超声联合超声造影评价颈动脉斑块稳定性的价值研究

Value of ultrasound combined with CEUS in evaluating the stability of carotid plaque

关键词:  超声造影  颈动脉斑块  稳定性

Key words:  contrast-enhanced ultrasound  carotid plaque  stability

摘要:

目的 结合病理结果探讨常规超声联合超声造影（contrast enhanced ultrasound，CEUS）在颈动脉斑块稳定性评估中的应用价值。方法 选取48例拟接受颈动脉内膜剥脱术（carotid endarterectomy，CEA）的患者，共58个斑块，术前行常规超声及CEUS检查，选取目标斑块明确斑块回声及造影评分，评估斑块稳定性；术后对目标斑块行HE染色及CD34免疫组化染色，进行病理评分及斑块内微血管密度（microvessel density，MVD）计数，比较超声及病理结果。结果 低回声及混合回声的斑块较强回声斑块更为不稳定；CEUS评分与病理评分及MVD数目之间呈正相关（r=0.56，P=0.00；r=0.68，P=0.00）；CEUS检查结果与病理检查结果较为一致，两者结果的一致率为68.79%，Kappa=0.63（0.4 < Kappa ≤ 0.75），一致性良好，具有明显统计学意义（P<0.01）。结论 常规超声结合CEUS检查是一种颈动脉狭窄手术术前无创、准确、可靠的评估颈动脉斑块稳定性的方法。

Abstract:

Objective To explore the application value of conventional ultrasound combined with Contrast enhanced ultrasound (CEUS) in evaluating the stability of carotid plaques and compare with pathological results. Methods Forty-eight patients, who underwent Carotid Endarterectomy (CEA), were selected including a total of 58 plaques. Routine ultrasound and CEUS examination were performed preoperatively, and target plaques were selected to determine the echo of the plaques. HE and CD34 immunohistochemical stains were performed on the target plaques, and microvessel density (MVD) was counted. Ultrasound and pathological results were compared. Results The hypoechoic plaques and mixed echo plaques were more unstable than the hyperechoic palques; There was a positive correlation between CEUS score and pathological score and the number of MVD; The results of CEUS examination were consistent with those of pathological examination, with a consistency rate of 68.79%, a good consistency of Kappa=0.63 (0.4 < Kappa ≤ 0.75), and a statistical significance (P<0.01). Conclusion Routine ultrasound combined with CEUS examination is a noninvasive, accurate and reliable method to evaluate the stability of carotid artery plaques before carotid stenosis surgery.