目的:以病理性斑块内出血为金标准,评价超声预测颈动脉易损斑块破裂风险的临床应用价值。
方法:共纳入118例因症状性颈动脉狭窄而接受动脉内膜切除术的患者。常规超声评估斑块厚度,面积狭窄率,回声,和表面形态。通过对比增强超声(CEUS)和追踪斑块内非增强区域评估新生血管形成。根据新生血管分级(0-4),斑块被归类为低,中介-,和高风险。病理范围内新鲜斑块内出血作为诊断斑块破裂风险的金标准。因此,我们将患者分为有破裂风险组和无破裂风险组,以使用超声评估斑块破裂风险的关键因素的价值.
结果:在118例患者中,高血压占71.2%,高脂血症68.6%,糖尿病52.5%,和他汀类药物病史64.4%。在破裂风险组中,糖尿病,吸烟,狭窄率明显高于未破裂危险组(P<.001);斑块厚度≥4mm(P>.05);主要是低回声,表面形态不规则(P<.001),斑块中的非增强区域(P<.001),新生血管形成>2级(P<.001)。与低风险组相比,中危组斑块破裂风险高7.219倍,高危组斑块破裂风险高18.333倍.关键超声参数的观察者间一致性kappa值>0.75,组内相关系数为0.919(P<0.01)。
结论:常规超声和超声造影在预测易损颈动脉斑块破裂风险方面均具有重要的临床意义。从而能够进行卒中风险分层和斑块破裂风险评估。
OBJECTIVE: To assess the clinical utility of ultrasound in predicting the risk of carotid vulnerable plaque rupture using pathological intraplaque hemorrhage as the gold standard.
METHODS: A total of 118 patients who underwent endarterectomy due to symptomatic carotid artery stenosis were enrolled. Conventional ultrasound assessed the plaque thickness, area stenosis rate, echo, and surface morphology. Neovascularization were assessed by contrast-enhanced ultrasound (CEUS) and tracing intraplaque nonenhanced areas. According to neovascularization grade (0-4), plaques were classified as low-, intermediate-, and high risk. Fresh intraplaque hemorrhage within the pathology was adopted as the gold standard for diagnosing plaque rupture risk. Thus, we divided patients into ruptured risk and nonruptured risk groups to assess the value of crucial factors for plaque rupture risk using ultrasound.
RESULTS: Of the 118 patients, hypertension accounted for 71.2%, hyperlipidemia 68.6%, diabetes 52.5%, and statin history 64.4%. In the rupture risk group, diabetes, smoking, and stenosis rate were significantly higher than the nonrupture risk group (P < .001); plaque thickness ≥4 mm (P > .05); and mainly hypoechoic with irregular surface morphology (P < .001), nonenhanced areas in the plaques (P < .001), and neovascularization >grade 2 (P < .001). Compared with the low-risk group, plaque rupture risk was 7.219 times higher in the medium-risk group and 18.333 times higher in the high-risk group. The kappa value of the interobserver consistency of crucial ultrasound parameters was >0.75, and the intraclass correlation coefficient was 0.919 (P < .01).
CONCLUSIONS: Both conventional ultrasound and CEUS have significant clinical importance in the prediction of rupture risk in vulnerable carotid plaques, thereby enabling stroke risk stratification and the assessment of plaque rupture risk.