Three-dimensional power-mode ultrasound for quantification of the progression of carotid artery atherosclerosis

Elucidation of the dynamic nature of plaque progression has important implications for clinicians. The present study sought to establish an in vivo method for visualizing structural changes in carotid plaques. Three-dimensional reconstruction of parallel two-dimensional gray-scale B-mode ultrasound combined with power-mode examination of 38 carotid artery plaques was performed in a prospective study of 32 patients (18 men, 14 women; mean age 67.5 ± 7.6 years). Initial mean plaque volume was 391 μl. After a mean of 18.9 months carotid artery plaque progression had occurred in 15% of carotid artery plaques, with plaque volume increasing 59% in these cases. Plaque volume remained constant, within a range of ± 20% in 85% of cases. Progressive plaques were predominantly hypoechoic (3/5 cases) or had an ulcerated surface in cases of a hyperechoic echogenicity (2/5 cases). Risk factors and drug therapy were unrelated to plaque progression. This study illustrates that the combination of three-dimensional ultrasound with power-mode imaging improves the separation of the intraluminal plaque surface from the vessel lumen. Three-dimensional reconstruction of atherosclerotic carotid artery plaques enables the reproducible quantification of plaque volume and is therefore an excellent technique for longitudinal trials assessing progression or regression of carotid artery disease. Received: 14 January 1999/Received in revised form: 27 August 1999/Accepted: 15 October 1999     

Four-dimensional ultrasonographic characterization of plaque surface motion in patients with symptomatic and asymptomatic carotid artery stenosis.

BACKGROUND AND PURPOSE: In vitro studies of atherosclerotic plaque fracture mechanics suggest that analysis of local variations in surface deformability may provide information on relative vulnerability to plaque fissuring or rupture. We investigated plaque surface deformations in patients with symptomatic and asymptomatic carotid artery disease using 4-dimensional ultrasonography and techniques for measuring optical flow. METHODS: Four-dimensional ultrasound examinations of carotid artery plaques were performed in 23 asymptomatic and 22 symptomatic patients with 50% to 90% stenosis of the internal carotid artery. Plaque surface motion during 1 cardiac cycle was computed with a hierarchical model-based motion estimator. Results were compared with plaque echogenicity and surface structure. RESULTS: Of the 45 patients examined, plaque surface motion estimates were obtained for 18 asymptomatic and 13 symptomatic patients. There were no significant differences in echogenicity or surface structure of asymptomatic and symptomatic plaques (P>0.05). Results of motion estimation showed that asymptomatic plaques had surface motion vectors of equal orientation and magnitude to those of the internal carotid artery, whereas symptomatic plaques demonstrated evidence of inherent plaque movement. There was no significant difference in maximal plaque velocity between symptomatic and asymptomatic plaques (P<0.14). Maximal discrepant surface velocity (MDSV) in symptomatic plaques was 3.85+/-1.26 mm/s (mean+/-SD), which was significantly higher (P<0.001) than MDSV of asymptomatic plaques with 0.58+/-0.42 mm/s (mean+/-SD). CONCLUSIONS: ++MDSV of carotid artery plaques is significantly different in asymptomatic and symptomatic disease. Further studies are warranted to determine whether plaque surface motion patterns can identify vulnerable plaques in patients with carotid artery stenosis.     

Volumetric Assessment of Plaque Progression With 3-Dimensional Ultrasonography Under Statin Therapy

BACKGROUND AND PURPOSE: Lowering of serum cholesterol levels with HMG-CoA reductase inhibitors (statins) slowed the progression of atherosclerosis in the carotid arteries in several clinical trials using carotid artery intima media thickness as primary outcome measure. Whereas conventional ultrasonography is limited to thin 2-dimensional image planes, 3-dimensional (3D) ultrasonography provides quantitative measurement of the entire carotid artery plaque volume. This study aims to assess the feasibility of 3D ultrasonography to monitor plaque progression in hypercholesterolemic patients. METHODS: The authors prospectively assessed the progression of 31 carotid artery plaques over 15.1 +/- 4.5 months in a study of 23 patients (6 women, 17 men; mean age = 61.7 +/- 7.5 years) with hypercholesterolemia under therapy with HMG-CoA reductase inhibitors. All patients were maintained on a lipid-lowering diet. Sixteen patients were additionally treated with statins. Quantitative measurements of carotid artery plaque volumes were performed after 3D reconstruction of exactly parallel transverse duplex ultrasound scans (slice distance = 0.1 mm) into volumetric 3D data sets and segmentation of voxels representing the carotid artery plaque. RESULTS: Within the treatment group, plaques were significantly less frequently progressive if they had a hypoechoic echogenicity (11%, n = 9 vs 64%, n = 14; P = .016) or if baseline serum cholesterol levels were above 8.0 mmol/L (9%, n = 11 vs 75%, n = 12; P = .002). CONCLUSION: Three-dimensional ultrasonography extends the measurement of the arterial wall thickness to the 3D volume of an entire atherosclerotic plaque including analysis of its morphology and configuration. However, further clinical trials with an adequate sample size to achieve sufficient statistical power are necessary to assess the effect of statin therapy on plaque progression.     

Smoking habit as a putative risk factor for carotid plaque ulcers

Carotid plaque ulcers are thought to represent a cause for ischemic stroke. However, largely because the lack of reliable diagnostic methods, factors predisposing plaques to ulceration are not known. Based on ultrasound appearances, this study examined associations between carotid ulcers and traditional cardiovascular risk factors. The subjects comprised 1076 patients with carotid plaques as evidenced by ultrasound. Carotid ulcers were diagnosed by the presence of large obvious excavation (≥ 2 mm in depth) on the plaque surface, with a well-defined back wall at its base. As a putative associate for ulcers, severity of plaques was quantified by the plaque score. Prevalence of traditional cardiovascular risk factors was generally higher in patients with ulcers (n = 52) than in those not, so was average plaque score. When controlling for plaque score, smoking habit was found to be associated with 2.2 (95% CI: 1.1 to 4.6) fold higher likelihood for the existence of ulcers. We propose a possible role of smoking habit for the ulceration of carotid plaques.     

Carotid artery disease in patients with retinal vein and artery occlusion]

To evaluate carotid artery disease in patients with retinal vein occlusion (RVO) and with retinal artery occlusion (RAO), 41 RVO patients (male 21, female 20, mean age 63 +/- 12 years) and 59 RAO patients (male 39, female 20, mean age 66 +/- 12 years) were investigated. All patients were examined neurologically and underwent carotid ultrasound examination. Using carotid ultrasound, carotid artery disease was evaluated in terms of presence of plaque, echogenicity of the plaque, degree of stenosis, or presence of ulceration. Carotid plaque or occlusion of the carotid artery was observed more frequently in RAO patients than in RVO patients (ipsilateral side: p < 0.01, contralateral side: p < 0.001; Fisher's exact test). Heterogeneous plaque was found more frequently in RAO patients compared to RVO patients (ipsilateral side: p < 0.01, contralateral side: p < 0.02; Fisher's exact test). Ulcerated plaque was found only in patients with RAO. In conclusion, carotid artery disease was more frequently found in patients with RAO than in patients with RVO.     

Progression of carotid atherosclerosis in Japanese patients with coronary artery disease.

BACKGROUND AND PURPOSE: Along with the recent changes in lifestyle in Japan, the incidence of coronary artery disease has increased while the incidence of stroke appears to be decreasing. We investigated the relation between the progression of carotid atherosclerosis and the severity of coronary artery disease in the Japanese population. METHODS: The 2-year change in extracranial carotid atherosclerosis in 50 Japanese patients who underwent coronary angiography was evaluated using carotid echotomography. To quantify the extent of carotid atherosclerosis, the maximal thickness measurements of all plaques were summed for an individual plaque score, except for new plaques found on reexamination. Carotid disease progression was evaluated by the sum of plaque score change and the thickness of the new plaque found on reexamination. RESULTS: The plaque score changed by -3.2 to 10.1 mm (mean +/- SD, 1.06 +/- 2.42 mm). The extent of coronary atherosclerosis (p less than 0.02) and serum total cholesterol level (p less than 0.01) were different between the progressing (n = 17) and the nonprogressing (n = 30) groups of carotid atherosclerosis when the progressing group included the patients with a delta plaque score of greater than or equal to 1.0 mm. Neither age, serum triglyceride level, serum high-density lipoprotein cholesterol level, pack-years of smoking, percentage of smokers, percentage of hypertensive patients, nor percentage of diabetic patients was different between the two groups. Carotid disease progression was significantly higher in patients with three-vessel coronary disease than in patients without significant coronary artery disease (p less than 0.005). There was a significant positive linear correlation between carotid disease progression and Gensini's coronary artery disease score (R = 0.411, p less than 0.005). CONCLUSIONS: Our data showed that severe coronary artery disease and a high serum total cholesterol level were strong predictors for carotid disease progression in Japanese patients with high rates of coronary artery disease.     

颈动脉粥样硬化斑块与脑梗死的临床相关分析

目的分析颈动脉粥样硬化斑块与脑梗死的关系。方法对临床诊断98例脑梗死(脑梗死组)和同时期的82例非脑梗死患者(对照组)行颈部血管行彩色多普勒超声检查,并对两组颈动脉粥样硬化斑块发生率、大小、性质、好发部位以及颈动脉狭窄程度进行对比分析。结果 1脑梗死组与对照组颈动脉粥样硬化斑块检出率均较高,差异无统计学意义(81.6%vs72.9%,P0.05),但面积大于20mm2斑块的检出率急性脑梗死组显著高于对照组(38.8%vs9.8%,P0.01);2两组颈动脉硬化斑块的分布部位均以颈总动脉分叉处为主,两组间比较,差异无统计学意义(66.6%vs62.7%,P0.05);3两组颈动脉狭窄发生率及程度比较,脑梗死组均高于对照组(χ2=6.98,P0.05)。结论颈动脉粥样硬化斑块形成与脑梗死的有密切相关性,彩色多普勒超声技术对高风险、老年人的脑卒中早期预防及诊治有重要意义。     

颈动脉超声在无症状脑梗死患者中的应用分析

目的分析无症状脑梗死患者的颈动脉超声特点及应用价值。方法选取2015-12—2016-11于我院接受治疗的无症状脑梗死患者40例(观察组),症状性脑梗死40例(症状组),另选取健康体检者32例为对照组,回顾性分析其颈动脉彩超特征。结果斑块检出率、IMT厚度、Crouse斑块积分及斑块形态3组组间比较差异均有统计学意义(P0.05);狭窄程度观察组与对照组比较差异有统计学意义(P0.05),观察组与症状组比较差异无统计学意义(P0.05);3组颈内动脉血流参数比较差异具有统计学意义(P0.05),颈总动脉血流参数观察组与症状组比较差异有统计学意义(P0.05),观察组与对照组比较差异无统计学意义(P0.05)。结论存在颈部动脉硬化及斑块但尚未明确诊断无症状脑梗死者,颈动脉彩超观察斑块的形态和性质尤为重要;诊断明确的无症状脑梗死患者,应常规筛查颈动脉超声评估斑块情况,定期监测颈动脉斑块及血流参数变化,给予早期干预,预防疾病进一步发展。     

Association between arterial bifurcation anatomy and angiographic plaque ulceration among 4,627 carotid stenoses

Stability of atheromatous plaques is influenced by local mechanical and haemodynamic factors, such as plaque motion and shear stress. However, although blood vessel anatomy is an important determinant of haemodynamics, particularly at bifurcations, there have been no previous clinical studies of the association between arterial anatomy and plaque ulceration. We therefore studied arterial anatomy and plaque ulceration using angiograms of 4,627 carotid bifurcations with atheromatous disease from the European Carotid Surgery Trial (ECST). We studied the vessel diameter and area ratios that have been shown in flow models to affect local haemodynamics and shear stress, and which are known to vary widely between and within individuals (internal to common, external to common, external to internal carotid artery and outflow/inflow area). Angiographic plaque surface morphology was defined as ulcerated or not ulcerated. To avoid any potential bias due to selective inclusion of patients in the ECST, we studied the contralateral, and usually asymptomatic, as well as the symptomatic carotid artery. To correct for the effects of systemic factors that might influence plaque stability, we also studied the relationship between the degree of asymmetry of bifurcation anatomy within individuals and the presence of plaque ulceration. Despite considerable inter-individual variation in carotid anatomy, we found no association between the prevalence of angiographic plaque ulceration and any of the anatomical parameters studied in either symptomatic or contralateral carotid arteries. There were also no associations between ipsilateral bifurcation anatomy and plaque ulceration in individuals with unilateral plaque ulceration. Carotid arterial anatomy does not appear to be an important determinant of plaque stability. Other factors that influence local haemodynamics, such as the anatomy and composition of the plaque itself may be more important.     

Ultrasonogram of carotid artery in endoarterectomy patients]

Ultrasonograms of the carotid artery were compared with the intraoperative finding of atheroma plaque in terms of stenosis, fragility, ulceration and calcification. Soft type, intermediate type and these mixed type plaques were fragile plaques in almost all cases. All hard type plaques were tough plaques. The detection of stenosis and calcification was satisfactory, however that of ulceration was not sufficient. The stenotic lesions frequently existed in bilateral carotid arteries and the intima was easy to become thick even after the endoarterectomy. The ultrasonogram was thought to be the essential study for the carotid artery lesions.     

Preoperative B-mode ultrasound plaque appearance compared with carotid endarterectomy specimen histology

In carotid artery stenosis both the degree of the lesion and its plaque morphology are thought to be associated with the carrier's thromboembolic risk. In this study we evaluated the diagnostic preciseness of non-invasively B-mode ultrasound in predicting the histopathological plaque structure. We examined 44 patients with > 50% ICA stenosis by B-mode within 6 weeks prior to carotid endarterectomy. At the affected bifurcations, up to 10 different regions of interest (ROI) per artery were investigated. Plaque appearance was classified according to 6 subtypes considering different ultrasonic plaque features. Postoperatively, plaque specimens were examined histopathologically for their relative content of calcification, fibrous tissue and different soft tissue. B-mode ultrasound was compared with histopathological features in ROI. A total of 265 regions of interest were evaluated. In mainly echolucent types of plaques, atheromatous debris was most frequently seen, whereas fibrosis was rare. Homogeneous echolucent plaques showed a high proportion of cholesterol and/or recent haemorrhage. Thrombosis at the plaque surface was often seen in "completely echolucent" plaque type (each P<0.001). Carotid B-mode ultrasonography is able to predict the histopathological components and the texture of carotid plaques.     

Site of carotid plaque ulceration in relation to direction of blood flow: an angiographic and pathological study

BACKGROUND: Rupture of atherosclerotic plaque is the main cause of acute coronary syndromes and carotid territory ischaemic stroke. Haemodynamic stress is important in early plaque formation and may affect the stability of mature plaques. There is some evidence that macrophage infiltration and plaque rupture tend to localise to the proximal (upstream) part of the plaque where shear stress is highest. However, previous studies have been too small to assess this reliably. We studied the site of ulceration in a large number of carotid plaques. METHODS: We studied angiograms of 3007 symptomatic carotid stenoses, and the pathological appearance of 119 carotid plaques (77 asymptomatic), to identify the presence and position of plaque ulceration. RESULTS: Angiographic ulceration, which was present in 421 patients (14%), was more likely to be PROXIMAL than DISTAL to the point of maximum stenosis (OR = 16.6, 95% CI = 11.6-26.9, p < 0.001). This trend increased with severity of stenosis (p = 0.002). Pathological examination of the 119 carotid plaques also showed that ulceration was more likely to occur proximal to the point of maximum stenosis (OR = 6.1, 95% CI = 2.8-13.6, p < 0.001). CONCLUSIONS: Ulceration of carotid plaques, visible on angiography or on pathological examination, is seen most often in the proximal (upstream) part where shear stress is highest.     

Effect of TRK-100, a stable orally active prostacyclin analogue, on platelet function and plaque size in atherothrombotic strokes

Patients with carotid atheromatous lesions were prospectively studied with indium-111 platelet imaging, platelet aggregability and B-mode real-time ultrasound tests to determine the short-term effects of orally active prostacyclin analogue TRK-100 (40 micrograms, three times daily for 4 weeks). To establish baseline values, all patients underwent indium-111 platelet imaging, platelet aggregation study and B-mode ultrasound. The results were positive for carotid plaque and platelet accumulation. Visual analysis showed repeated platelet scintigrams to be unchanged in five patients without antithrombotic therapy; repeated ultrasound studies showed no change in eight of ten plaques, while one showed progression and one regression of the plaque. In five TRK-100 treated patients, five of seven lesions with platelet accumulation at the baseline became negative, and two remained unchanged during the treatment; repeated B-mode ultrasound tests indicated eight of nine plaques remained unchanged, while one showed plaque size reduction. Quantitative analysis demonstrated that, TRK-100 significantly reduced the ADP aggregation (1 microM) from 55.2 +/- 21.3% to 24.0 +/- 14.7% (+/- SD; p less than 0.05) and the platelet accumulation index (25.7 +/- 17.2% vs 10.4 +/- 10.4%; p less than 0.05). However, there was no significant reduction in plaque scores during TRK-100 therapy compared with the baseline (2.70 +/- 2.75 mm vs 2.51 +/- 2.58 mm). The data obtained suggested that short-term TRK-100 therapy has an inhibitory effect on platelet accumulation in carotid atheroma but does not cause significant changes in plaque size.     

The symptomatic carotid plaque

BACKGROUND: The natural histories of equally severe symptomatic and asymptomatic carotid stenoses are very different, which suggests dichotomy in plaque behavior. The vascular biology of the symptomatic carotid plaque is presented in this review. SUMMARY OF REVIEW: Histology studies comparing asymptomatic and symptomatic plaques were identified from MEDLINE. Reports in which stenosis severity was not stated or not similar for symptomatic and asymptomatic patients were excluded. In vitro studies and reports from the coronary circulation were reviewed with regard to the vascular biology of the plaque. Histology studies comparing carotid plaques removed from symptomatic and asymptomatic patients reveal characteristic features of unstable plaques: surface ulceration and plaque rupture (48% of symptomatic compared with 31% of asymptomatic, P<0.001), thinning of the fibrous cap, and infiltration of the cap by greater numbers of macrophages and T cells. In vitro studies suggest that macrophages and T cells release cytokines and proteinase, which stimulate breakdown of cap collagen and smooth muscle cell apoptosis and thereby promote plaque rupture. CONCLUSIONS: Infiltration of inflammatory cells to the surface of carotid plaques may be a critical step in promoting plaque rupture and resultant embolization or carotid occlusion. Further understanding of cell recruitment and behavior in carotid atherosclerosis may allow better detection of unstable plaques and therapeutic methods of plaque stabilization.     

The unstable plaque

Ischaemic strokes and transient ischaemic attacks are commonly caused by cerebral embolism originating from formation of a platelet-rich thrombus superimposed on an atherosclerotic plaque or by atherothrombotic plaque rupture in a carotid or intracranial artery. Despite advances made through ultrasound imaging in our understanding of atherosclerotic plaque progression and regression, the issue of whether differences in plaque structure alone can distinguish between lesions that become symptomatic and others that remain clinically silent continues to be debated. Recent biochemical and imaging studies have identified characteristics that may reflect a high risk of vulnerability, such as outward, abluminal plaque remodelling, the presence of intra-plaque haemorrhage, inflammation, severe flow disturbances around the encroaching lesion, plaque cap thinning and ulceration, and abnormal plaque motion. Plaque stability may be improved through management of traditional cardiovascular risk factors or with biological or pharmacological agents that target pathways involved in plaque pathophysiology. Unstable plaques place patients at risk of unpredictable ischaemic events and in patients with such lesions, specific preventive treatment beyond long-term antiplatelet therapy can be used to prevent new or recurrent events.     

The short-term effect of atorvastatin on carotid plaque morphology assessed by computer-assisted gray-scale densitometry: a pilot study

Soft, lipid-containing carotid plaques, which appear echolucent on ultrasound imaging, have been associated with increased risk of ischemic stroke. We sought to investigate the effect of short-term treatment with atorvastatin on the change of carotid plaque echodensity. We treated 40 stroke-free and statin-naive subjects with 80 mg atorvastatin daily for 30 days. Computer assisted gray-scale densitometry (GSD) index was calculated at baseline and 30 days after treatment from the normalized plaque images. A multiple logistic regression was used to assess the effect modification of low-density lipoprotein (LDL) cholesterol on plaque stabilization after adjusting for age, sex, and smoking. The average number of carotid plaques at baseline was 2 (range: 0-5; 27 subjects with carotid plaque) and did not change 30 days following atorvastatin treatment. The mean GSD index significantly increased from 73±16 (range: 1-125) at baseline to 89±15 (range: 1-137) at 30 days after treatment (P<0.05). The adjusted odds ratio for the positive GSD plaque index change (vs. no change or decreased gray-scale median (GSM) index) was 1.71 (95% confidence interval: 1.1-7.6, P<0.01). In conclusion, we observed decreased echolucency (increased echodensity) of carotid artery plaques after short-term treatment with atorvastatin.     

高血压患者颈动脉粥样硬化斑块与发生脑梗死的相关关系

目的探索高血压患者颈动脉粥样硬化斑块与发生脑梗死的相关关系。方法选取2014年1月至2015年3月期间在本院住院的148例高血压患者作为研究对象,其中男性85例,女性63例,根据患者是否有脑梗死病史,分为梗死组和非梗死组。其中梗死组患者65例,非梗死组患者83例。利用高频超声技术检测并记录两组患者的颈动脉内—中膜厚度(IMT)、粥样斑块位置及大小、管腔狭窄程度和回声强度。结果梗死组患者27例IMT增厚,33例斑块形成,其IMT增厚、斑块形成的发生例数均明显高于非梗死组,差异有统计学意义(χ~2=17.418,P0.001);梗死组患者IMT厚度、斑块大小以及回声强度均明显大于非梗死组,差异有统计学意义(t=32.143、32.826、12.639;均P0.001);梗死组患者管腔狭窄程度超过50%的有29例,非梗死组管腔狭窄程度超过50%的有18例,梗死组患者的管腔狭窄程度明显比非梗死组严重,差异有统计学意义(χ~2=8.843,P=0.003)。结论高血压患者颈动脉粥样硬化斑块形成及其性质与发生脑梗死密切相关,对高血压患者定期行颈部动脉彩色多谱勒超声扫查,及时了解患者颈动脉斑块形成情况,积极采取干预措施,对于预防以及诊治脑梗死具有重大的临床意义。     

Prevalence of extracranial carotid artery disease detectable by echo-Doppler in an elderly population.

BACKGROUND AND PURPOSE: Little information is available on extracranial carotid artery disease in free-living elderly individuals. We sought to evaluate the prevalence of carotid lesions in the elderly. METHODS: Using echo-Doppler, we assessed the prevalence of possible atherosclerotic lesions in the internal carotid arteries (n = 478) and the external and common carotid arteries (n = 956) of 239 subjects 65-94 years of age living in retirement homes in Seattle, Wash. RESULTS: We found that 152 (31.8%) internal carotid arteries were affected by nonstenosing plaque and 37 arteries (7.7%) had stenosis or occlusion. In addition, 193 (20.2%) external or common carotid arteries showed nonstenosing plaques. There were 128 subjects (53.6%) with internal carotid disease, 106 (44.3%) with evidence of external or common carotid disease, and 75 (31.4%) affected by disease in all three sites. There were 80 subjects (33.5%) with no ultrasound evidence of carotid disease. We found that the presence and severity of carotid disease increased between the decades 65-74 and 75-84. We also demonstrated a positive association between systolic blood pressure and ultrasound evidence of carotid disease that was independent of age. CONCLUSIONS: The prevalence of extracranial artery disease in an apparently healthy population was high, although stenoses in most instances were not severe. We conclude that noninvasive ultrasound methods identify a relatively small fraction of individuals (5% of the total) at high risk for stroke or transient ischemic attack. Echo-Doppler might be used to monitor further disease progression and to evaluate the efficacy of different therapeutic or preventive interventions.     

颈动脉粥样硬化易损斑块超声标志与脑血管疾病关系的研究进展

颈动脉粥样硬化易损斑块与缺血性脑血管事件的发生密切相关。颈动脉超声不仅可以量 化颈动脉狭窄程度,还可以评估颈动脉粥样硬化斑块的易损性。三维超声可定量评估颈动脉粥样硬 化斑块的体积,超声造影可显示斑块内新生血管的密度及分布区域,剪切波弹性成像可测定斑块组 织的硬度,反映斑块不同部位的组织成分。颈动脉超声技术的发展使其在缺血性卒中诊疗领域中的 应用更加广泛,对颈动脉血流动力学和管壁的评价更加精确,有助于临床判断脑血管事件的风险并 进行相应的干预。     

微血流模式背景下超声造影评估颈动脉斑块稳定性的价值

目的 评估微血流模式造影在计量位于颈动脉之间斑块内新长出的血管密度与数量的临床价值.方法 选取郑州大学第一附属医院148例颈动脉粥样硬化患者,共255枚颈动脉斑块,主要包括低回声和混合回声的斑块.常规超声扫查患者双侧颈动脉,同时记录斑块的相关信息,然后对颈动脉斑块进行超声造影(CEUS)检查及微血流模式(SMI)环境下...