多层螺旋CT血管造影在颈部动脉狭窄扩张和支架置入术中的临床应用

目的:探讨多层螺旋CT血管造影(MSCTA)诊断颈部动脉狭窄和粥样硬化斑块及其在血管腔内球囊扩张和支架置入术中的价值。材料和方法:对105例症状性颈部动脉硬化狭窄患者进行MSCTA检查,其中24例于MSCTA检查前后2周内进行了数字减影血管造影(DSA)检查,49例进行了彩色多普勒超声(CFDS)检查。MSCTA扫描横断面轴位图像应用三维重建技术作图像后处理,每段病变动脉的狭窄程度和成分比例由GEAW4.3工作站AVA软件自动测量。其中狭窄程度与DSA相比较,评价MSCTA自动测量血管诊断颈部动脉狭窄的准确性。粥样硬化斑块密度分析与CFDS相比较,评价MSCTA彩色编码技术分析成分比例的准确性。结果:以DSA为金标准,MSCTA影像判断颈部动脉硬化狭窄患者病变动脉≥70%狭窄的敏感性为96.4%,特异性为91.0%,阴性预测率为97.6%,阳性预测率为86.9%,准确性为93.1%。MSCTA检出的粥样硬化斑块图密度分析与CFDS的符合率为80.3%,其中诊断钙化斑块的敏感性为83.3%,特异性为98.2%,准确性为96.7%,阴性预测率为98.2%,阳性预测率为83.3%。结论:MSCTA影像判断颈部动脉硬化狭窄患者病变动脉≥70%狭窄以及诊断钙化斑块有较高的敏感性、特异性和准确性,有助于制订手术方案,选择介入材料及对术中病变部位栓子脱落危险性的评估。     

132例中青年缺血性脑卒中颈动脉硬化危险因素分析

目的探讨中青年缺血性脑卒中颈部动脉硬化危险因素。方法对132例缺血性脑卒中患者行颈动脉彩色多普勒超声检查和危险因素进行回顾性分析,分别检查颈总动脉、颈总动脉窦部及颈内外动脉。结果 132例中有89例颈动脉检出粥样硬化斑块,检出率67.42%,颈动脉单纯内膜增厚41例,检出率46.06%。斑块形成48例,约占89例颈部动脉硬化53.93%。结论原发性高血压、脂肪肝、吸烟、血糖异常等是中青年缺血性脑卒中颈部动脉硬化得主要危险因素。     

SonoCT成像技术诊断甲状腺疾病的价值

目的 :探讨实时复合成像 (SonoCT)技术对甲状腺疾病的诊断价值。材料和方法 :对比分析 49个甲状腺病灶的SonoCT与普通超声实时成像结果。结果 :SonoCT对病灶边界及内部回声等状况的显示明显优于普通实时成像 ,对小病变尤为明显。结论 :SonoCT能清楚显示病灶边界及内部回声 ,提高诊断准确性。     

实时复合成像和极端分辨率技术诊断乳腺肿块的临床价值

目的:探讨实时复合成像(SonoCT)、极端分辨率技术(Xres)成像技术在诊断乳腺肿块中的应用价值.材料和方法:对比分析48例乳腺肿块的普通超声成像与SonoCT、Xres成像.结果:SonoCT、Xres成像技术对病灶边界及内部回声等状况的显示明显优于普通超声.结论:SonoCT、Xres成像技术能清晰显示肿块边界、内部回声及边缘特征,具有较高的临床应用价值.     

超声对颈动脉斑块稳定性相关因素的研究

目的：探讨颈动脉粥样硬化斑块稳定性的相关因素。方法：使用颈部血管超声检查方法，分别检测颈部血管8个位点的血管内径、内膜-中膜厚度（IMT），并对IMT、IMTarea、MIMT、斑块积分、超声声像分型等指标进行分析。结果：IMT、IMTarea、MIMT、血管内径、斑块积分、颈动脉管腔狭窄程度与斑块稳定性密切相关。结论：颈动脉超声检查可作为检测颈动脉粥样硬化斑块稳定性的重要手段。     

SonoCT诊断技术在结节性甲状腺肿显像中的应用

SonoCT诊断技术因其可以获得比普通超声扫描多几倍的图像信息,在国外早期应用研究中,特别是针对乳腺肿块的检测获得较好的效果~([1]).本研究采用SonoCT诊断技术对结节性甲状腺肿(结甲)的非同类结节进行观察,从形态、边界、内部回声等结构变化与普通超声进行对比研究,评价该技术的实际临床应用价值.     

靶向超声造影评价兔腹主动脉粥样硬化的实验研究

目的探讨超声造影剂的靶向制备技术;评价携CD54单抗的超声造影剂在动脉粥样硬化诊断中的靶向价值和意义.方法整合CD54单克隆抗体及白蛋白微泡制备靶向超声造影剂.新西兰大白兔20只,高脂饮食建立动脉粥样硬化模型并随机分两组,分别使用普通和靶向造影剂行腹主动脉超声造影.视频密度法评价两种造影剂对腹主动脉内膜和粥样硬化斑块的造影增强效应.结果两组造影后血管内膜和粥样硬化斑块的视频峰值与造影前视频基础值相比均有显著增加(P<0.01).第1、2组实验对象分别使用普通和靶向造影剂造影后,两组对应的血管内膜和粥样硬化斑块的峰值视频密度之间的差异有统计学意义(P<0.01).结论携CD54单抗造影剂对粥样硬化血管内膜及斑块有靶向显影价值,可提高超声诊断敏感性.     

血管超声分析颈部动脉血流动力学改变及颈动脉斑块的临床研究

颈部动脉病变检查手段有磁共振血管造影（MRA）、数字减影血管造影（DSA）、螺旋CT血管造影（CTA）及血管超声。DSA是金标准,但价格较高,并发症较多;而MRA及CTA也未能在基层医院普及。颈部血管超声具有无创、经济、操作简单、重复性好等优点,可用于确定颈动脉粥样硬化斑块存在的部位、范围,预防缺血性脑血管疾病的发生,     

颈动脉斑块预测高血压脑卒中的意义

目的：研究高血压患者颈动脉硬化斑块形成与高血压脑卒中的相关关系。方法采用高频彩色多普勒超声检测85例高血压并颈动脉硬化斑块形成患者及40名健康人颈动脉的内膜-中膜厚度及斑块形成情况,分析单纯高血压患者与高血压脑卒中患者颈动脉内膜增厚及斑块形成情况。结果85例高血压患者动脉硬化斑块形成共166处,其中硬斑块64处,软斑块102处;管腔狭窄共计30例,其中轻度管腔狭窄11例,中度狭窄12例,重度狭窄7例。以动脉粥样斑块3处以上作为预测患者发生高血压脑卒中,其敏感性80％,特异性82％,阳性预测值83％。结论高频超声能有效检测高血压脑卒中患者的颈动脉斑块形成,为临床预测高血压脑卒中提供有价值的信息。     

脉压对脑梗死患者颈总动脉影响的超声观察

目的:使用超声技术观察脉压对脑梗死患者颈总动脉的不同类型斑块的发生情况和物理形状的影响。方法:用二维高频超声和M型超声观察A组187例脑梗死患者颈总动脉的不同类型斑块的发生情况、内中膜厚度、收缩期管径、舒张期管径,结合血压,计算颈总动脉的动脉硬化指数、动脉可扩张度和周向扩张率,并与B组232例非脑梗死者比较。结果:脑梗死组和对照组及各分组之间比较,脑梗死组中PP≥60mmHg组与血压正常组比较、PP<60mmHg组与血压正常组比较,斑块的检出率增加,中内膜增厚,内径增加,动脉硬化指数增加,动脉可扩张度下降,周向扩张率明显下降。脑梗死组中PP≥60mmHg组与血压正常组比较,这种变化更明显。脑梗死组中内膜普遍达到有病理学意义的增厚(大于1mm)。结论:高脉压型高血压在脑梗死的发病机制中有重要的作用。如果超声发现高脉压的高血压患者颈总动脉中内膜增厚,检出斑块,内径明显增加,动脉硬化指数明显增加,动脉可扩张度明显下降,周向扩张率明显下降,则高度提示脑梗死的可能,从而为脑梗死的防治提供帮助。     

彩色多普勒检测老年人颈动脉与脑梗塞的研究

目的：应用彩色多普勒超声技术检测老年人颈动脉结构及血流动力学改变与脑梗塞的相关性，评价其临床价值。方法：使用彩色多普勒超声诊断仪检测颈、椎动脉结构及血流参数。结果：脑梗塞患者颈动脉粥样硬化(CAS)斑块侧向性188／236占79．7％；血流参数以颈内动脉(ICA)、舒张末期血流速度(EDV)、平均血流速度(TAV)明显减慢，(阻力指数)RI增高。结论：CAS斑块，且多为软斑、溃疡斑和颈动脉血流参数改变与脑梗塞密切相关，可作为临床早期发现脑梗塞的诊断参考指标，具有重要临床价值。     

Fly through ultrasound imaging in assessment of carotid atherosclerosis: a pictorial essay

To assess fly through ultrasound imaging (FTUS) in evaluation of carotid artery atherosclerosis, we prospectively performed conventional sonography and FTUS of the carotid artery on 66 patients with suspicion for atherosclerosis. Characteristics of arterial intima, atherosclerotic plaque, luminal narrowing, and carotid stent graft displayed on FTUS were compared with that on conventional sonography. On FTUS, normal carotid artery wall was smooth in appearance, mild carotid atherosclerosis appeared focal arterial wall irregularity and small plaque formation, arterial luminal reduction resulted from progressive artery plaques, and carotid stent had irregular inner lumen and tight fit against the arterial wall. A total of 38 plaques were detected by conventional sonography, while 48 plaques were depicted by FTUS in 25 patients. Using magnetic resonance angiography as a reference standard, 17 cases with >50% and 3 cases with < 50% luminal reduction measured on FTUS. However, all those 20 cases were measured with >50% luminal reduction on conventional sonography. Compared with conventional sonography, FTUS can dynamically display intraluminal structure on real-time three-dimensional imaging morphologically to improve the accuracy in detecting atherosclerotic plaque and assessing luminal narrowing in the carotid artery.     

High definition imaging of carotid arteries using a standard commercial ultrasound "B" scanner. A preliminary report.

Sixteen carotid arteries in nine patients with transient ischaemic attacks and carotid bruits were examined by direct scanning grey scale ultrasound using a 10 HMz probe attached to a standard commercial apparatus. Findings using ultrasound were compared with a contrast arteriogram performed on the following day and, in two cases, with the surgical appearances during endarterectomy. Atheromatous plaques were demonstrated in five common carotid arteries by ultrasound. Arteriography failed to show proximal plaques in two common carotid arteries and extension of bifurcation disease into the adjacent common carotid in a third patient. Ultrasound detected four stenotic and one occluded internal carotid artery. One internal carotid artery with a 25% stenosis was shown by arteriography but not by ultrasound. Of the five external carotid stenoses, one with a minimal stenosis of less than 10% was not demonstrated. In all cases, stenoses in excess of 30% were shown by ultrasound. Surgical findings correlated more closely with details of the plaques as shown by ultrasound than by arteriography. It is suggested that ultrasound might be used to pre-select reliably those patients who would benefit from a contrast arteriogram and, thus, to protect those with normal carotid arteries from a potentially hazardous invasive investigation.     

数字减影CT血管成像与彩色多普勒超声对颈动脉粥样硬化斑块检出率及斑块性质、狭窄程度判定的效果比较

目的比较数字减影CT血管成像（DSCTA）与彩色多普勒超声（CDUS）对颈动脉粥样硬化斑块的检出、斑块性质及狭窄程度判定的价值以及一致性。方法回顾性分析2015年1月至2017年10月就诊的可疑颈动脉狭窄患者90例,分别进行DSCTA与CDUS检查。采用卡方检验对比斑块分布、大小、斑块性质和狭窄程度。结果90例患者双侧颈部DSCTA检查发现52例颈动脉狭窄,3例为双侧狭窄,其中轻度狭窄29例、中度狭窄9例、重度狭窄12例,完全闭塞2例;检出斑块175处,其中钙化斑块133处、混合斑块30处、脂质斑块12处。90例患者双侧颈部CDUS检查发现54处颈动脉狭窄,3例为双侧狭窄,其中轻度狭窄26例、中度狭窄10例、重度狭窄16例,完全闭塞2例;检出斑块218处,其中钙化斑块138处、混合斑块39处、脂质斑块41处。DSCTA与CDUS诊断颈动脉狭窄的差异无统计学意义（χ2=0.75,P=0.861）;CDUS检查发现了更多的可见斑块及脂质斑块, < 5 mm的小斑块（60处）检出率明显高于DSCTA（25处）,差异有统计学意义（χ2=10.035,P=0.002）。结论DSCTA与CDUS对颈动脉狭窄的诊断效能均较高,具有较好的临床应用价值。CDUS对 < 5 mm斑块的检出优于DSCTA。     

西宁地区老年高血压患者颈动脉超声检测与临床的探讨

目的:探讨西宁地区各级高血压患者的颈动脉粥样硬化程度,了解老年高血压患者动脉粥样硬化的状况。方法:检测分析西宁地区173例老年高血压患者颈动脉(CADIA)内径、内膜中层厚度(IMT)、斑块发生率并与47例健康老人对照。结果:高血压组较对照组颈动脉内径及内膜中层厚度逐渐增加,P<0.01;高血压病各级之间颈动脉IMT比较差别有显著性,P<0.05,随着高血压分级增加颈动脉IMT逐渐增厚;高血压组的斑块发生率明显高于正常时照组。结论:动脉IMT增厚是动脉粥样硬化的早期特征,血压增高是引起高血压病颈动脉变化的一个重要因素,颈动脉超声检测对于老年高血压病的诊断分级和防治及其并发症具有重要意义,应作为西宁地区老年高血压患者的常规检测项目。     

The use of Speckle Reduction Imaging (SRI) Ultrasound in the characterization of carotid artery plaques

BACKGROUND AND PURPOSE: Speckle Reduction Imaging is a new algorithm that improves the image quality of B-mode scanning by reducing the reverberation artifacts. In the present study the value of this method for the characterization of atherosclerotic plaques in the internal carotid artery was investigated. METHODS: Two hundred and twenty two patients (161 men, 61 women; mean age 73 years) referred for carotid ultrasound evaluation were included in the study. Patients with plaques of the internal carotid artery as identified by conventional B-mode scanning were investigated also with the addition of Speckle Reduction Imaging (SRI) with the use of a 4-11-MHz wide band linear transducer. Plaque morphology was rated according to a standardized protocol by two independent observers. RESULTS: For the determination of plaque echogenicity, the reproducibility of SRI (kappa=0.83) was higher than that of conventional B-mode ultrasound (kappa=0.68). The interobserver agreement for plaque surface characterization was also higher for SRI (kappa=0.8) than for conventional B-mode (kappa=0.61). At the evaluation of the image quality through a semiquantitative analysis, SRI was rated superior in the plaque texture resolution, plaque borders determination, vessel wall demarcation and fibrous cap depiction. In addition, the level of "speckle" was reduced with the use of SRI. CONCLUSIONS: SRI is a technique that shows good general agreement with high-resolution B-mode and can be used for the characterization of atherosclerotic plaques in the carotid artery. Furthermore, because this advanced technique allows reduction of ultrasound artifacts, it improves the image quality allowing more precise visualization of plaque morphological details.     

hs-CRP联合颈动脉斑块检测对冠心病的预测意义

目的探讨高敏C反应蛋白（hs-CRP）联合颈动脉斑块对冠心病的预测价值。方法将140例观察对象分为对照组30例、稳定型心绞痛组（SA组）40例、急性冠脉综合征（ACS）组70例[不稳定型心绞痛组（UA组）50例和急性心肌梗死组（AMI组）20例],所有患者均行体表颈动脉超声检查（包括颈动脉内膜中层厚度、斑块情况）、冠脉造影和血清高敏C反应蛋白（hs—CRP）,比较3组患者颈动脉斑块情况、冠状动脉病变情况及血清高敏C反应蛋白（hs—CRP）水平。结果与对照组相比,冠心病组患者颈动脉斑块发生率较高;ACS组hs—CRP水平明显高于SAP组和对照组。结论hs—CRP水平有助于冠状动脉内不稳定斑块的预测;颈动脉斑块有助于冠脉斑块的预测．颈动脉斑块联合hs—CRP对急性冠脉综合征有一定的预测意义。     

Role of digitalized angiography by venous route in the study of carotid bifurcation. Value in the diagnosis of ulcerated lesions

Intravenous DSA was performed in 149 patients with suspected arteriosclerotic disease of the carotid bifurcation. These patients were submitted to 163 endarterectomies. The radiological and surgical findings were correlated in a retrospective analysis. The sensitivity of the angiographic method in determination of the correct percentage stenosis was 79%, but only 36% for the diagnosis of ulcerated lesions. Sonography exhibited a sensitivity of 79% with respect to the degree of stenosis and 23% in the diagnosis of ulcerated plaques. The present paper demonstrates the limiting factors of DSA and sonography. Furthermore, it reveals the valuable complementary effect of both methods in detecting arteriosclerotic lesions of the carotid bifurcation.     

脑梗死与颈动脉粥样硬化斑块的关系

目的探讨脑梗死与颈动脉粥样硬化斑块的关系。方法对64例脑梗死患者和30例对照组进行颈动脉彩色多普勒超声检查。结果病例组斑块检出率79.7%,显著高于对照组斑块检出率16.7%(P<0.001)。颈动脉分叉处硬化斑块检出率约为55.4%,显著高于颈总动脉和颈内动脉斑块检出率(24.3%,20.3%)(P<0.001)。病例组中、重型患者软斑块检出率(28/45)显著高于轻型患者斑块检出率(3/19)(P<0.001)。结论脑梗死发病与颈动脉粥样硬化斑块相关。软斑块与脑梗死病情的轻重有一定关系。脑梗死患者颈动脉彩色多普勒超声检查有重要临床意义。