The relationship of carotid three-dimensional ultrasound vessel wall volume with age and sex: comparison to carotid intima-media thickness

The relationship of three-dimensional ultrasound (3DUS)-derived carotid vessel wall volume (VWV) was evaluated with respect to age and sex. B-mode and 3DUS images were acquired for 316 subjects from diverse groups including obese primary prevention, diabetic nephropathy, renal transplant and rheumatoid arthritis populations. The relationship for intima-media thickness (IMT) and VWV with age and sex were determined using Pearson-product-moment correlations. Mean IMT (r = 0.18, p = 0.001) and VWV (r = 0.24, p < 0.01) correlated modestly with age. There were modest correlations in males (IMT, r = 0.19, p = 0.003; VWV, r = 0.34, p < 0.001) and in females for IMT and age (r = 0.30, p = 0.007) but not between 3DUS VWV and age in females (r = 0.10, p = 0.4). Significant associations between plaque and VWV (r = 0.36, p = 0.001) but not IMT suggest different correlations in females that may be attributed to plaque.     

Calcium distribution in the vessel wall and intima-media thickness of the human carotid arteries

Increased common carotid artery (CCA) intima-media thickness (IMT) measured by B-mode ultrasound is an early marker of the atherosclerotic process. Arterial calcification is not clearly understood. Using the particle-induced X-ray emission (PIXE) method, we have looked for the location in the artery wall where calcium accumulated in the early phase of atherosclerosis. Twelve segments of CCAs of deceased stroke patients were investigated. In-vivo, carotid duplex ultrasound was performed with bilateral CCA IMT measurement at plaque-free sections. During autopsy, segments of carotid arteries were collected and filled under pressure with a stained histologic embedding material. The frozen arteries were cut into 60-microm-thick slices. Calcium distribution maps from the segments of arteries were determined by PIXE method. IMT measured by ultrasound and calcium distribution maps measured by PIXE were compared. In our cross-sectional study, using the PIXE analysis and ultrasound images, we could demonstrate early calcium accumulation in the media layer. Our results have also shown a significant relationship between calcium content of distributional maps measured by PIXE analysis and corresponding IMT on B-mode ultrasound images of human CCAs.     

超声造影成像技术评价颈动脉斑块内新生血管与斑块声学特性的关系

目的本研究应用超声造影成像技术评价颈动脉斑块内新生血管与斑块声学特性的关系。方法104例伴颈动脉粥样斑块患者行颈动脉常规及超声造影检查,通过肉眼观测及定量分析斑块造影增强情况。结果软斑造影增强比例明显高于其他类型斑块（P〈0.001）;软斑的增强强度明显高于其他类型斑块（P〈0.001）;软斑的斑块增强强度与颈动脉管腔内造影增强强度比值也高于其他类型斑块（P〈0.001）。结论研究表明软斑造影增强显著高于其他类型斑块。超声造影技术为评价斑块内新生血管特点及其与斑块声学特性的关系提供了新方法。     

颈动脉壁内-中膜厚度及斑块与冠心病的关系

目的利用无创高分辨率二维超声比较冠心病患者与非冠心病患者颈动脉内膜中层厚度(intima-mediathickness,IMT)及粥样斑块的发生情况,探讨IMT及粥样斑块与冠心病的相关性。方法经冠状动脉造影的137例患者根据血管病变分为4组:冠状动脉造影正常组(n=31)、单支病变组(n=36)、双支病变组(n=33)、3支病变组(n=37),在冠状动脉造影前、后1周内进行颈动脉超声检查,同时测定其生化、血脂水平,测量患者的收缩压、舒张压;计算体重指数,并记录其吸烟史、高血压史、糖尿病史。结果冠状动脉病变组患者的颈动脉壁内-中膜厚度及粥样斑块的发生明显高于冠状动脉造影正常组,且有统计学意义;随着病变的加重,其颈动脉壁内-中膜厚度及粥样斑块的发生明显增加。结论颈动脉壁内-中膜厚度与冠心病有一定的相关性,可利用颈动脉超声检查来预测冠心病的发生。     

超声造影评价颈动脉斑块类型与斑块内新生血管关系

目的 采用灰阶谐波CEUS评价斑块内新生血管与常规超声显示斑块类型之间的关系。方法 收集98例颈动脉粥样硬化患者共113个斑块,根据回声特征及形态学分为均质、非均质及溃疡型斑块,均质斑块又分为低回声、等回声及强回声斑块。分析斑块回声特征与造影增强模式特点。结果 CEUS显示低回声斑块新生血管检出率明显高于等回声(χ²=10.64,P=0.001)、强回声(χ²=18.62,P<0.001)及溃疡型斑块(χ²=7.38,P=0.007);但低回声与非均质斑块新生血管检出率的差异无统计学意义(χ²=2.20,P=0.138)。增强的64个斑块中,46个(46/64,71.88%)斑块表现为由管壁外膜向斑块内增强,其中44个弥漫性增强,2个为束状增强;18个(18/64,28.13%)斑块表现为由管腔向斑块内蔓延的稀疏增强。各类型斑块间CEUS增强模式的差异无统计学意义(P>0.05)。结论 CEUS可提供更多有关于斑块内新生血管的信息,有助于进一步判断斑块稳定性。     

高频超声联合VTIQ评价颈动脉斑块与脑梗死关系

目的：应用VTIQ技术评价颈动脉斑块软硬度诊断脑梗死的可行性、稳定性及预测价值,探讨高频超声与VTIQ（virtual touch tissue imaging quantification,VTIQ）技术联合预判脑梗死的临床价值。方法：收集60例脑梗死患者和40例非脑梗死患者,根据斑块总风险评分标准筛选出代表性斑块行高频超声和VTIQ检查。记录斑块回声类型（patch echo type,PEH）、狭窄率（stenosis rate,SR）和剪切波速度（shear wave velocity,SWV）,比较两组患者的PET构成比、SR及SWV。Bland-Altman检验观察者间一致性。ROC曲线分析三者独立预测脑梗死的临床效能及最佳诊断界值,Logistic回归结合ROC曲线分析多参数联合预测脑梗死的临床价值。结果：两组患者PET构成比及SR的比较均有统计学差异（P=0.000）。脑梗死组SWV显著低于非脑梗死组（P=0.004）。PET、SR、SWV诊断脑梗死的曲线下面积（area under cueve,AUC）分别为0.291、0.722、0.664。SWV观察者间一致性良好。以SWV≤3.435m∕s为界值预测脑梗死的敏感性、特异性、准确性分别为60%、62.5%、70.5%。PET与SR联合预测脑梗死的AUC为0.806;The AUC of cerebral infarction predicted by PET and SR was 0.806. PET、SR和SWV三者联合预测脑梗死的AUC提升到0.945,敏感性、特异性、准确性分别提高到91.67%、82.5%、87%。结论：VTIQ技术评价颈动脉斑块软硬度诊断脑梗死具有可行性和可重复性,颈动脉狭窄率仍然是脑梗死预测的金指标,VTIQ与高频超声联合应用可以提升脑梗死的诊断价值。     

超声造影评价颈动脉粥样硬化斑块的新生血管与冠心病的关系

目的 应用超声造影评价颈动脉粥样斑块的稳定性与冠心病的相关关系.方法 冠心病伴颈动脉粥样斑块患者67例,斑块厚度均＞2.0 mm,其中急性冠状动脉综合征(ACS)组35例,稳定性冠心病(sCAD)组32例.行颈动脉常规及超声造影检查,肉眼观测及定量分析斑块造影增强情况.结果 ACS组软斑的例数高于sCAD组,差异有统计学意义(P＜0.001).ACS组斑块造影增强比例显著高于sCAD组(P=0.037),ACS组斑块增强强度显著高于sCAD组(P＜0.001),ACS组斑块增强强度与颈动脉管腔内增强强度比值显著高于sCAD组(P=0.026).斑块增强强度预测ACS的灵敏度和特异度分别为74%和60%,斑块增强强度与颈动脉管腔内增强强度比值预测ACS的灵敏度和特异度分别为86%和67%.结论 ACS组斑块造影增强显著高于sCAD组.超声造影为评价颈动脉粥样斑块的稳定性与冠心病的相关关系及斑块的危险度分级提供了一种较为可靠的方法.     

高频超声对糖尿病患者颈动脉内膜-中膜厚度及斑块形成检测的意义

目的:探讨颈动脉高频超声在糖尿病动脉硬化中的应用价值。方法:使用ATL HDI-5000型高频超声对57例糖尿病患者及43例非糖尿病患者进行对照,观察其颈动脉内径、内膜-中膜厚度(IMT)、斑块形成及血流动力学情况。结果:糖尿病组颈总动脉最大IMT、阻力指数及斑块发生率均明显大于对照组,两组间有显著差异(P<0.01);血流PSV、EDV速度两组间无明显差异(P>0.05)。有合并症的糖尿病组最大IMT及斑块检出率大于无合并症糖尿病组。结论:高频超声能清晰显示颈动脉有无形态学改变(IMT、狭窄、阻塞及斑块的形态、结构)、观察血流状态,对判断糖尿病动脉硬化的病情进展、治疗效果、了解预后及对并发症的预防都有重要意义。     

超声对颈动脉斑块与脑卒中危险因素关系初探

目的研究颅外颈动脉硬化性斑块与脑卒中危险因素的关系。方法运用高频超声对142例患者行颅外颈动脉检测。将颈动脉斑块分为七型两大类,比较不同斑块与高血压、糖尿病、冠心病、短暂性脑缺血发作TIA、高血脂、吸烟等危险因素的相关性。结果短暂性脑缺血发作TIA组不稳定斑块、特别透声斑的发生率明显增高,有统计学意义。其余危险因素无论在有斑块组与无斑块组之间,还是在不稳定斑块组与稳定斑块组之间,均无统计学差异。结论高频超声能够检测不稳定斑块,对预防缺血性脑卒中有指导意义。     

超声造影评价不同狭窄程度颈动脉粥样斑块内的新生血管形成

目的 评价灰阶谐波超声造影技术显示不同程度颈动脉狭窄患者动脉粥样硬化斑块内新生血管形成的价值.方法 疑诊颈动脉狭窄患者58例,共73个斑块.常规超声评价颈动脉斑块回声类型,超声造影实时观察斑块内增强强度并进行分级.动脉狭窄程度以X线动脉造影检查结果为准.比较不同狭窄程度及不同回声类型颈动脉斑块的增强强度.结果 颈动脉90%以下狭窄各组间斑块增强强度与动脉狭窄程度之间无相关性(P=0.358),但90%以上狭窄(包括闭塞)组斑块增强强度明显增加,两者之间差异有统计学意义(P=0.008).不同斑块回声类型的斑块增强强度差异有统计学意义(P=0.000).结论 超声造影能够实时观察颈动脉粥样硬化斑块的增强过程,反映斑块内新生血管的形成,从而为评价斑块的稳定性提供重要信息.

Abstract：

Objective To evaluate contrast-enhanced ultrasound imaging of carotid atherosclerosis with different stenostic degree as a clinical tool to study intraplaque neovascularization.Methods Fifty-eight patients suspected of carotid stenosis with 73 plaques were studied by standard and contrast-enhanced ultrasound.Plaque echogenicity at standard ultrasound were evaluated.Contrast enhancement within the plaques was categorized as 0 - 4 degree and compared to the stenosis degree and the plaque echogenicity.The degree of stenosis was determined by intravenous digital subtraction angiography.Results In the group with stenosis less than 90% ,stenosis degree was not associated with the grade of contrast enhancement (P =0.358),while the grade of enhancement was significantly higher in the group with sever stenosis(＞90%).The grades of enhancement were significantly different between plaques with different echogenicity (P =0.000).Conclusions Contrast-enhanced real-time ultrasound imaging can demonstrate the enhancement of carotid plaques non-invasively,which is helpful for assessing intraplaque neovascularization and provide valuable information for plaque risk stratification     

超声造影评价不同狭窄程度颈动脉粥样斑块内的新生血管形成

Objective To evaluate contrast-enhanced ultrasound imaging of carotid atherosclerosis with different stenostic degree as a clinical tool to study intraplaque neovascularization.Methods Fifty-eight patients suspected of carotid stenosis with 73 plaques were studied by standard and contrast-enhanced ultrasound.Plaque echogenicity at standard ultrasound were evaluated.Contrast enhancement within the plaques was categorized as 0 - 4 degree and compared to the stenosis degree and the plaque echogenicity.The degree of stenosis was determined by intravenous digital subtraction angiography.Results In the group with stenosis less than 90% ,stenosis degree was not associated with the grade of contrast enhancement (P =0.358),while the grade of enhancement was significantly higher in the group with sever stenosis(＞90%).The grades of enhancement were significantly different between plaques with different echogenicity (P =0.000).Conclusions Contrast-enhanced real-time ultrasound imaging can demonstrate the enhancement of carotid plaques non-invasively,which is helpful for assessing intraplaque neovascularization and provide valuable information for plaque risk stratification     

阿托伐他汀强化降脂对老年颈动脉斑块患者颈动脉内膜中层厚度及血管内皮功能的影响

目的 探讨老年颈动脉斑块患者经强化降脂后,血管内皮功能和颈动脉内膜中层厚度(CIMT)的变化.方法 102例确诊为老年颈动脉斑块的患者随机分为阿托伐他汀常规剂量组(10 mg/d)48例及强化降脂组(20 mg/d)54例,治疗1年后检测TC、LDL-C、HDL-C和TG水平,超声观察CIMT最厚处和最薄处、肱动脉内皮依赖性舒张(FMD)及颈动脉斑块指数(P1)的变化.结果 2组治疗后1年CIMT最厚处和PI与治疗前比较差异无统计学意义(P均＞0.05),但是CIMT最薄处、FMD、TC、LDL-C和TG水平与治疗前比较差异有统计学意义[常规降脂组:CIMT最薄处(0.85±0.20)、(0.83±0.22)mm,FMD(3.85±1.41)%、(7.91±1.05)%,TC(6.46±1.19)、(4.82±1.26)mmol/L,LDL-C(4.71±1.00)、(3.16±1.00)mmol/L,TG(1.55±0.45)、(1.49±0.44)mmol/L;强化降脂组:CIMT最薄处(0.84±0.20)、(0.63±0.17)mm,FMD(3.74±1.38)%、(10.25±1.58)%,TC(6.36±1.06)、(4.10±1.00)mmol/L,LDL-C(4.73±1.01)、(2.28±1.26)mmol/L,TG(1.56±0.53)、(1.50±0.49)mmol/L,P均＜0.05].而且治疗后1年强化降脂组较常规降脂组差异更明显(P均＜0.05).结论 强化降脂治疗能更有效地降低TC和LDL-C水平,改善内皮功能,降低CIMT.阿托伐他汀具有稳定斑块、减缓粥样硬化斑块进展的作用.     

Influence of coronary pulsation on volumetric intravascular ultrasound measurements performed without ECG-gating. Validation in vessel segments with minimal disease

Volumetric analysis of coronary arteries can be performed using intravascular ultrasound (IVUS) images selected at 1 mm intervals without ECG gating. However, there are few data regarding the influence of coronary pulsation on this volumetric analysis. We developed two models of consecutive area measurements consisting of duplicated area measurements from short coronary segments and virtual measurements based on a sine function. These models allowed the re-calculation of volumes using different sets of frames from the same simulated segments. The variability of the volume determinations was evaluated by its percent standard deviation [%SD = (SD/the mean value) × 100]. The relation of the variability to the extent of external elastic membrane (EEM) area change during the cardiac cycle (amplitude) and heart rates (frequency) were examined. In 58 short coronary segments of 15 patients, consecutive IVUS images were measured [%EEM area change: 12.3 ± 7.7 %, heart rate 78 ± 21 beats/min (bpm)]. In both models, %SD of the volume calculations was directly proportional to the %EEM area change and showed two peaks at heart rates of 60 ± 2 and 90 ± 2 bpm. In the model based on actual coronary measurements, the %SD of volume calculations of a segment with 10% EEM area change was 0.7% except for heart rates of 60 ± 2 and 90 ± 2 bpm. The variability of a volumetric analysis based upon measuring IVUS images at constant intervals without ECG gating is affected by coronary pulsation, extent of cross-sectional area changes, and heart rate. Despite these limitations, this method is feasible and provides reproducible volume measurements.     

慢性阻塞性肺疾病患者支气管壁厚度与肺功能的相关性

目的 分析各级慢性阻塞性肺疾病(COPD)患者右肺上叶尖段支气管管壁厚度的变化,评估管壁厚度与肺功能的相关性。方法 对经临床诊断为1~4级COPD的患者各15例,共60例(COPD组)和15名正常体检者(正常对照组),均在1周内分别接受64层MSCT扫描和PFT肺功能检查,在与右肺上叶尖段支气管垂直层面图像上测量支气管壁厚度,计算壁厚直径比(TDR)、支气管壁面积百分比(WA%),分析各指标的变化,评估其与肺功能的相关性。结果 COPD组支气管壁较正常对照组明显增厚,且随着级别的提高逐渐增厚,各级别的TDR、WA%值均高于正常对照组,差异有统计学意义(P均＜0.05);TDR和WA%与第1秒用力呼气量实测值占预测值百分比 、用力呼气中段流量 、第1秒用力呼气量占用力肺活量的百分比 和一氧化碳弥散量 均呈负相关,与残气量与肺总量的比值(RV/TLC)呈正相关(r=0.77,0.76), P值均＜0.05。结论 各级COPD患者右肺上叶尖段支气管的TDR和WA%与其肺功能指标存在良好的相关性,可以较准确、直观地评估其气道重构、气道直径与气流受限的关系,可作为评估气流受限较敏感的指标。     

耳折征患者颈动脉内膜中层厚度和斑块发生率的临床观察

目的 分析双侧耳折征(DELC)患者的颈动脉内膜中层厚度(IMT)、颈动脉斑块发生率的情况。方法 选取50岁以上患者110例,其中DELC组60例,对照组50例。所有患者测量体质量、身高,记录吸烟史及高血压病、2型糖尿病、脑梗死、心肌梗死病史,应用彩色多普勒超声检查颈动脉结构。对比两组年龄、男性比例、体质量指数(BMI)、吸烟率、患病率(高血压病、2型糖尿病、脑梗死、心肌梗死)、颈动脉IMT、斑块发生率。结果 与对照组相比,DELC组BMI、吸烟者无显著增加,但年龄更大[(72.6±8.4)岁比(66.1±14.7)岁,P0.05],高血压病(75.0%比56.0%,P0.05)、2型糖尿病(45.0%比26.0%,P0.05)、陈旧性脑梗死(43.3%比22.0%,P0.05)、陈旧性心肌梗死(36.7%比16.0%,P0.05)患病率更高。与对照组相比,DELC组颈动脉IMT明显增厚[(1.21±0.27)mm比(0.84±0.21)mm,P0.05)],斑块发生率明显增加(85%比62%,P0.05)。结论 对于DELC患者,应加强动脉粥样硬化及其危险因素的筛查。     

颈动脉斑块内新生血管超声造影分级与炎症反应的相关性研究

目的应用超声造影半定量评估颈动脉斑块内新生血管,分析其与循环血中性粒细胞与淋巴细胞计数比值(NLR)的相关性,探讨NLR对斑块内新生血管及斑块易损性的影响。方法选取行颈动脉斑块超声造影检查的受试者132例,应用超声造影半定量评估斑块内新生血管的分级并进行分组:1~2级60例(A组)、3级44例(B组)和4级28例(C组)。同时获取各组循环血白细胞计数(WBC)、中性粒细胞计数(NE)、淋巴细胞计数(LY)及NLR。采用Spearman相关性分析斑块超声造影分级与循环血中白细胞各亚型的相关性;Logistic回归进一步分析影响斑块内新生血管的独立危险因素。结果A、B、C组间WBC和NE依次增高,LY依次减低,各组间比较差异均有统计学意义(均P<0.01);A组NLR最小,C组NLR最大,各组间比较差异均有统计学意义(P<0.01)。斑块内新生血管分级与循环血中WBC、NE和NLR均呈正相关(r=0.30、0.59、0.77,均P<0.01),与LY呈负相关(r=-0.50,P<0.01)。三组中脑梗死患者构成比在C组最高,差异有统计学意义(P<0.05)。Logistic回归分析显示NLR是斑块内新生血管的独立危险因素,且循环血中NLR每增加1.08,斑块内新生血管分级增加一级。结论循环血中NLR与斑块内新生血管密切相关,是其独立危险因素;NLR每增加1.08,斑块内新生血管分级增加一级。     

能谱CTA分析颈动脉斑块成分及其与脑梗死的关系

目的 探讨能谱CT血管成像（CTA）区分颈动脉粥样硬化斑块成分的可行性，并分析斑块类型与脑梗死的相关性。方法 对60例经超声检出的颈动脉狭窄患者行头颈部能谱CTA和颅脑MRI。分别测量斑块、脂肪、肌肉和骨骼组织的CT值及有效原子序数，获得40~140 keV单能量图像平均CT值的特征能谱曲线，计算能谱曲线斜率。根据MRI结果评估患者是否存在脑梗死；根据能谱CTA结果将斑块分为脂质斑块、脂质核心为主的混合斑块、纤维成分为主的混合斑块、纤维斑块及钙化斑块，将脂质斑块和脂质/纤维混合斑块归为不稳定斑块，纤维斑块和钙化斑块归为稳定斑块。比较各斑块的能谱曲线斜率及有效原子序数差异；计算存在各类型斑块患者的脑梗死发生率。结果 共纳入109个斑块，包括21个脂质斑块、11个脂质核心为主混合斑块、30个纤维成分为主混合斑块、15个纤维斑块及32个钙化斑块。各斑块能谱曲线斜率及有效原子序数差异均有统计学意义（F=1 494.83、2 108.74，P均<0.01）。19例存在脂质斑块，11例见脂质核心为主混合斑块，19例存在纤维成分为主混合斑块，10例见纤维斑块，20例见钙化斑块。MRI于各类型斑块患者中分别检出13例、6例、7例、2例及1例脑梗死，相应脑梗死发生率分别为68.42%（13/19）、54.55%（6/11）、36.84%（7/19）、11.11%（1/9）及0（0/20）；60例总体脑梗死发生率为45.00%（27/60），其中存在不稳定斑块和稳定斑块患者脑梗死发生率分别为53.06%（26/49）和3.33%（1/30）。结论 能谱CTA可用于细化分析颈动脉斑块成分及类型。斑块脂质成分越多，稳定性越差，患者发生脑梗死的风险越高。     

超声弹性成像检测颈动脉易损斑块对脑卒中的价值研究

目的:探讨实时超声弹性成像技术检测颈动脉易损斑块对预防脑卒中的临床价值。方法:随机选取60例拟进行颈动脉内膜剥脱术(CEA)的患者,术前采用超声检查记录颈动脉斑块厚度、管腔狭窄率、斑块处收缩期最大流速(Vmax),对斑块行实时超声弹性成像检查,记录弹性评分及应变率比值(B/A)。术后进行病理及免疫组化检查。结果:根据的斑块回声分成三组:脂质型斑块组(A组)、混合型斑块组(B组)、均质型斑块组(C组)。三组斑块间颈动脉斑块厚度、管腔狭窄率、Vmax差异无统计学意义。三组斑块间的弹性评分、B/A比值、脂质核心大小差异有统计学意义(P<0.05)。将斑块的B/A比值与脂质核心大小建立一元直线回归方程,回归系数有统计学意义(P<0.05)。以B/A<7.6,检测易损斑块的灵敏度为90.5%,特异度为72.2%。结论:实时超声弹性成像技术有望成为临床早期发现易损斑块的可靠方法,这对预防脑卒中的发生具有重要的临床价值。