三维超声评估颈动脉斑块易损性的可行性

摘要

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Personx2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 vs3.4±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 x2 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.