颈动脉超声和能谱CT以及MR高分辨率管壁成像诊断颈动脉斑块稳定性的临床价值

李依明; 郑吟诗; 林光耀; 黄文起; 潘翔珍; 黄小艳

doi:10.16766/j.cnki.issn.1674-4152.002692

颈动脉超声和能谱CT以及MR高分辨率管壁成像诊断颈动脉斑块稳定性的临床价值

doi: 10.16766/j.cnki.issn.1674-4152.002692

1.
商丘市第一人民医院影像中心，河南商丘 476100
2.
商丘市第一人民医院病理科
3.
商丘市第一人民医院超声科

基金项目:

河南省医学科技攻关计划联合共建项目 LHGJ20191496

详细信息

通讯作者:
李依明, E-mail: liyiming906@163.com

中图分类号: R445R543.4
计量
- 文章访问数: 314
- HTML全文浏览量: 201
- PDF下载量: 10
- 被引次数: 0
出版历程
- 收稿日期: 2021-09-08
- 网络出版日期: 2022-11-30

Clinical value of carotid ultrasound, energy spectral CT and MR high-resolution vessel wall imaging in judging the stability of carotid artery plaque

1.
Imaging Center of Shangqiu First People' s Hospital, Shangqiu, Henan 476100, China

摘要

摘要: 目的探讨颈动脉超声(US)、能谱CT和MR高分辨率管壁成像(HR-VWI)3种不同诊断方式对颈动脉斑块稳定性的诊断效能。方法收集2018年1月—2020年6月于商丘市第一人民医院接受颈动脉内膜剥脱手术的颈动脉粥样硬化患者42例。所有患者均行US、能谱CT和MR HR-VWI检查，以斑块病理分析结果为金标准，判断US、能谱CT、MR HR-VWI对颈动脉斑块稳定性的诊断价值。结果 42例患者术后共取得53块斑块。US检查共检出43块斑块; 能谱CT检查共检出49块斑块，不同成分的斑块能谱曲线斜率及有效原子序数由高到低依次为：钙化斑块、内部出血斑块、纤维斑块以及脂质斑块，不同成分的斑块能谱曲线斜率及有效原子序数相比，差异有统计学意义(均P＜0.05)；MR HR-VWI检查共检出51块斑块。以病理结果为金标准，能谱CT与MR HR-VWI检出率、准确度、特异度和灵敏度均高于US(均P＜0.05)。能谱CT和MR HR-VWI诊断颈动脉斑块稳定性的曲线下面积为0.819(95% CI：0.698~0.941)和0.859(95% CI：0.750~0.967)，均高于US(0.669，95% CI：0.517~0.821)。结论能谱CT、MR HR-VWI对颈动脉斑块成分分析以及斑块稳定性的诊断效能均优于US，可为颈动脉斑块稳定性的诊断和治疗方法的选择提供临床参考依据。
- 颈动脉斑块 /
- 能谱CT /
- MR高分辨率管壁成像 /
- 超声
Abstract: Objective To explore the diagnostic efficacy of carotid artery ultrasound (US), energy spectral CT and MR high-resolution wall imaging (HR-VWI) in the stability of carotid plaque. Methods A total of 42 patients with carotid atherosclerosis undergoing carotid endarterectomy were selected from January 2018 to June 2020 in the Shangqiu First People' s Hospital. All patients underwent US, energy spectral CT and MR HR-VWI examinations. The diagnostic values of US, energy spectral CT and MR HR-VWI in evaluating the stability of carotid plaques were judged based on the pathological analysis results of plaques as the gold standard. Results A total of 53 plaques were obtained from 42 patients after surgery. A total of 43 plaques were detected by US examination, and 49 plaques were detected by energy spectral CT. The slopes of energy spectrum curves and effective atomic numbers of plaques with different components were calcified plaque, internal bleeding plaque, fibrous plaque and lipid plaque from high to low. Significant differences were found in the slopes of energy spectrum curves and effective atomic numbers of plaques with different components (all P < 0.05). A total of 51 plaques were detected by MR HR-VWI. With the pathological results as the gold standard, the detection rates, accuracy, specificity and sensitivity of energy spectral CT and MR HR-VWI were higher than those of US (all P < 0.05). Both energy spectral CT and MR HR-VWI showed a higher area under the curve of 0.819 (95% CI: 0.698-0.941) and 0.859 (95% CI: 0.750-0.967), respectively, for the diagnosis of carotid plaque stability than US (0.669, 95% CI: 0.517-0.821). Conclusion Energy spectral CT and MR HR-VWI are superior to US in the analysis of carotid plaque composition and plaque stability, providing clinical reference for the diagnosis of carotid plaque stability and the selection of treatment methods.
- Carotid plaque /
- Energy spectral CT /
- MR high-resolution vessel wall imaging /
- Ultrasound

HTML全文

图 1 颈动脉US检查图像

注：患者男性，80岁。A为US示右侧颈总动脉分叉处混合斑块，表面欠光整；B为US示右侧颈总动脉分叉处管腔狭窄，血流呈湍流；C为US示右侧颈总动脉分叉处管腔狭窄，狭窄远段血流速度增快。

Figure 1. US examination image of carotid artery

下载: 全尺寸图片幻灯片

图 2 不同成分颈动脉斑块的CT图像和能谱曲线图

注：A为颈部斑块CT轴位图，选取感兴趣区；B示黄色曲线为颈部纤维成分斑块的能谱曲线，蓝色曲线为周围肌肉的能谱曲线，两者曲线斜率相近；C示绿色曲线为颈部脂肪成分斑块的能谱曲线，紫色曲线为周围脂肪的能谱曲线，两者曲线斜率相似，呈弓背样；D示红色曲线为内部出血成分斑块的能谱曲线，黄色曲线为血液的能谱曲线，两者曲线斜率相近；E示蓝色曲线为颈部钙化斑块的能谱曲线，红色曲线为骨骼的能谱曲线，两者曲线斜率相近。

Figure 2. CT images and energy spectrum curves of carotid plaques with different components

下载: 全尺寸图片幻灯片

图 3 右侧颈内动脉斑块MR HR-VWI图像

注：红色箭头示斑块内出血，蓝色箭头示斑块内钙化，黄色箭头示斑块内脂质。A为PDWI；B为T₁WI；C为T₂WI；D为3D TOF。

Figure 3. MR HR-VWI image of right internal carotid artery plaque

下载: 全尺寸图片幻灯片

图 4 US、能谱CT、MR HR-VWI对颈动脉斑块诊断价值的ROC曲线图

Figure 4. ROC curve of diagnostic value of US, energy spectrum CT and MR HR-VWI in carotid plaque

下载: 全尺寸图片幻灯片

表 1 MR HR-VWI检查扫描参数

Table 1. MR HR-VWI check scanning parameters

扫描参数	T₁WI	PDWI	T₂WI	3D TOF
TR(ms)	800.0	2 000.0	2 000.0	20.0
TE(ms)	20.70	12.17	204.40	7.90
FOV(cm)	16×16	16×16	16×16	16×16
Matrix(pixels)	256×256	256×256	256×256	320×256
Thk/Sp(mm)	2.0/1.0	2.0/1.0	2.0/1.0	2.0/0.0

下载: 导出CSV

表 2 不同成分颈动脉斑块能谱CT分析参数比较(x±s)

Table 2. Comparison of energy spectrum CT analysis parameters of carotid plaques with different components (x±s)

斑块成分	块数	曲线斜率	有效原子序数
纤维斑块	13	2.16±0.49	8.79±0.95
脂质斑块	22	-3.27±0.67^a	3.51±0.72^a
内部出血斑块	9	2.74±0.53^ab	9.13±0.81^b
钙化斑块	5	3.52±0.73^abc	11.86±1.13^abc
F值		26.068	9.160
P值		< 0.001	< 0.001
注：与纤维斑块比较，^aP＜0.05；与脂质斑块比较，^bP＜0.05；与内部出血斑块比较，^cP＜0.05。

下载: 导出CSV

表 3 颈动脉MR HR-VWI检查结果[块(%)]

Table 3. Results of carotid MR HR-VWI examination [block(%)]

斑块成分	块数	MR HR-VWI信号特征
斑块成分	块数	T₁WI	PDWI	T₂WI	3D TOF
纤维斑块	12	5(41.67)^a	-	-	8(66.67)^e
脂质斑块	22	15(68.18)^b	17(77.27)^b	-	16(72.73)^b
内部出血斑块	9	8(88.89)^c	7(77.78)^c	7(77.78)^c	8(88.89)^f
钙化斑块	8	6(75.00)^d	5(62.50)^d	5(62.50)^d	7(87.50)^d
注：^a为等信号；^b为等信号或稍高信号；^c为高信号；^d为不规则低信号；^e为带状低信号；^f为混杂或高信号；“-”为未获得明显信号。

下载: 导出CSV

表 4 US、能谱CT、MR HR-VWI对颈动脉斑块的诊断价值

Table 4. US, energy spectrum CT and MR HR-VWI in the diagnosis of carotid plaque

项目	AUC	95% CI	最佳截断值	灵敏度(%)	特异度(%)
US	0.669	0.517~0.821	0.337	71.86	61.90
能谱CT	0.819	0.698~0.941	0.638	78.13	85.71
MR HR-VWI	0.859	0.750~0.967	0.718	81.25	90.48

下载: 导出CSV

参考文献(23)

[1]	LIU Y, WANG M X, ZHANG B, et al. Size of carotid artery intraplaque hemorrhage and acute ischemic stroke: A cardiovascular magnetic resonance Chinese atherosclerosis risk evaluation study[J]. J Cardiovasc Magn Reson, 2019, 21(1): 36. doi: 10.1186/s12968-019-0548-1
[2]	刘凯莉, 左春洁, 陈大有, 等. 彩色多普勒超声与CTA对脑梗死患者颈动脉粥样硬化斑块的形态特点和生物学特性的评估价值[J]. 湖南师范大学学报(医学版), 2018, 15(2): 118-121. doi: 10.3969/j.issn.1673-016X.2018.02.036 LIU K L, ZUO C J, CHEN D Y, et al. Evaluation value of color Doppler ultrasound and CTA on morphological and biological characteristics of carotid atherosclerotic plaques in patients with cerebral infarction[J]. Journal of Hunan Normal University(Medical Edition), 2018, 15(2): 118-121. doi: 10.3969/j.issn.1673-016X.2018.02.036
[3]	LI Y, ZHU G M, DING V, et al. Assessing the relationship between atherosclerotic cardiovascular disease risk score and carotid artery imaging findings[J]. J Neuroimaging, 2019, 29(1): 119-125. doi: 10.1111/jon.12573
[4]	KASSEM M, FLOREA A, MOTTAGHY F M, et al. Magnetic resonance imaging of carotid plaques: Current status and clinical perspectives[J]. Ann Transl Med, 2020, 8(19): 1266. doi: 10.21037/atm-2020-cass-16
[5]	赵克强, 谢霞, 尹洪芳, 等. 颈动脉易损斑块影像学评估与术后病理的临床队列研究[J]. 中华医学杂志, 2018, 98(30): 2424-2428. doi: 10.3760/cma.j.issn.0376-2491.2018.30.011 ZHAO K Q, XIE X, YIN H F, et al. Clinical cohort study of imaging evaluation and postoperative pathology of carotid vulnerable plaque[J]. Chinese Journal of Medicine, 2018, 98(30): 2424-2428. doi: 10.3760/cma.j.issn.0376-2491.2018.30.011
[6]	陈真婧, 沈伟强, 朱华勇, 等. 能谱CT成像对颈动脉粥样硬化斑块成分的分析[J]. 中华全科医学, 2016, 14(3): 449-451, 458. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.037 CHEN Z J, SHEN W Q, ZHU H Y, et al. Analysis of components of carotid atherosclerotic plaque by energy spectrum CT imaging[J]. Chinese Journal of General Practice, 2016, 14(3): 449-451, 458. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.037
[7]	BRINJIKJI W, HUSTON J R, RABINSTEIN A A, et al. Contemporary carotid imaging: From degree of stenosis to plaque vulnerability[J]. J Neurosurg, 2016, 124(1): 27-42. doi: 10.3171/2015.1.JNS142452
[8]	董莉, 于薇, 王振常, 等. 国人基于MRI颈动脉狭窄预警易损斑块的效能研究[J]. 中国医学影像学杂志, 2019, 27(10): 736-739, 744. doi: 10.3969/j.issn.1005-5185.2019.10.004 DONG L, YU W, WANG Z C, et al. Study on the efficacy of early warning of vulnerable plaque based on MRI in Chinese carotid artery stenosis[J]. Chinese Journal of Medical Imaging, 2019, 27(10): 736-739, 744. doi: 10.3969/j.issn.1005-5185.2019.10.004
[9]	郝泽林, 吴建跃, 滕振飞, 等. 急性脑梗死患者血清学指标与神经功能缺损和脑梗死体积及颈动脉斑块性质的相关性研究[J]. 中华全科医学, 2020, 18(11): 1803-1806. doi: 10.16766/j.cnki.issn.1674-4152.001623 HAO Z L, WU J Y, TENG Z F, et al. Study on the correlation between serum indexes of patients with acute cerebral infarction, neurological deficit, cerebral infarction volume and carotid plaque properties[J]. Chinese General Medicine, 2020, 18(11): 1803-1806. doi: 10.16766/j.cnki.issn.1674-4152.001623
[10]	李韩建, 陈春美, 徐钐, 等. 颈动脉CTA和超声在动脉斑块和狭窄患者中的诊断效果及影像学特点[J]. 河北医学, 2020, 26(7): 1084-1087. doi: 10.3969/j.issn.1006-6233.2020.07.007 LI H J, CHEN C M, XU Z, et al. Diagnostic effect and imaging features of carotid CTA and ultrasound in patients with arterial plaque and stenosis[J]. Hebei Medical Science, 2020, 26(7): 1084-1087. doi: 10.3969/j.issn.1006-6233.2020.07.007
[11]	陈金丽, 叶晓燕, 楼阿丽. 超声造影对颈动脉狭窄患者颈动脉粥样硬化斑块稳定性的评估价值[J]. 重庆医学, 2020, 49(7): 1097-1101. doi: 10.3969/j.issn.1671-8348.2020.07.015 CHEN J L, YE X Y, LOU A L. Evaluation value of contrast-enhanced ultrasound in carotid atherosclerotic plaque stability in patients with carotid stenosis[J]. Chongqing Medical, 2020, 49(7): 1097-1101. doi: 10.3969/j.issn.1671-8348.2020.07.015
[12]	张猛, 张小玲, 黎海燕, 等. CT能谱成像对颈动脉斑块成分的评估价值及对缺血性脑卒中预防的指导作用[J]. 现代医学, 2018, 46(6): 651-656. https://www.cnki.com.cn/Article/CJFDTOTAL-TDYX201806011.htm ZHANG M, ZHANG X L, LI H Y, et al. The evaluation value of CT energy spectrum imaging in carotid plaque composition and its guiding role in the prevention of ischemic stroke[J]. Modern Medicine, 2018, 46(6): 651-656. https://www.cnki.com.cn/Article/CJFDTOTAL-TDYX201806011.htm
[13]	CROMBAG G, SCHREUDER F, VAN HOOF R, et al. Microvasculature and intraplaque hemorrhage in atherosclerotic carotid lesions: A cardiovascular magnetic resonance imaging study[J]. J Cardiovasc Magn Reson, 2019, 21(1): 15. doi: 10.1186/s12968-019-0524-9
[14]	李韩建, 陈春美, 徐钐, 等. 颈动脉CTA和超声在动脉斑块和狭窄患者中的诊断效果及影像学特点[J]. 河北医学, 2020, 26(7): 1084-1087. doi: 10.3969/j.issn.1006-6233.2020.07.007 LI H J, CHEN C M, XU Z, et al. Diagnostic effect and imaging features of carotid CTA and ultrasound in patients with arterial plaque and stenosis[J]. Hebei Medical Science, 2020, 26(7): 1084-1087. doi: 10.3969/j.issn.1006-6233.2020.07.007
[15]	MURGIA A, ERTA M, SURI J S, et al. CT imaging features of carotid artery plaque vulnerability[J]. Ann Transl Med, 2020, 8(19): 1261. doi: 10.21037/atm-2020-cass-13
[16]	刘良进, 曾艳妮, 徐佳, 等. 能谱CT判断颈动脉粥样硬化斑块成分及稳定性的临床价值[J]. 现代仪器与医疗, 2019, 25(4): 6-10, 24. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYI201904002.htm LIU L J, ZENG Y N, XU J, et al. Clinical value of energy spectrum CT in judging the composition and stability of carotid atherosclerotic plaque[J]. Modern Instrument and Medicine, 2019, 25(4): 6-10, 24. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYI201904002.htm
[17]	远奇, 马玉波. 18F-FDG PET/CT和MRI评估颈动脉粥样硬化斑块炎症活动程度的价值分析[J]. 中国CT和MRI杂志, 2020, 18(9): 24-27. doi: 10.3969/j.issn.1672-5131.2020.09.008 YUAN Q, MA Y B. Value analysis of 18F-FDG PET/CT and MRI in evaluating inflammatory activity of carotid atherosclerotic plaque[J]. Chinese Journal of CT and MRI, 2020, 18(9): 24-27. doi: 10.3969/j.issn.1672-5131.2020.09.008
[18]	FITZPATRICK L A, BERKOVITZ N, DOS S M, et al. Vulnerable carotid plaque imaging and histopathology without a dedicated MRI receiver coil[J]. Neuroradiol J, 2017, 30(2): 120-128. doi: 10.1177/1971400916678244
[19]	巴建, 苗红, 张艾红. 磁共振高分辨技术在脑梗死复发患者颈动脉斑块评估中的应用观察[J]. 癫痫与神经电生理学杂志, 2020, 29(1): 17-20. https://www.cnki.com.cn/Article/CJFDTOTAL-OBED202001006.htm BA J, MIAO H, ZHANG A H. Application of high-resolution magnetic resonance imaging in the evaluation of carotid plaque in patients with recurrent cerebral infarction[J]. Journal of Epilepsy and Neuroelectrophysiology, 2020, 29(1): 17-20. https://www.cnki.com.cn/Article/CJFDTOTAL-OBED202001006.htm
[20]	戴志成, 宿艳, 张静, 等. MRI评估缺血性脑卒中患者颈动脉粥样硬化斑块成分及负荷与缺血征象的相关性[J]. 中国CT和MRI杂志, 2019, 17(11): 26-28. https://www.cnki.com.cn/Article/CJFDTOTAL-CTMR201911009.htm DAI Z C, SU Y, ZHANG J, et al. MRI evaluation of correlation between carotid atherosclerotic plaque composition and load and ischemic signs in patients with ischemic stroke[J]. Chinese Journal of CT and MRI, 2019, 17(11): 26-28. https://www.cnki.com.cn/Article/CJFDTOTAL-CTMR201911009.htm
[21]	SUN J, ZHAO X Q, BALU N, et al. Carotid plaque lipid content and fibrous cap status predict systemic CV outcomes: The MRI substudy in AIM-HIGH[J]. JACC Cardiovasc Imaging, 2017, 10(3): 241-249.
[22]	PORAMBO M E, DEMARCO J K. MR imaging of vulnerable carotid plaque[J]. Cardiovasc Diagn Ther, 2020, 10(4): 1019-1031.
[23]	付德利, 孟凡琴, 李明山. 颈动脉内膜剥脱术前MRI检测颈动脉斑块易损性与术后病理对照研究[J]. 中国临床医生杂志, 2020, 48(7): 830-832. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLYS202007023.htm FU D L, MENG F Q, LI M S. Comparative study of MRI examination of carotid plaque vulnerability before carotid endarterectomy and postoperative pathology[J]. Chinese Journal of Clinicians, 2020, 48(7): 830-832. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLYS202007023.htm