摘要
目的 探讨超声多模态成像技术在判断颈动脉斑块稳定性及预测脑梗死(CI)发病的临床价值.方法 前瞻性筛选2021年10月至2023年10月我院收治的存在颈动脉粥样硬化斑块患者89例.以数字减影血管造影术(DSA)为金标准判断斑块的稳定性,将患者分为不稳定组(n=49)和稳定组(n=40),比较两组超声多模态成像技术[二维超声(2DUS)、三维超声(3DUS)、超声造影(CEUS)及剪切波弹性成像技术(SWE)]参数;随访12个月,根据CI是否发病将患者分为发生组(n=34)和未发生组(n=55),分析发生组与未发生组临床资料,并以Logistic回归分析影响CI发病的危险因素,用受试者工作特征曲线(ROC)分析超声2DUS、3DUS及SWE、CEUS对CI发病的预测价值.结果 不稳定组动脉内膜-中膜厚度(IMT)、混合回声和低回声斑块占比、溃疡斑块占比、较大脂质核心斑块占比、斑块总体积(TPV)、CEUS模式2～3级占比高于稳定组,而平均杨氏模量值(Mean YM)则低于稳定组(P＜0.05).发生组低回声斑块占比、TPV、CEUS模式2～3级占比高于未发生组,而Mean YM则低于未发生组(P＜0.05).多因素Logistic回归模型显示,回声特征为低回声、高TPV、CEUS分级2～3级和低Mean YM值是导致患者CI发病的独立危险因素(P＜0.05).ROC曲线显示,低回声、TPV、CEUS分级2～3级、Mean YM单独预测CI发病的AUC为0.699、0.640、0.703、0.718,采用log(P)联合预测AUC(95％CI)为0.909(0.829～0.960),联合预测效能较单独预测效能更好(P＜0.05).结论 超声多模态成像的斑块回声特征、斑块体积、CEUS分级和SWE模式Mean YM值与颈动脉斑块稳定性之间关系紧密,且斑块回声特征、斑块体积、CEUS分级、Mean YM值联合检测对CI发病具有较高的预测价值.
Abstract
Objective To investigate clinical value of ultrasonic multimodal imaging in evaluating the stability of carotid plaque and predicting the onset of cerebral infarction(CI).Methods From October 2021 to October 2023,prospective screening of 89 patients with carotid atherosclerotic plaque admitted to our hospital.Digital subtraction angiography(DSA)was used as the gold standard to determine stability of plaques.Patients were divided into unstable group(n=49)and stable group(n=40).Param-eters of multi-modal ultrasound imaging techniques[2D ultrasound(2DUS),3D ultrasound(3DUS),contrast-enhanced ultrasound(CEUS)and shear-wave elastography(SWE)]were compared between two groups.After 12 months of follow-up,patients were di-vided into occurrence group(n=34)and non-occurrence group(n=55)according to whether they have CI.Clinical data of occur-rence group and non-occurrence group were analyzed,and risk factors affecting the incidence of CI were analyzed by Logistic re-gression.The predictive value of 2DUS,3DUS,SWE and CEUS in CI was analyzed by receiver operating characteristic curve(ROC).Results The intima-media thickness(IMT),proportion of mixed echo and low-echo plaques,proportion of ulcerative plaques,proportion of large lipid core plaques,total plaque volume(TPV),and proportion of CEUS model 2～3 in unstable group were higher than those in stable group,while Mean Young's modulus(Mean YM)was lower than that in stable group(P＜0.05).Multivariate Logistic regression model showed that echo characteristics was low echo,high TPV,CEUS grade 2～3 and low Mean YM value were independent risk factors for CI(P＜0.05).ROC curve showed that the AUC of low echo,TPV,CEUS grades 2～3 and Mean YM were 0.699,0.640,0.703 and 0.718,respectively.And the AUC of 95％CI was 0.909(0.829～0.960)combined with log(P).The efficiency of combined prediction was better than that of single prediction(P＜0.05).Conclusion The plaque echo characteristics,plaque volume,CEUS grading and Mean YM value of SWE pattern in multimodal ultrasound imaging are close-ly related to the stability of carotid plaque,and the combined detection of plaque echo characteristics,plaque volume,CEUS grading and Mean YM value has high predictive value for the incidence of CI.
基金项目
省部共建中亚高发病成因与防治国家重点实验室开放课题项目(SKL-HIDCA-2022-NKX8)
维普
万方数据