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
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- 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

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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

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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

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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

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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

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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。

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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。

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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

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