颈动脉粥样硬化斑块新生血管的超声造影强化特征研究

目的 探讨颈动脉粥样硬化斑块新生血管的超声造影(contrast-enhanced ultrasonography，CEUS)强化特征。 方法 运用实时超声造影技术对78例有颈动脉粥样硬化斑块患者进行斑块新生血管强化特征分级和量化分析，探讨斑块新生血管灌注模式以及斑块强化与斑块厚度的关系，并根据斑块回声分类进行斑块强化特征的组间比较。对5例患者颈动脉内膜剥脱术后斑块的病理组织学微血管计数与术前斑块超声造影强化指标进行相关分析。 结果 78个斑块常规超声显示低回声斑23 例（29.49％）, 混合回声斑30 例（38.46％），等回声斑20 例（25.64％）, 高回声斑5例（6.41％）；斑块最厚者5.5 mm ,最薄者2.6 mm。本组60例（76.9%）颈动脉粥样硬化斑块CEUS显示不同程度的新生血管强化。斑块厚度与斑块强化程度存在相关关系（r=0.686，P<0.05）。低回声斑和混合回声斑强化程度高于等回声斑及高回声斑（P<0.05）；斑块病理组织学新生血管数量分级与超声造影强化程度呈正相关（r=0.886，P<0.05）。 结论 超声造影能够实时地观察和评价颈动脉粥样硬化斑块内的新生血管的灌注特征，为斑块易损性的临床评估提供了新的影像学检查方法。

Characteristics of Carotid Atherosclerotic Plaques in Contrast-enhanced Ultrasonography of Neovascularization

Objective To examine the characteristics of carotid arteriosclerotic plaques in contrast-enhanced ultrasonography (CEUS) of neovascularization. Methods Seventy-eight patients with carotid atherosclerotic plaques were examined with real-time CEUS. The perfusion modes of neovascularization in relation to the carotid arteriosclerotic plaques were identified. Patients were categorized into four groups according to their plaque echo. Five patients with serious atherosclerotic carotid artery disease received carotid endarterectomy. The intra-plaque neovascularization recorded by CEUS were validated by post-surgery pathology examinations of the tissues. Results In routing ultrasound examinations, 23 (29.49％) plaques were identified with low-echo, 30 (38.46％) with mixed-echo, 20 (25.64％) with equal-echo, and 5 (6.41％) with high-echo. The CEUS imaging revealed 60 carotid atherosclerotic plaques (76.9%）with various degrees of enhancement in intra-plaque neovascularization. The thickness of plaques was correlated with the enhanced intensity of ultrasonography, with a Pearson correlation coefficient of 0.686 (P<0.05). Compared with equal and high echo plaques, the enhanced intensity of ultrasonography in low and mixed echo plaques was higher (P<0.05). The intra-plaque neovascularization recorded by CEUS was correlated with the grade of neovascularization resulted from post-surgery examinations (Spearman coefficient=0.886, P<0.05). Conclusion The real-time CEUS can assess the neovascularization in carotid atherosclerotic plaques non-invasively and quantitatively.