颈动脉硬化斑块内新生血管的超声造影研究

目的探讨超声造影在评价颈动脉硬化斑块内新牛血管中的应用价值。方法对96例颈动脉硬化斑块患者，行实时超声造影评价颈动脉硬化斑块造影增强情况，运用声学定量分析软件存机分析，根据斑块回声分组并进行组间比较。对9例有外科手术指征的患者行颈动脉内膜剥脱术，对造影观察的颈动脉硬化斑块病理切片行内皮细胞标志物CD34单克隆抗体以及新生血管标记物Ⅷ因子、PBS缓冲液染色，分析颈动脉斑块造影增强情况与组织病理学新生血管的相关性。结果不同回声斑块造影增强率按由高至低顺序排列分别为低回声、等回声、混合回声、高回声，其中低回声、等回声、混合回声组间斑块增强数两两比较均无统计学差异（P〉0．05），低回声、等吲声及混合回声与高回声组间比较均有统计学差异（P〈0．05）。对颈动脉硬化斑块病理组织学与超声造影结果分析提示，造影剂增强效应较强的斑块在组织学上新生血管形成数量较多，两者呈正相关性（r=0．773，P=0．015）。结论超卢造影可实时观察斑块内新生血管情况，无创性评价斑块稳定性。

A study on contrast-enhanced ultrasonography of neovascularizatin in carotid arteriosclerosis plaque

Objective To discuss the value of contrast-enhanced uhrasonography in quantitative as- sessment of neovascularization in plaques of carotid arteriosclerosis. Methods A total of ninety-six patients with carotid atherosclerotic plaques were examined with real-tlme contrast-enhanced ultrasonography. Digital cine clips were reviewed using coded phase-inversion harmonic ultrasound （CPI） technology analysis soft- ware. The results of four groups according to plaque echo were compared. Nine patients with significant atherosclerotic carotid artery disease received a contrast-enhanced uhrasonography examation before a carotid endarterectomy. At the time of surgery, carotid plaque samples were surgically removed and stained with specific vascular markers（CD34, yon Willebrand factor, and hemosiderin） designed to identify the presence and degree of neovascularization. The intra-plaque neovascularization recorded on preoperative contrast-enhaned carotid ultrasound was compared with the degree of neovascularization in the tissue specimens. Results The enhanced intensity of uhrasonography ranging from high to low plaque is low , equal, mixed, and hard plaque （high echo）. Compared with low echo, equal and mixed plaque echo were with hard plaque, P 〈 0.05. The intra-plaque neovascularization recorded on preoperative contrast-enhaned carotid ultrasound was correlated with the grade of neovascularization in the tissue specimens. This correlation value was 0. 773 using Spearman~ rank method. Conclusions The real-time contrast-enhanced uhrasonography can assess the neovascularization within carotid atherosclerotic plaque non-invasively and quantitatively and provide valuable information for plaque risk stratification.