颈动脉超声和能谱CT以及MR高分辨率管壁成像诊断颈动脉斑块稳定性的临床价值

  目的  探讨颈动脉超声(US)、能谱CT和MR高分辨率管壁成像(HR-VWI)3种不同诊断方式对颈动脉斑块稳定性的诊断效能。  方法  收集2018年1月—2020年6月于商丘市第一人民医院接受颈动脉内膜剥脱手术的颈动脉粥样硬化患者42例。所有患者均行US、能谱CT和MR HR-VWI检查，以斑块病理分析结果为金标准，判断US、能谱CT、MR HR-VWI对颈动脉斑块稳定性的诊断价值。  结果  42例患者术后共取得53块斑块。US检查共检出43块斑块; 能谱CT检查共检出49块斑块，不同成分的斑块能谱曲线斜率及有效原子序数由高到低依次为:钙化斑块、内部出血斑块、纤维斑块以及脂质斑块，不同成分的斑块能谱曲线斜率及有效原子序数相比，差异有统计学意义(均P＜0.05)；MR HR-VWI检查共检出51块斑块。以病理结果为金标准，能谱CT与MR HR-VWI检出率、准确度、特异度和灵敏度均高于US(均P＜0.05)。能谱CT和MR HR-VWI诊断颈动脉斑块稳定性的曲线下面积为0.819(95% CI:0.698~0.941)和0.859(95% CI:0.750~0.967)，均高于US(0.669，95% CI:0.517~0.821)。  结论  能谱CT、MR HR-VWI对颈动脉斑块成分分析以及斑块稳定性的诊断效能均优于US，可为颈动脉斑块稳定性的诊断和治疗方法的选择提供临床参考依据。 

Clinical value of carotid ultrasound,energy spectral CT and MR high-resolution vessel wall imaging in judging the stability of carotid artery plaque

  Objective  To explore the diagnostic efficacy of carotid artery ultrasound (US), energy spectral CT and MR high-resolution wall imaging (HR-VWI) in the stability of carotid plaque.  Methods  A total of 42 patients with carotid atherosclerosis undergoing carotid endarterectomy were selected from January 2018 to June 2020 in the Shangqiu First People' s Hospital. All patients underwent US, energy spectral CT and MR HR-VWI examinations. The diagnostic values of US, energy spectral CT and MR HR-VWI in evaluating the stability of carotid plaques were judged based on the pathological analysis results of plaques as the gold standard.  Results  A total of 53 plaques were obtained from 42 patients after surgery. A total of 43 plaques were detected by US examination, and 49 plaques were detected by energy spectral CT. The slopes of energy spectrum curves and effective atomic numbers of plaques with different components were calcified plaque, internal bleeding plaque, fibrous plaque and lipid plaque from high to low. Significant differences were found in the slopes of energy spectrum curves and effective atomic numbers of plaques with different components (all P < 0.05). A total of 51 plaques were detected by MR HR-VWI. With the pathological results as the gold standard, the detection rates, accuracy, specificity and sensitivity of energy spectral CT and MR HR-VWI were higher than those of US (all P < 0.05). Both energy spectral CT and MR HR-VWI showed a higher area under the curve of 0.819 (95% CI: 0.698-0.941) and 0.859 (95% CI: 0.750-0.967), respectively, for the diagnosis of carotid plaque stability than US (0.669, 95% CI: 0.517-0.821).  Conclusion  Energy spectral CT and MR HR-VWI are superior to US in the analysis of carotid plaque composition and plaque stability, providing clinical reference for the diagnosis of carotid plaque stability and the selection of treatment methods.