CE-MRA和Doppler-US对颈动脉斑块不稳定性评估的对比研究

目的探讨对比增强磁共振血管成像(CE-MRA)和多普勒超声(Doppler-US)检查技术对判断颈动脉血管斑块不稳定性的临床应用价值。方法对同济大学附属东方医院2006年5月至2007年7月收治的86例不同程度颈动脉病变患者(包括53例明确为颈内动脉系统缺血性脑血管病急性期患者和33例头晕头痛患者)的颈动脉同时进行CE-MRA和Doppler-US检查,分析颈动脉血管壁斑块的灌注增强表现、管腔狭窄程度以及斑块形态、密度、信号,并比较两种方法对评估不稳定性颈动脉斑块的敏感度。结果Doppler-US发现不稳定斑块者32例,不稳定斑块检出率为37.2%,CE-MRA发现不稳定斑块者42例,不稳定斑块检出率为48.9%。与Doppler-US组比较,CE-MRA检出率较高,两组比较差异有统计学意义(P<0.05)。不稳定斑块处血管壁强化明显高于稳定性斑块。结论Doppler-US和CE-MRA在评价颈动脉粥样硬化斑块的结构、性质和血流动力学改变方面各有优势,CE-MRA对不稳定性颈动脉斑块的敏感度较Doppler-US高,两者结合,能够为临床缺血性脑卒中的病因学研究和风险预测提供重要和准确的信息。

Assessing the Instability of carotid artery atherosclerostic plaques by using contrast-enhanced magnetic resonance angiography and Doppler ultrasound

Objective To compare contrast-enhanced magnetic resonance angiography(CE-MRA)and Doppler ultrasound(Doppler-US)in assessing the instability of carotid artery atherosclerostic plaques and to primarily discuss the application of CE-MRA to clinic.Methods Totally 86 cases including 53 acute forebrain ischemic stroke and 33 dizziness were enrolled in our study.All the patients underwent examinations of carotid artery and plaques with both CE-MRA and Doppler-US.The degree of stenosis,the characteristics and the enhanced signals of the plaques were analysed.Results Instable carotid plaques were found with Doppler-US in 32(37.2 %)of 86 cases and with CE-MRA in 42(48.9 %)of 86 cases.The sensitivity of CE-MRA was significantly higher than Doppler-US(P<0.05).The contrast-enhanced signal was showed in instable carotid plaques.Conclusion Our data suggest that CE-MRA and Doppler-US have their own advantages in analysing the instability of carotid plaques.Combination of both can provide more accurate information in studying the risk factors and prognosticate of ischemic stroke.