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。

The value of detecting carotid vulnerable plaque with ultrasound elastography in the prevention of stroke

Objective To explore the value of real-time ultrasound elastography in the detection of carotid artery plaque stability in the prevention of stroke.Methods Randomly selected 60 cases of patients to carotid endarterectomy(CEA),preoperative the patients were examined by color ultrasound to record the thicknessof the carotid plaques,luminal stenosis rate and maximum velocity in the plaque(Vmax).The carotid artery plaque was examined by real-time ultrasound elastography,recorded the elasticity score and the strain rate ratio.Then for pathological and immunohistochemical examination postoperatively.Results According to the level of echo,all the plaques were divided into three groups:group of lipid plaques(A),group of mixed echo plaques(B)and group of homogeneous plaques(C).There were no significant differences in carotid artery plaque thickness,lumen stenosis rate and maximum velocity(Vmax)among the three groups(P>0.05).The difference of elasticity score and strain rate ratio had statistically significant among the three groups(P<0.05).The difference of lipid core size had statistically significant among the three groups(P<0.05).To establish a linear regression equation with strain rate ratio and lipid core,and the regression coefficient was statistically significant(P<0.05).With B/A<7.6 to find the vulnerable plaques,the sensitivity was 90.5%and specificity was 72.2%.Conclusion Real-time ultrasound elastography is expected to be a reliable method to find vulnerable plaques earlier,which has important clinical value in the prevention of ischemic cerebrovascular disease.