三维超声检查在评估CEA后再狭窄中的作用

目的 探讨三维超声在评估颈动脉内膜斑块切除术（CEA）后再狭窄中的价值。方法 回顾性分析2016年3月至2020年2月CEA治疗的272例颈动脉狭窄的临床资料。采用三维超声定量检测术前颈动脉斑块灰阶中位数值（GSM）、总体积（TPV）、GSM/TPV和最大横截面积，以及手术前后残余管腔面积。术后随访6~53个月，中位时间28.5个月，超声或CTA显示残余管腔面积小于术后50%定义为术后再狭窄。结果 272例中，术后发生再狭窄25例再狭窄组；9.19%（25/272）]；再狭窄程度55~89%，平均（74.6±10.3）%。247例未发生再狭窄（未狭窄组）。与未狭窄组相比，再狭窄组术前GSM明显降低（P<0.05），术后残余管腔面积明显缩小（P<0.05）。两组术前TPV、GSM/TPV、最大横截面积和术前残余管腔面积无统计学差异（P>0.05）。ROC曲线分析结果显示，术前GSM和术后残余管腔面积判断术后再狭窄的曲线下面积分别为0.854（95%置信区间0.798~0.967；P<0.05）、0.866（95%置信区间0.802~0.946；P<0.05），最佳临界值分别为36.8、139.7 mm2。术前GSM≤36.8预测术后再狭窄的敏感性和特异性分别为84.3%和76.8%。术后残余管腔面积≤139.7 mm2预测再狭窄的敏感性和特异性分别为86.9%和80.5%。结论 CEA治疗单发粥样斑块导致的颈动脉狭窄仍有一定的再狭窄率；三维超声检测颈动脉斑块的多个参数对评估术后再狭窄有较好的应用价值，尤其是GSM和术后残余管腔面积。

Value of three-dimensional ultrasound in evaluation of restenosis after carotid endarterectomy

Objective To explore the value of three-dimensional ultrasound in the evaluation of restenosis after carotid endarterectomy(CEA).Methods The clinical data of 272 patients with carotid stenosis who underwent CEA from March 2016 to February 2020 were analyzed retrospectively.Three-dimensional ultrasound was used to quantitatively analyze the median gray scale value(GSM),total volume(TPV)of carotid plaque,ratio of GSM to TPV(GSM/TPV),maximum cross-sectional area,and residual lumen area before and after the operation.Postoperative follow-up ranged from 6 to 53 months,with a median time of 28.5 months.The postoperative restenosis was defined that the residual lumen area was less than 50%using ultrasound or CTA.Results Of 272 patients,25 patients(9.19%,25/272)had restenosis after the operation,and the degree of restenosis ranged from 55%to 89%,with an average of(74.6±10.3)%.Two hundred and forty-seven patients had no restenosis(non-stenosis group).Compared with the non-stenosis group,the preoperative GSM and the residual lumen area significantly reduced in the restenosis group after the surgery(P<0.05).There was no significant difference in preoperative TPV,GSM/TPV,maximum cross-sectional area and preoperative residual lumen area between the two groups(P>0.05).ROC curve analysis results showed that the areas under curve for preoperative GSM and postoperative residual lumen area to judge postoperative restenosis were 0.854(95%confidence interval 0.798~0.967;P<0.05)and 0.866(95%confidence interval 0.802~0.946;P<0.05),and the best cut-off values were 36.8 and 139.7 mm2,respectively.The sensitivity and specificity of preoperative GSM≤36.8 for predicting postoperative restenosis were 84.3%and 76.8%,respectively.The sensitivity and specificity of postoperative residual lumen area≤139.7 mm2 for predicting restenosis were 86.9%and 80.5%,respectively.Conclusions There is a certain restenosis rate after the CEA due to single carotid atherosclerotic plaque.Multiple parameters of carotid plaque detected by three-dimensional ultrasound have a good application value in evaluating the postoperative restenosis,especially GSM and postoperative residual lumen area.