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目的 高分辨率磁共振血管壁成像(HR-VWI)联合超声造影(CEUS)检查对颈动脉粥样硬化患者颈动脉易损斑块的诊断价值。方法 选取接受颈动脉内膜剥脱术的颈动脉粥样硬化患者76例,根据数字减影血管造影(DSA)检查显示的斑块性质将患者分为易损组(42例)和稳定组(34例)。比较两组临床资料及实验室检查指标[同型半胱氨酸(HCY)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)等],采用多因素Logistic回归模型分析患者颈动脉易损斑块形成的危险因素;两组均行HR-VWI、CEUS检查,采用Kappa检验分析HR-VWI、CEUS检查结果与DSA检查结果的一致性;采用ROC曲线分析HR-VWI、CEUS及两者联合诊断易损斑块的效能。结果 两组HCY、HDL-C、LDL-C比较差异均有统计学意义(P均<0.05)。多因素Logistic回归分析显示,高HCY、低HDL-C、高LDL-C是颈动脉易损斑块形成的危险因素(P均<0.05)。DSA检查易损斑块检出率为55.26%(42/76),HR-VWI、CEUS检查易损斑块检出率分别为53.95%(41/76)、50.00%(38/76),HR-VWI联合CEUS检查易损斑块检出率为59.21%(45/76),4种方法检出率比较差异均无统计学意义(P均>0.05)。HR-VWI、CEUS诊断易损斑块与DSA检查呈中等一致性(Kappa值分别为0.443、0.421),HR-VWI联合CEUS检查诊断易损斑块与DSA检查呈高度一致性(Kappa值为0.758)。HR-VWI、CEUS诊断易损斑块的AUC分别为0.722、0.713,灵敏度分别为73.81%、69.05%,准确度分别为72.37%、71.05%;两者联合诊断的AUC、灵敏度、准确度分别为0.876、92.86%、88.16%;联合诊断效能最高(P均<0.05)。结论 HR-VWI联合CEUS检查诊断颈动脉粥样硬化患者颈动脉易损斑块的价值优于两者单独。
Abstract：Objective To explore the value of high-resolution vessel wall imaging(HR-VWI) combined with contrast-enhanced ultrasound(CEUS) in the diagnosis of vulnerable carotid plaques in patients with carotid atherosclerosis. Methods Totally, 76 patients with carotid atherosclerosis who underwent carotid endarterectomy were divided into vulnerable group(42 cases) and stable group(34 cases) according to the plaque nature of digital subtraction angiography(DSA). Patients in both groups underwent HR-VWI and CEUS examinations. Kappa test was used to analyze the consistency between HR-VWI, CEUS examination results and DSA examination results. ROC curve was used to analyze the efficacy of HR-VWI and CEUS in diagnosing vulnerable plaques. Results The differences in hcy, hdl-c, and ldl-c between the two groups were statistically significant(P<0.05). Multivariate Logistic regression analysis showed that high HCY, low HDL-C, and high LDL-C were risk factors for the formation of vulnerable carotid plaques(all P<0.05). The detection rate of vulnerable plaques in DSA examination was 55.26%(42/76), while, the detection rates of vulnerable plaques in HR-VWI and CEUS examinations were 53.95%(41/76) and 50.00%(38/76), respectively. The detection rate of vulnerable plaques in HR-VWI combined with CEUS examination was 59.21%(45/76). The detection rates of the four methods were compared, and all P values were greater than 0.05. HR-VWI and CEUS diagnosis of vulnerable plaques showed moderate consistency with DSA examination(Kappa values of 0.443 and 0.421, respectively), while, HR-VWI combined with CEUS diagnosis of vulnerable plaques showed high consistency with DSA examination(Kappa value of 0.758). The AUC of HR-VWI and CEUS in diagnosing vulnerable plaques was 0.722 and 0.713, respectively, with sensitivities of 73.81% and 69.05%, and accuracies of 72.37% and 71.05%, respectively. The AUC, sensitivity, and accuracy of the combined diagnosis of the two were 0.876, 92.86%, and 88.16%, respectively. The combined diagnostic efficacy was the highest(all P<0.05). Conclusion The value of HR-VWI combined with CEUS in diagnosis of vulnerable plaque is better than that of both alone.
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基本信息:
DOI：10.20258/j.cnki.1006-9011.2025.12.005
中图分类号:R445;R543.4
引用信息:
[1]单继广,刘芳只,刘翠杰.高分辨率磁共振血管壁成像联合超声造影检查对颈动脉粥样硬化患者颈动脉易损斑块的诊断价值[J].医学影像学杂志,2025,35(12):21-26.DOI:10.20258/j.cnki.1006-9011.2025.12.005.
基金信息:
河北省2025年度医学科学研究课题计划（编号：20251280）
2025-12-30
2025-12-30