例,女31例,年龄42~80岁,平均(63.5±7.7)岁,共105个斑块,依据有无发生斑块同侧脑缺血症状分为症状组和非症状组。记录斑块声像图特征(斑块的表面形态、新生血管等)。采用双盲法,以临床症状为标准分组,对于超声声像图进行χ^2检验,明确两种诊断方法的相关性及一致性。结果(1)两组间CEUS显示斑块表面形态(χ^2=6.865,P=0.032)、CEUS增强程度(χ^2=22.494,P<0.001);SMI图像斑块表面形态(χ^2=10.367,P=0.006)、SMI显示新生血管(χ^2=8.186,P=0.041),差异有统计学意义。(2)SMI和CEUS显示斑块表面形态的相关性(r=0.856,P<0.001)和诊断一致性(r=0.802,P<0.001)均较高。症状组中,SMI显示斑块裂隙及表面小凹陷占33.9%(20/59),CEUS显示斑块裂隙及表面小凹陷占25.4%(15/59),SMI对斑块表面细微不规则的显示更好。以斑块表面1级为标准时,CEUS显示斑块表面判断症状性斑块的灵敏度42.4%,特异性80.4%,SMI显示斑块表面判断症状性斑块的灵敏度54.2%,特异性76.1%。两者特异性相似,灵敏度SMI稍高于CEUS。(3)CEUS和SMI显示斑块内新生血管的相关性(r=0.802,P<0.001)较好,诊断一致性中等(r=0.539,P<0.001)。以增强程度2级为标准时,CEUS判断症状性斑块的灵敏度75.8%,特异性67.4%,相同标准下SMI判断症状性斑块的灵敏度58.6%,特异性69.5%。两者特异性相似,灵敏度CEUS高于SMI。结论SMI、CEUS显示斑块表面形态一致性较好,均较二维超声与症状相关性强,SMI对裂隙和斑块表面小凹陷的显示率及可重复性高于CEUS;与SMI显示新生血管相比,CEUS增强程度与症状相关性更强,两者特异性相似,CEUS敏�
Objective To observe the plaque surface morphology and neo-vascularization within the plaque using superb microvascular imaging(SMI)and contrast-enhanced ultrasound(CEUS),and to compare the correlation and consistency of the two technologies based on making clinical diagnosis of symptomatic carotid artery plaque as the standard.Methods A total of 92 patients undergoing carotid ultrasonography in Beijing Tiantan Hospital from August 2016 to October 2017 were recruited,including 61 males and 31 females,aged(63.5±7.7)years(range,42-80 years.A total of 105 plaques were found.According to whether or not to have plaque-induced ipsilateral ischemic symptoms,patients were divided double-blindly into the symptom group and the non-symptom group.The features of plaque(including surface morphology and neo-vascularization)were recorded.The ultrasonographic findings were chi-squarely tested.Results There were statistically significant differences in the surface morphology and enhancement degree of CEUS between carotid artery plaque-induced ischemic symptom group and the non-symptom group(χ^2=6.865,P=0.032;χ^2=22.494,P<0.001).The SMI-detected surface morphology and neo-vascularization had statistically significant differences between the two groups(χ^2=10.367,P=0.006;χ^2=8.186,P=0.041).The correlations of plaque surface morphology(r=0.856,P<0.001)and diagnostic consistency(r=0.802,P<0.001)between SMI and CEUS were higher.In the symptom group,SMI-showed plaque fissures and small surface pitting were in 33.9%(20/59)of patients,and CEUS-showed plaque fissures and small surface pitting were in 25.4%(15/59)of patients.And SMI had a better detection rate of slight and irregular appearances on plaque surface.Taking the first grade of the plaque surface as the standard,CEUS showed a sensitivity of 42.4%and specificity of 80.4%for detecting symptomatic plaques,and SMI showed a sensitivity of 54.2%and specificity of 76.1%.The two methods had similar specificity,and SMI had a slightly higher sensitivity than did CEUS.CEUS and SMI had
作者
李海欣
余海歌
何文
宁彬
魏世纪
刘梦泽
Li Haixin;Yu Haige;He Wen;Ning Bin;Wei Shiji;Liu Mengze(Ultrasound Diagnosis Department,Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital),Beijing 100080,China;Ultrasound Diagnosis Department,Beijing Tian Tan Hospital,Capital Medical University,Beijing 100050,China)
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2019年第9期989-993,共5页
Chinese Journal of Geriatrics
基金
北京市医院管理局临床技术创新项目基金(XMLX201608)
颈动脉斑块稳定性超声造影及弹性成像研究(首发2016-2-2045).
关键词
颈动脉血栓形成
超声检查
Carotid artery thrombosis
Ultrasonography
