双能量CT和320排CT冠状动脉减影技术的临床应用

双能量CT与320排CT目前已广泛应用于临床,在心血管相关检查领域也得到较多应用。冠状动脉CT血管成像具有较高的阴性预测值,一定程度上避免了不必要的有创操作,但因为钙化斑块及金属支架产生的硬化伪影,对评估冠状动脉管腔狭窄程度造成了干扰,导致狭窄程度被过分评估或无法评估,故减影技术被应用于冠状动脉成像,通过去除钙化斑块及支架,从而显示出真实管腔,减少了对管腔狭窄程度的误判。现就双能量CT及320排CT减影技术的原理、发展、临床应用以及不足之处进行阐述。     

颈动脉彩色多普勒超声监测脑梗死复发的研究

目的通过使用多普勒彩超技术对颈动脉内膜厚度(IMT)、颈动脉狭窄程度及颈动脉斑块的稳定性进行分析,从而为脑梗死的复发提供监测及预防脑梗死的复发提供临床依据。方法选取102例脑梗死患者,分为初发脑梗死患者和复发脑梗死患者两组,使用多普勒彩超技术对颈动脉内膜厚度(IMT)、颈动脉狭窄程度及颈动脉斑块的稳定性质进行检测。结果初发组的IMT厚度为(0.95±0.19)mm,复发患者的厚度为(1.06±0.15)mm,复发患者颈动脉内膜增厚并且显著厚于初发组。同时复发组的斑块总例数、不稳定斑块例数以及颈动脉血管狭窄程度要显著高于初发组。结论通过多普勒彩超技术对颈动脉内膜厚度(IMT)、颈动脉狭窄程度及颈动脉斑块的稳定性进行监测,可以作为脑梗死复发的预报指标,是预防脑梗死复发的重要措施。     

高分辨率磁共振成像在颅内动脉粥样硬化中的应用

颅内动脉粥样硬化性狭窄(intracranial atherosclerotic stenosis, ICAS)是中国卒中患者的主要病因。如何通过影像学检查准确发现和识别易损斑块, 加强对ICAS患者缺血性卒中的预测和防治, 是临床需要解决的关键问题, 也是当前面临的挑战。随着磁共振血管壁成像在ICAS中的应用, 影像学检查为临床提供了除狭窄程度之外更多关于狭窄处血管结构和斑块稳定性的有用信息, 提高了对ICAS的评估能力, 推动了ICAS朝着更精准的诊疗方向发展。     

彩超对颈动脉非稳定性斑块的诊断分析

目的分析彩色多普勒超声对颈动脉非稳定性斑块进行临床诊断的意义。方法随机选取我院2010年~2016年的60例缺血性脑卒中患者的临床资料进行回顾性分析。结果本组60例患者采用彩色多普勒超声进行诊断,53例患者发现颈动脉斑块,7例患者未发现颈动脉斑块。按斑块稳定性分析,53例患者其中11例考虑稳定性斑块,42例考虑非稳定性斑块;按血管狭窄率分析,53例患者狭窄率70%的合计9例,狭窄率低于70%的患者合计44例。结论颈动脉非稳定性斑块引发的脑卒中,较斑块管腔狭窄引发的脑卒中更多。彩色多普勒超声发现非稳定性斑块并作出评估,对于干预患者的发病以及预后具有更大的临床意义。     

超声造影对颈动脉粥样硬化斑块稳定性评估的研究进展

脑缺血性疾病患者中约20%有颈动脉粥样硬化斑块。大量证据表明,斑块的稳定性而非血管腔狭窄程度在脑血管疾病的发病中发挥关键作用。约25%～50%的缺血性脑卒中与易损斑块脱落有关,而斑块内新生血管形成是斑块不稳定的重要标志之一。近年来,超声造影技术通过对斑块内新生血管的诊断,被广泛应用于颈动脉粥样硬化斑块的稳定性评估。     

冠脉内斑块性质的影象学检测

在冠心病的发生、发展和转归中，冠脉内斑块的性质较其导致的管腔狭窄程度更具有决定意义。正确评估冠脉内斑块性质可指导冠心病的危险分层和临床治疗。本文就检测冠脉内斑块性质的影象学技术作一综述。     

64层螺旋CT冠状动脉成像及冠状动脉彩色编码技术的临床应用

目的探讨64层螺旋CT冠状动脉成像及冠状动脉彩色编码技术在冠心病诊断的临床应用。方法对74例临床拟诊冠心病的患者进行64层螺旋CT冠状动脉成像检查。重建冠状动脉图像,显示冠状动脉分支血管,测量冠状动脉狭窄程度、长度;对检出的86段粥样硬化斑块采用彩色编码技术进行标记和测算。结果64层螺旋CT冠状动脉成像受心率影响较大,在控制心率≤70次／min时,冠状动脉1-13段血管97．4％（823／845）图像质量为1级,粥样硬化斑块及冠状动脉狭窄清晰显示。彩色编码技术检出不稳定斑块27块,其中19个斑块导致冠状动脉26％～50％狭窄,5个斑块导致冠状动脉51％-75％狭窄。结论64层螺旋CT冠状动脉成像及冠状动脉彩色编码技术可以非创伤性地显示冠状动脉狭窄程度及导致冠状动脉狭窄的斑块中各成分形态、分布及比例,可作为对冠心病患者进行筛查及初步预后评估的首选方法。     

冠脉内斑块性质的影象学检测

在冠心病的发生，发展和转归中，冠脉内斑块的性质较其导致的管腔狭窄程度更具有决定意义。正确评估冠脉内斑块性质可指导冠心病的危险分层和临床治疗。本文就检测冠脉内斑块性质的影象学技术作一综述。     

高血压患者心外膜脂肪体积与冠状动脉狭窄程度和斑块稳定性的关系

目的探讨高血压患者心外膜脂肪体积(EATV)与冠状动脉狭窄严重程度及斑块稳定性的关系。方法选取2018年4月至2019年7月采用64排CT检查的高血压患者210例为研究对象。计算各患者对应的EATV,依据检查结果确定高血压患者的冠状动脉是否存在斑块及斑块类型,斑块患者共148例为观察组,其中混合斑块患者56例,钙化斑块患者39例,非钙化斑块患者53例;无斑块患者62例作为对照组。采用Gensini积分系统评估高血压患者冠状动脉狭窄严重程度。比较高血压患者EATV大小与冠状动脉狭窄严重程度的相关性。比较不同斑块类型的高血压患者EATV情况及斑块组中高血压患者EATV大小与冠状动脉斑块稳定性的关系。结果观察组患者EATV大于对照组(P0.05);观察组患者Gensini积分高于对照组(P0.01)。混合型斑块高血压患者EATV钙化斑块高血压患者EATV非钙化斑块高血压患者EATV(P0.05)。斑块组中EATV≥85 mL高血压患者斑块不稳定发生率大于EATV85 mL者(P0.01)。结论高血压患者EATV与冠状动脉狭窄严重程度及斑块稳定性有关,患者EATV越大,冠状动脉狭窄程度越严重,斑块不稳定发生率越高。     

有症状和无症状颈动脉狭窄患者斑块表面运动的四维超声特征

体外研究证实 ,在动脉硬化斑块破裂导致脑栓塞形成之前就已经发现斑块表面的不对称运动。体内不稳定的动脉硬化斑块在破裂前是否亦有如此的斑块运动 ,目前尚不肯定。作者应用四维超声技术显示动态三维图像 ,系统研究颈动脉狭窄患者斑块表面的变形 ,并定量评估斑块运动。方法　选取 2 2例有症状和 2 3例无症状颈动脉狭窄达 50 %～ 90 %的患者进行四维超声检测 ,以评估斑块的回声性质和表面形态。有症状颈动脉狭窄患者在发病后 4 8小时内行四维超声检查 ,无症状颈动脉狭窄患者四维超声检测后 ,随访 6个月 ,评估斑块的稳定性和临床表现。记录一…     

SPIRAL COMPUTED TOMOGRAPHY ANGIOGRAPHY (SCTA) AND COLOR CODED DUPLEX ULTRASOUND (CCDUS): TWO COMPLEMENTARY DIAGNOSTIC TECHNIQUES FOR ASSESSMENT OF EXTRACRANIAL CEREBRAL ARTERY STENOSIS

Atherosclerotic lesions of the extracranial cerebral arteries account for ischemic stroke in over half of all cases. The risk of stroke associated with symptomatic carotid artery disease is related to the severity of the stenosis. Results of the two major clinical trials, North American Symptomatic Carotid Endarterectomy Trial (NASCET) and European Carotid Surgery Trial (ECST), showed that patients with symptomatic carotid artery disease may benefit from carotid endarterectomy. Therefore, detection and quantification of stenosis are essential. Discrepancies in the angiographic criteria used in both NASCET and ECST trials resulted in continued controversy about the most accurate method of measuring carotid artery stenosis. Moreover, to avoid complications related to the angiography procedure, a good evaluation of vessel wall and plaque composition need to be considered. Both SCTA and CCDUS are non invasive techniques that could overcome angiographic complications and give detailed information on stenosis grading and plaque characteristics. They have been used to evaluate carotid stenosis as a single or combined methods.     

Spiral computed tomography angiography (SCTA) and color coded duplex ultrasound (CCDUS): two complementary diagnostic techniques for assessment of extracranial cerebral artery stenosis

Atherosclerotic lesions of the extracranial cerebral arteries account for ischemic stroke in over half of all cases. The risk of stroke associated with symptomatic carotid artery disease is related to the severity of the stenosis. Results of the two major clinical trials, North American Symptomatic Carotid Endarterectomy Trial (NASCET) and European Carotid Surgery Trial (ECST), showed that patients with symptomatic carotid artery disease may benefit from carotid endarterectomy. Therefore, detection and quantification of stenosis are essential. Discrepancies in the angiographic criteria used in both NASCET and ECST trials resulted in continued controversy about the most accurate method of measuring carotid artery stenosis. Moreover, to avoid complications related to the angiography procedure, a good evaluation of vessel wall and plaque composition need to be considered. Both SCTA and CCDUS are non invasive techniques that could overcome angiographic complications and give detailed information on stenosis grading and plaque characteristics. They have been used to evaluate carotid stenosis as a single or combined methods.     

有症状颈动脉狭窄患者颈动脉斑块的稳定性:高分辨率磁共振成像研究

目的 探讨高分辨率磁共振成像(high-resolution magnetic resonance inaging,HR-MRI)评价有症状颈动脉狭窄患者斑块稳定性的价值以及不稳定斑块和血管重度狭窄的危险因素.方法 纳入有症状颈动脉狭窄患者,通过HR-MRI评价有症状颈动脉狭窄患者颈动脉斑块成分判断斑块的稳定性.收集行颈动脉内膜切除术患者的颈动脉斑块进行病理学检查,比较术前HR-MRI与术后病 理学检查结果的一致性.收集所有患者的临床资料,分析颈动脉斑块稳定性和血管狭窄程度的危险因素.结果 共219例狭窄程度＞50％的有症状颈动脉狭窄患者接受HR-MRI检查.其中102例(46.6％)存在稳定斑块,117例(53.4％)患者存在不稳定斑块;118例(53.9％)中度狭窄,101例(46.1％)重度狭窄.35例患者接受颈动脉内膜切除术,其中19例(54.3％) HR-MRI显示斑块不稳定,20例(57.1％)病理学检查显示斑块不稳定,二者高度一致(κ =0.942,P＜0.001).不稳定斑块组男性(P=0.007)、高脂血症(P=0.013)、吸烟(P＜0.001)的患者构成比以及总胆固醇(P=0.001)、低密度脂蛋白胆固醇(P＜0.001)和空腹血糖(P=0.001)水平显著高于稳定斑块组.多变量logistw 回归分析显示,男性[优势比(odds ratio,OR)2.33,95％可信区间(confidence interval,CI) 1.08 ～ 5.04;P=0.032]、吸烟(OR 3.45,95％ CI 1.67～7.14;P=0.001)和空腹血糖水平较高(OR 1.26,95％ CI 1.07～1.48;P =0.006)是斑块不稳定的独立危险因素.中度狭窄组与重度狭窄组患者的所有资料均未显示出显著性差异.结论 HR-MRI能准确评估有症状颈动脉狭窄患者的斑块稳定性.性别、吸烟和空腹血糖增高是颈动脉不稳定斑块的独立危险因素.     

复合手术在颈动脉狭窄病变治疗中的初步应用

目的探讨颈动脉内膜切除术（CEA）联合其他术式（一站式复合手术）在治疗复杂性颈动脉狭窄病变中的临床意义。方法回顾性分析2010年3月-2013年10月因复杂缺血性颈动脉病变（包括颈动脉颅外段多处重度狭窄、单支颈动脉颅外段串联狭窄、支架内再狭窄、颈总动脉或颈内动脉完全闭塞）在首都医科大学宣武医院和山东省聊城市人民医院行一站式复合手术的10例患者的临床资料。复合手术方式分为3类,①病变侧CEA＋支架置入术;②颈动脉直视下支架置入术;③CEA＋透视下球囊导管取栓术。结果①2例接受CEA＋支架置入术的患者,术后影像学检查示闭塞或重度狭窄的血管管腔狭窄消失、血运恢复,头晕、肢体麻木、乏力、黑蒙等症状明显改善;②2例接受颈动脉直视下支架置入术的患者,术后影像学检查示狭窄的血管重新成形,血运良好,患者头痛、头晕等症状得以改善或未再加重;③6例接受CEA＋透视下球囊导管取栓术的患者,术后影像学检查示闭塞或重度狭窄的颈动脉开通、血运恢复,患者一侧肢体乏力、头晕、发作性头痛等症状得以缓解或未再加重。④随访患者6～24个月,影像学复查显示无再狭窄发生,再通血管血流通畅,颅内血供较术前明显改善。结论一站式复合手术可有效解除颈动脉分又过高或斑块远端过高、颈动脉串联样狭窄、颈内动脉合并颈总动脉狭窄、支架术后再狭窄等单一传统手术无法完成的复杂的狭窄性颈动脉病变。     

脑心通胶囊治疗颈动脉粥样硬化斑块的疗效观察

目的观察脑心通胶囊对颈动脉粥样硬化斑块的治疗作用及其对心脑血管事件的影响。方法将符合入选标准的400例颈动脉粥样硬化斑块患者随机分为治疗组（200例）和对照组（200例）。治疗组予以脑心通胶囊4粒口服,3次/d;对照组给予阿司匹林100mg口服,1次/d,治疗期为1年。两组均随访1年,在治疗初始和随访1年时行彩色多普勒超声检查颈动脉内径、血流阻力、斑块稳定性与颈动脉狭窄率,对疗效进行评价并记录心脑血管事件。结果治疗后颈动脉内径、血流阻力、斑块稳定性、颈动脉狭窄率及斑块积分等方面比较,治疗组均优于对照组,差异有统计学意义。治疗组患者的心脑血管事件少于对照组。结论 脑心通胶囊能有效地干预颈动脉粥样硬化斑块的发生发展并减少心脑血管事件的发生。     

多层螺旋CT冠心病诊断进展

随着现代医学影像学技术的发展,多层螺旋CT（MSCT）冠状动脉成像技术目前作为临床诊断冠心病（CHD）首选的无创性检查方法,近年已成为影像学研究的热点。本文通过MSCT对冠状动脉钙化、狭窄、斑块性质、术后改变、心脏功能5个方面评价的综合分析,综合阐述了MSCT在诊断CHD中发挥的重要作用。     

Assessment of Carotid Artery Stenosis and the Use of Statins

General thinking has previously centered on managing carotid artery stenosis (CAS) by carotid endarterectomy and subsequently, stenting for higher risk patients. However for CAS and other forms of vascular disease, especially when asymptomatic, there is new emphasis on defining underlying mechanisms. Knowledge of these mechanisms can lead to medical treatments that result in possible atherosclerotic plaque stabilization, and even plaque regression, including in the patient with CAS. For now, the key medication class for a medical approach are the statins. Their use is supported by good cardiovascular clinical trial evidence including some directed carotid artery studies, especially with a demonstrated decrease in carotid intima-media thickness. Procedural controversy still exists but the current era in medicine offers significant support for medical management of asymptomatic CAS while techniques to recognize the vulnerable plaque evolve. If CAS converts to a symptomatic status, early referral for endarterectomy or stenting is indicated.     

PLACD-7T Study: Atherosclerotic Carotid Plaque Components Correlated with Cerebral Damage at 7 Tesla Magnetic Resonance Imaging

Introduction:

In patients with carotid artery stenosis histological plaque composition is associated with plaque stability and with presenting symptomatology. Preferentially, plaque vulnerability should be taken into account in pre-operative work-up of patients with severe carotid artery stenosis. However, currently no appropriate and conclusive (non-) invasive technique to differentiate between the high and low risk carotid artery plaque in vivo is available. We propose that 7 Tesla human high resolution MRI scanning will visualize carotid plaque characteristics more precisely and will enable correlation of these specific components with cerebral damage.

Study objective:

The aim of the PlaCD-7T study is 1: to correlate 7T imaging with carotid plaque histology (gold standard); and 2: to correlate plaque characteristics with cerebral damage ((clinically silent) cerebral (micro) infarcts or bleeds) on 7 Tesla high resolution (HR) MRI.

Design:

We propose a single center prospective study for either symptomatic or asymptomatic patients with haemodynamic significant (70%) stenosis of at least one of the carotid arteries. The Athero-Express (AE) biobank histological analysis will be derived according to standard protocol. Patients included in the AE and our prospective study will undergo a pre-operative 7 Tesla HR-MRI scan of both the head and neck area.

Discussion:

We hypothesize that the 7 Tesla MRI scanner will allow early identification of high risk carotid plaques being associated with micro infarcted cerebral areas, and will thus be able to identify patients with a high risk of periprocedural stroke, by identification of surrogate measures of increased cardiovascular risk.     

What's happening in carotid stent? A case report of prominent plaque protrusion after carotid artery stenting observed on angioscopy

Thromboembolic complications after carotid artery stenting (CAS) remain an unsolved problem, and several intravascular imaging tools have been proposed to clarify the mechanism of these complications. We report a case of intraprocedural plaque protrusion revealed by angioscopy. A 64-year-old woman underwent CAS for left carotid artery stenosis. After stent placement, optical frequency domain imaging demonstrated some plaque protrusion, and angioscopy showed prominent mobile plaque fragments protruding into the vessel between stent struts and confirmed the coverage of the protruded plaque after the overlapping stent was placed. Compared with other tools, angioscopy more clearly revealed plaque protrusion in the vessel after CAS.     

三维超声血管斑块定量分析技术诊断颈动脉血管狭窄及斑块特征的应用

目的 探讨实时三维超声（real-time 3D ultrasound,RT-3DU）血管斑块定量分析（vascular plaque quantification,VPQ）技术诊断颈动脉血管狭窄及斑块特征的应用。 方法 对2020年1月~2021年1月于新疆医科大学第七临床医学院接受RT-3DU检查的颈动脉斑块患者40例（颈动脉斑块共57处）进行分析,应用RT-3DU VPQ技术检测颈动脉相关参数,同时应用动脉CT血管造影术检测颈动脉狭窄程度,比较分析两种方式诊断颈动脉狭窄程度的一致性。 结果 在40例颈动脉斑块患者中,其颈动脉内中膜厚度为（1.33 ± 0.14）mm,斑块回声强度为（36.29 ± 7.51）dB,标化壁指数（NWI）为（0.64 ± 0.18）,57处颈动脉斑块厚度为（3.6 ± 0.5）mm。轻度、中度及重度狭窄组患者的NWI比较差异显著（P<0.05）,且重度狭窄组患者的NWI高于轻度及中度狭窄组,中度狭窄组患者的NWI高于轻度狭窄组（P<0.05）。RT-3DU VPQ检查诊断颈动脉局部管腔存在9处轻度狭窄,43处中度狭窄,5处重度狭窄;动脉CT血管造影检查诊断颈动脉局部管腔存在6处轻度狭窄,38处中度狭窄,13处重度狭窄。RT-3DU VPQ和动脉CT血管造影检查诊断颈动脉局部管腔狭窄程度的一致性较高（Kappa=0.819）。 结论 对于颈动脉斑块患者,应用RT-3DU VPQ技术可测定其血管狭窄程度,还可量化分析斑块回声强度、累及部位血管负荷变化。