河北医科大学学报 ›› 2022, Vol. 43 ›› Issue (6): 706-710.doi: 10.3969/j.issn.1007-3205.2022.06.018

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超声造影联合三维超声评估颈动脉斑块易损性对急性缺血性脑卒中的预测价值

  

  1. 1.河北北方学院附属第一医院超声医学科，河北 张家口 075000；2.河北省怀来县中医医院超声医学科，河北 怀来 075400
  • 出版日期:2022-06-25 发布日期:2022-06-29
  • 作者简介:张力维（1986-），女，河北张家口人，河北北方学院附属第一医院主治医师，医学硕士，从事超声医学诊断研究。
  • 基金资助:
    河北省医学科学研究课题计划（20210404）

Predictive value of carotid plaque vulnerability assessed by contrast-enhanced ultrasound combined with three-dimensional ultrasound in acute ischemic stroke

  1. 1.Department of Ultrasound, the First Affiliated Hospital of Hebei North University, Zhangjiakou 
    075000, China; 2.Department of Ultrasound, Huailai Hospital of Traditional 
    Chinese Medicine, Hebei Province, Huailai 075400, China
  • Online:2022-06-25 Published:2022-06-29

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摘要： 目的 探讨超声造影联合三维超声评估颈动脉斑块易损性对急性缺血性脑卒中（acute ischemic stroke,AIS)的预测价值。
方法 选取就诊于我院常规超声检查存在颈动脉斑块且厚度≥2.0 mm的门诊或住院患者261例。根据临床诊断是否发生AIS分为AIS组（126例）及NAIS组（135例）。颈动脉优选斑块行超声造影及三维超声检查，分别获得2组患者颈动脉斑块超声造影定量参数［增强强度（enhanced intensity,EI）］及三维超声定量参数［斑块厚度（plaque thickness,PT）、斑块体积（plaque volume,PV）、面积狭窄率(percent area stenosis,PAS)、灰阶中位数（gray-scale median,GSM）］，比较2组间上述各参数的差异。采用受试者工作特征（receiver operating characteristic,ROC）曲线分析差异有统计学意义的参数单独及联合检测对AIS的预测价值并确定其截断值。
结果 AIS组患者颈动脉斑块EI值高于NAIS组，GSM值低于NAIS组，差异均有统计学意义（P＜0.05），2组颈动脉斑块PT、PV与PAS差异均无统计学意义（P＞0.05）。以EI 11.6作为预测AIS发生的截断值，其曲线下面积为0.730，敏感度和特异度分别为76.19%、62.22%；以GSM 33.5作为预测AIS发生的截断值，其曲线下面积为0.752，敏感度和特异度分别为78.57%、62.22%；联合检测的曲线下面积为0.840，敏感度和特异度分别为85.71%、71.11%。
结论 EI及GSM联合检测可较准确的评估颈动脉斑块的易损性，对AIS有较高的预测价值。


关键词: 卒中, 颈动脉狭窄, 超声检查

Abstract: Objective To investigate the predictive value of carotid plaque vulnerability assessed by contrast-enhanced ultrasound combined with three-dimensional ultrasound in acute ischemic stroke(AIS). 
Methods A total of 261 outpatients or inpatients with carotid plaque thickness ≥2.0 mm detected after routine ultrasound examinations in our hospital were selected. According to the clinical diagnosis of AIS, all patients were divided into AIS group(n=126) and non-AIS group(n=135). Preferred carotid plaques were examined by contrast-enhanced ultrasound and three-dimensional ultrasound. The contrast-enhanced ultrasound quantitative parameter enhanced intensity(EI) and three-dimensional ultrasound quantitative parameters of carotid plaque thickness(PT), plaque volume(PV), percent area stenosis(PAS) and gray-scale median(GSM) were obtained. The above parameters were compared between two groups. The receiver operating characteristic(ROC) curve was used to analyze the predictive value of the parameters alone or in combination with statistical significance in AIS between two groups, and the cut-off value was determined. 
Results The EI value of carotid plaque in AIS group was higher than that in non-AIS group, and the GSM value was lower than that in non-AIS group(all P＜0.05); There was no significant difference in PT, PV and PAS of carotid plaque between two groups(all P＞0.05). Taking EI of 11.6 as cut-off value for predicting AIS, the area under curve was 0.730, and the sensitivity and specificity were 76.19% and 62.22%, respectively; Taking GSM of 33.5 as cut-off value for predicting AIS, the area under curve was 0.752, and the sensitivity and specificity were 78.57% and 62.22%, respectively; The area under curve of combined detection in predicting AIS was 0.840, and the sensitivity and specificity were 85.71% and 71.11%, respectively. 
Conclusion The combined detection of EI and GSM can accurately evaluate the vulnerability of carotid plaque and has a good predictive value for AIS.

Key words: stroke, carotid stenosis, ultrasonography

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