超声造影对不同回声类型颈动脉斑块内新生血管的分析

目的运用超声造影成像(CEUS)联合灰阶中位数(GSM)技术,感兴趣区(ROI)定位跟踪,分析斑块的超声造影视觉评分、造影参数、GSM值,定量评估颈动脉斑块内新生血管的生成情况,为无创定量评估颈动脉粥样硬化斑块的稳定性提供影像学依据。方法常规超声上获得64个斑块的GSM值并将斑块分成均质低回声、不均质低回声、不均质高回声、均质高回声四组。超声造影获得斑块的造影增强强度视觉评分、造影参数,比较组间差异,并分析造影参数与GSM值之间的相关性。结果四组斑块的GSM值之间(F=29.365,P0.001)、超声造影视觉评分增强分级中的增强强度值之间(χ~2=17.951,P0.001)差异具有统计学意义,斑块的回声越低超声造影视觉评分增强越明显。四组斑块的超声造影增强强度值(χ~2=29.025,P0.001)、增强密度值(χ~2=30.871,P0.001)、不同分值的超声造影增强强度值(χ~2=23.709,P0.001)之间差异均具有统计学意义。斑块的增强强度(r=-0.376,P=0.000)、增强密度(r=-0.252,P=0.000)均与斑块的GSM值呈负相关,相关性显著。斑块的回声越低,GSM值越低,超声造影增强强度值及增强密度值则越高,间接提示斑块内新生血管生成越多,斑块稳定性就越差,可能越容易发生脑血管事件。结论 CEUS联合GSM技术能更加客观地定量评估颈动脉斑块内新生血管的生成情况,为无创定量评估颈动脉粥样硬化斑块的稳定性提供影像学依据,进而有助于临床的诊治和预防。     

脑梗死病人颈动脉粥样硬化的临床观察

目的探讨脑梗死与颈动脉粥样硬化之间的关系。方法脑梗死病人与非脑梗死者各60例，行颈部超声检查，比较两组颈动脉颅外段粥样硬化斑块的有无及回声强度。结果脑梗死病人颈动脉有粥样硬化斑块检出率为70．00％；非脑梗死病人中宽块检出率为18．33％，两者比较差异有统计学意义（P〈0．01）。脑梗死病人不稳定斑块数高达66．67％，非脑梗死病人不稳定斑块（呈低回声软斑及混杂回声的混合斑）仅占总斑块数的18．18％，二者比较有统计学意义（P〈0．01）。结论颈动脉粥样硬化与脑梗死的发生有密切关系，颈动脉粥样硬化的不稳定性斑块脱落是造成脑梗死的重要原因之一。     

脑梗死与颈动脉粥样硬化斑块的相关性分析

目的探讨脑梗死与颈动脉粥样硬化斑块的相关性。方法对55例脑梗死病人进行颈动脉彩色多普勒超声检查,观察其斑块的部位、性质以及粥样硬化斑块的回声强度、部位、数目等。结果脑梗死病人颈动脉粥样硬化斑块检出率为85.5%;斑块的好发部位为颈总动脉分叉处、颈总动脉主干;复发性脑梗死病人颈动脉粥样硬化斑块检出率达100.0%;脑梗死病人的颈动脉粥样硬化斑块多为不稳定性斑块。结论脑梗死的发生与颈动脉粥样硬化斑块密切相关,不稳定性斑块是引起脑梗死的主要危险因素之一。     

颈动脉粥样硬化疾病评分与高分辨率磁共振成像特征关系研究

目的探讨脑缺血患者颈动脉粥样硬化疾病评分(CAS)与颈动脉粥样硬化疾病及临床指标的相关性。方法选取近期(2周)脑梗死或短暂性脑缺血发作的患者96例进行颈动脉高分辨MRI检查。测量颈动脉斑块所致的管腔狭窄、最大管壁厚度及斑块累及范围。选取颈动脉斑块内仅含富脂质核不稳定成分的图像,使用CASCAD软件进行分析,计算CAS值,根据CAS值分为低危组和高危组。分析CAS与临床指标的相关性。结果 96例患者检测到148支颈动脉斑块内仅含富脂质核,平均CAS值(21.6±17.5)%,其中CAS 1级29支、2级52支、3级41支、4级26支。CAS值与颈动脉管腔狭窄、管壁最大厚度及斑块累及范围呈正相关(r=0.610、r=0.569和r=0.527,P0.01)。不同CAS级别颈动脉管腔狭窄、最大管壁厚度及斑块累及范围差异有统计学意义(P0.01)。CAS值与LDL及HDL/TG比值相关(r=0.469,P0.01;r=-0.269,P0.05);高危组收缩压、舒张压及LDL水平较低危组明显升高(P0.05)。结论 CAS与颈动脉粥样硬化疾病关系密切,且与脂质代谢相关。CAS级别越高,未来颈动脉斑块发生出血及纤维帽破裂的可能越大。     

高频超声检测颈动脉粥样硬化与脑梗死相关性探讨

目的 探讨颈动脉粥样硬化与脑梗死的相关性.方法 应用高频超声对150例脑梗死患者和100名健康者进行颈动脉超声检查,测量颈动脉内径、内-中膜厚度,有无斑块,斑块分布部位、大小及内部回声特点,观测颈动脉内部及血流情况、收缩期血流峰值速度(PSV)、血流阻力指数(RI)、S/D值,并将脑梗死患者颈动脉超声检查结果与脑部CT或磁共振成像(MRI)检查结果比较.结果 脑梗死组与对照组颈动脉粥样硬化阳性率(尤其是软斑阳性率)差异有统计学意义(P<0.05),脑梗死部位与颈动脉粥样硬化斑块(特别是软斑)的侧向符合率高.结论 颈动脉粥样硬化与脑梗死密切相关.     

声学密度定量技术对无名动脉斑块致脑梗死的危险性的价值

目的探讨声学密度定量技术评价无名动脉粥样斑块致脑梗死的危险性价值。方法分析脑梗死组与无脑梗死组无名动脉各类斑块的例数、狭窄程度,测定各类斑块声学密度值及复合斑块内各种回声面积占整个斑块面积百分比。结果脑梗死组脂质斑块及复合斑块例数明显多于无脑梗死组,且复合斑块内低回声区域占整个斑块面积的百分比明显大于无脑梗死组。结论声学密度定量技术能够评价无名动脉斑块的稳定性及危险性。     

用高频超声评估颈动脉粥样硬化与脑梗死的关系

目的　应用高频超声评估颈动脉粥样硬化与脑梗死的关系。方法　用高频超声对 52例脑梗死患者与 50例非脑梗死患者的颈动脉作扫查 ,观察血管直径 ,内膜 -中膜 ( IMT)厚度、光滑度 ,有无斑块、斑块位置 ,回声强度。结果　脑梗死组的颈动脉直径较对照组增宽 ,IMT较对照组增厚、毛糙 ,粥样斑块多发生于颈总动脉分叉处 ,斑块数目较对照组增多 ,尤以软斑及混合斑为著。结论　颈动脉粥样硬化与脑梗死的发生密切相关     

超声高精细血流联合弹性成像技术对颈动脉粥样硬化斑块的诊断价值

目的 分析超声高精细血流联合弹性成像技术对颈动脉粥样硬化斑块的诊断价值。方法 选取住院的缺血性脑卒中患者(除外心源性病人及手术、血管内治疗的脑卒中患者)200例作为研究对象，均采用二维超声观察颈动脉粥样硬化斑块的位置、形态、表面是否有溃疡、纤维帽是否连续、斑块内部脂质核心回声、斑块基底部线样回声连续性；超声高精细血流联合弹性成像技术用于颈动脉硬化斑块内新生血管的数量、走行、分布等检验。对比两种检查方式对颈动脉粥样硬化斑块的诊断价值；对比两种检查方式颈动脉粥样硬化斑块检出率；统计不同斑块类型及性质实施超声高精细血流检查时的应变值及应变率；同时比较不同斑块性质弹性评分百分比。结果 二维超声图像可见，斑块位于左侧颈内动脉起始段后壁，形态欠规则，纤维帽不连续，表面未见溃疡，基底部回声不明显，内部未见明显脂质回声。超声高精细血流成像技术观察颈动脉斑块的图像，斑块的结构欠规则、表面不连续、内部为低回声、可见明显新生微血管。超声高精细血流成像技术与二维超声图像比较，诊断颈动脉粥样硬化斑的灵敏度、特异度及准确度均较高，差异有统计学意义(P<0.05)。易损斑块及稳定斑块实施超声高精细血流联合弹性...     

兔颈动脉硬化斑块新生血管生发规律的研究

目的应用超声造影技术观察斑块内血管新生在实验性动脉粥样硬化斑块中的生发规律及分布特点。方法将48只日本大耳白兔分随机分为正常组(12只)、对照组(12只)和模型组(24只)。正常组由普通饲料喂养,对照组予以假手术+高脂饲料喂养,模型组予以高脂饲料喂养+球囊拉伤。每周超声检查颈动脉,每两周行颈动脉超声造影检查。超声检查确认造模成功后,目标血管取材进行病理学及免疫组化检测。结果第4周模型组造模成功,8周时70%以上动物出现明显的颈动脉硬化斑块;低回声及混合回声斑块内增强信号较动脉外膜上增强信号密度大,主要集中于斑块的肩部,强回声斑块内部及管壁附着处未见明显增强信号。结论内膜损伤是颈动脉斑块形成的关键因素及始动环节,斑块内新生血及外膜滋养血管随斑块的生长而增多,外膜上滋养血管增生与斑块内血管新生具有一致性,斑块内新生血管可能主要由外膜滋养血管衍生而成。     

超微血流显像与超声造影评价极低回声区斑块内新生血管分布的研究初探

目的:探讨超微血流显像(SMI)技术在评价存在局限性极低回声区(JBA)的颈动脉粥样硬化斑块内新生血管的价值。方法:选取存在JBA的颈总动脉及颈内动脉起始段的低回声或低回声为主的不均质斑块进行SMI和超声造影(CEUS)检查,对检查结果进行对比,评估这些斑块内的新生血管状况。结果:SMI和CEUS检查显示38例存在JBA的斑块内均可见新生血管。斑块厚度0.21～0.63cm,平均(0.38±0.10)cm;斑块长度0.90～5.2cm,平均(2.21±1.06)cm;SMI及CEUS显示斑块内新生血管分级为1～2级,但在JBA区域未见明显新生血管。结论:有JBA的颈动脉粥样硬化斑块内新生血管比率高,但新生血管并不在JBA区域内。     

高频体表超声检测急性冠状动脉综合征患者颈动脉结构及功能

应用高频体表超声观察急性冠状动脉综合征患者颈动脉结构及血管内皮功能的变化 ,探讨动脉粥样硬化结构和功能与急性冠状动脉综合征的关系。对 35例急性冠状动脉综合征患者检测了颈动脉粥样硬化斑块、内膜中膜厚度、肱动脉内皮功能的变化 ,并与 2 7例稳定型心绞痛及 31例正常对照组进行比较。结果发现 ,内膜中膜厚度和内皮依赖性血管舒张功能在急性冠状动脉综合征组 (分别为 0 .10± 0 .0 2和 3.98± 1.6 5 )和稳定型心绞痛组(分别为 0 .11± 0 .0 4和 4 .76± 2 .37)与对照组 (分别为 0 .0 7± 0 .0 1和 9.33± 3.4 7)有显著差异 (P <0 .0 5 ) ,斑块积分和斑块指数在急性冠状动脉综合征组 (分别为 4 .0 6± 2 .2 1和 3.14± 1.97)与稳定型心绞痛组 (分别为 4 .17± 1.76和3.2 1± 1.88)间无差异 (P >0 .0 5 ) ,急性冠状动脉综合征组颈动脉粥样硬化斑块以不稳定型为主。研究结果提示 ,外周血管超声检查可观察动脉粥样硬化病变 ,颈动脉结构及血管内皮功能与冠状动脉粥样硬化有关。     

颈动脉粥样硬化致血小板活化及其与急性脑梗死的关系

为探讨颈动脉粥样硬化致血小板活化机制及其与急性脑梗死的关系,采用彩色多普勒血流显像仪和流式细胞仪分别测定115例急性脑梗死患者颈动脉及其周围血血小板表面CD62p、CD63的表达,并与30例非脑梗死头晕患者对照.结果发现,急性脑梗死患者颈动脉粥样硬化斑块较对照组明显增多,单侧脑梗死者同侧颈动脉斑块明显增加,达68.75%,双侧脑梗死者双侧颈动脉斑块达58.47%.斑块处狭窄,局部血流增快.颈动脉斑块患者血CD62p和CD63水平较正常动脉者明显增高,单侧颈内动脉粥样硬化斑块患者血CD62p和CD63的阳性率及荧光强度分别达4.72%±4.52%、5.38%±3.73%和1.50±0.26、1.38±0.14,双侧斑块者达7.72%±4.96%、6.78%±4.02%和1.59±0.37、1.41±0.18,后者较前者明显增高(P<0.05).脑梗死患者血小板活化率明显较对照组增高,并与颈动脉粥样硬化程度相关(P<0.05).结果提示,颈动脉粥样硬化构成"高剪切力+低剪切力"的特殊剪切力梯度活化血小板,可能是颈动脉粥样硬化导致急性脑梗死的一个重要发病因素.     

急性脑梗死OCSP分型与颈动脉粥样硬化的相关性

目的 探讨急性脑梗死患者OCSP分型与颈动脉粥样硬化的相关性.方法 对146例急性脑梗死患者进行OCSP分型,应用彩色多普勒超声检测脑梗死患者颈动脉病变情况,分析颈动脉粥样硬化斑块与急性脑梗死OCSP各亚型的相关性.结果 急性脑梗死患者OCSP各亚型构成比为:部分前循环梗死为43.1%,腔隙性梗死为39.0%,后循环梗死为11.6%,完全前循环梗死为6.3%;急性脑梗死患者颈动脉有斑块者占70.5%,完全前循环梗死+部分前循环梗死组患者中占斑块检出率的55.3%;不稳定性斑块患者的检出率为46.9%、斑块≥4个的患者为33.3%、斑块平均个数为3.26±1.87个,明显高于其它两型(P0.05).结论 颈动脉粥样硬化斑块及斑块稳定性、个数与完全前循环梗死和部分前循环梗死的形成密切相关,对颈动脉彩色多普勒超声检查有斑块检出者应尽早进行干预.     

Carotid and femoral atherosclerotic lesions in patients with coronary heart disease confirmed by angiography

INTRODUCTION: Clinically evident atherosclerosis is preceded by preclinical changes in the arterial wall. These changes are characterised by increased thickness of the intima-media complex (IMT). AIMS: A complex ultrasound assessment of the peripheral vessels as well as an attempt to find ultrasound parameters correlating with the burden of atherosclerotic lesions of the coronary arteries. METHODS: 231 patients who underwent both coronary angiography and ultrasound examination of the following arteries: common carotid artery (CCA), carotid bulb and common femoral artery (CFA) were enrolled. The IMT value, presence of plaque and Doppler blood flow parameters were evaluated. Selected clinical and biochemical risk factors of atherosclerosis were assessed. Two groups of patients were analysed: 200 patients with coronary artery disease confirmed by angiography (study group), and 31 patients with normal coronary arteries (control group). RESULTS: Significantly higher values of the IMT in the peripheral arteries were observed in patients with coronary artery lesions than in those without (CCA - 0.91 vs 0.61 mm, carotid bulb -- 1.31 vs 0.67 mm, CFA -- 1.38 vs 0.63 respectively, p<0.0001). Atherosclerotic plaques were present only in patients with coronary artery disease. Additionally, IMT values of the CCA, carotid bulb and CFA were significantly higher in patients with severe coronary artery disease (three vessel disease) than in patients with lesions in one or two coronary arteries. CONCLUSIONS: Patients with coronary lesions present with increased IMT values and higher plaque occurrence. Complex ultrasound evaluation of different peripheral arteries (CCA, carotid bulb and CFA) may be used as part of the cardiovascular risk stratification.     

MTT评价代谢综合征患者颈动脉粥样斑块生物力学特性的研究

目的 应用多道示踪技术探讨代谢综合征患者颈动脉正常部位和斑块部位、硬斑块和软斑块及斑块肩部和纤维帽硕部的径向速度、应变、应变率的变化规律.方法 对126例代谢综合征患者和60例正常人双侧颈动脉进行高频超声检查,检测颈动脉内膜中层厚度;多道示踪技术示踪颈动脉无斑块部位和斑块部位、斑块肩部和纤维帽硕部径向速度、应变和应变率,并进行分组分析.结果 代谢综合征组颈动脉内膜中层厚度高于对照组,差异有统计学意义(P＜0.05);对照组颈动脉收缩期最大径向速度高于代谢综合征组颈动脉无斑块部位的测定值,差异有统计学意义(P＜0.05);软斑块收缩期最大径向速度、最大应变率分别高于硬斑块,差异具有统计学意义(P＜0.05);颈动脉斑块肩部收缩期最大径向速度、应变率分别高于斑块纤维帽顶部,差异亦具有统计学意义(P＜0.05).结论 多道示踪技术可早期检测代谢综合征患者的颈动脉粥样硬化并准确评价动脉斑块生物力学特性,为在上游、早期有针对性干预心脑血管疾病提供了量化指标依据.     

陈旧性心肌梗死患者颈动脉粥样硬化与危险因素的关系

为探讨陈旧性心肌梗死患者颈动脉粥样硬化情况，对38例陈旧性心肌梗死患者的颈动脉内中膜厚度及斑块进行超声检测，与32例健康者作对照。结果发现，陈旧性心肌梗死患者的颈动脉内中膜厚度、斑块指数及斑块发生率明显高于对照组。多因素回归分析显示，年龄、总胆固醇、收缩压与颈动脉内中膜厚度密切相关。     

The predictive value of retinal vascular findings for carotid artery atherosclerosis: are further recommendations with regard to carotid atherosclerosis screening needed?

Vascular retinopathy is the consequence of vascular disease, and the retina is the only place where the arteries can be visualized directly. The purpose of this study was to evaluate the predictive value of retinal vascular findings for carotid artery atherosclerosis. From December 2009 to January 2011, the carotid intima-media thickness (IMT) and total plaque area (TPA) were measured in 179 consecutive patients, who received a fundoscopic examination. The patients were divided into groups as follows: normal retinal artery (normal; n = 44), diabetic retinopathy (DR; n = 25), retinal artery occlusion (RAO; n = 17), retinal vein occlusion (RVO; n = 67), and hypertensive retinopathy (HTN-R; n = 26). The subjects were classified according to the presence of an increased (≥1 mm) IMT and plaque. The values of the mean carotid IMT in the patients with vascular retinopathy (DR, 0.87 ± 0.14 mm; RAO, 1.18 ± 0.47 mm; RVO, 0.84 ± 0.14 mm; HTN-R, 0.90 ± 0.20 mm) were significantly increased compared with those in the normal subjects (0.77 ± 0.13 mm). A total 77 of 135 vascular retinopathy patients demonstrated an increased IMT (57 %), and 97 vascular retinopathy patients had carotid artery plaque (72 %). The relative risk of vascular retinopathy in the prediction of an increased IMT and the presence of plaque was 2.79 and 3.95, respectively. Although The TPA was significantly increased in the patients with RAO (1.87 ± 2.67 cm²) and RVO (0.27 ± 0.23 cm²) compared with the normal subjects (0.18 ± 0.23 cm², all Ps < 0.05), there was no significant difference in the ipsilateral carotid IMT and TPA of the affected eye compared with that of the contralateral eye. In conclusion, vascular retinopathy demonstrated a good predictive value in identifying asymptomatic carotid artery atherosclerosis, and this was not confined to the ipsilateral carotid artery of the affected eye. Further recommendations with regard to carotid atherosclerosis screening in patients with vascular retinopathy should be considered.     

A novel method for evaluating human carotid artery elasticity: possible detection of early stage atherosclerosis in subjects with type 2 diabetes

We recently developed a novel method for evaluating the elasticity of arterial walls, the phased tracking method. Herein, we evaluated atherosclerosis of the carotid artery with this method in 242 individuals with type 2 diabetes. In multiple regression analysis of subject status, age, systolic blood pressure and hyperlipidemia were found to be independently associated with carotid artery elasticity values. We also measured currently established values for atherosclerosis, carotid artery IMT and baPWV, in these subjects. Carotid artery elasticity correlated with max IMT (r=0.291, p<0.01), plaque score (PS) (r=0.220, p<0.01) and baPWV (r=0.345, p<0.01). Elasticity, max IMT and plaque score, all correlated with the number of risk factors for atherosclerosis, i.e. hypertension, hyperlipidemia and smoking, in addition to diabetes, consistent with the view that these values reflect atherosclerosis. Importantly, however, in subjects with IMT <1.1mm, who are classified as not having atherosclerosis as defined by IMT criteria, only carotid artery elasticity correlated with the number of risk factors (p<0.05). These results suggest that (1) the measured carotid artery elasticity values reflect atherosclerosis and (2) our novel method has potential for detecting atherosclerosis in its early stage.     

High red blood cell distribution width is closely associated with risk of carotid artery atherosclerosis in patients with hypertension

BACKGROUND:

A high red blood cell distribution width (RDW) may be associated with adverse outcomes in patients with heart failure and risk of death, and cardiovascular events in people with previous myocardial infarction. Ultrasound detection of carotid plaque helps to identify asymptomatic patients with advanced subclinical atherosclerosis, which can predict risk of cardiovascular death or myocardial infarction. However, the relationship of RDW and carotid artery atherosclerosis in hypertensive people is less certain.

OBJECTIVE:

To evaluate the association between RDW and carotid artery atherosclerosis in people with hypertension.

METHODS:

RDW was determined using a Coulter counter together with white blood cell count in 156 hypertensive inpatients 60 to 85 years of age. Carotid intimal-medial thickness (IMT) and carotid atherosclerotic plaques were identified by ultrasound imaging. Total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglyceride levels were determined using a multichannel analyzer. Systolic and diastolic blood pressures were measured manually.

RESULTS:

The number of patients with carotid artery atherosclerotic plaque, as well as the carotid IMT to inner diameter ratio, were significantly different among the different RDW groups of hypertensive inpatients (P<0.01). With linear regression analysis, increased carotid IMT and higher white blood cell count were identified to be significant and independent contributors to the RDW of hypertensive inpatients (P<0.05).

CONCLUSIONS:

A close relationship between high RDW and IMT, and the incidence of carotid plaque, was identified in 156 hypertensive inpatients.     

缺血性脑血管病患者颈内动脉斑块稳定性与氧化型低密度脂蛋白有关

目的探讨缺血性脑血管病患者颈内动脉斑块的形态学改变以及氧化型低密度脂蛋白表达情况及其与斑块稳定性的关系。方法对8例有缺血性脑血管病症状的死者进行尸体解剖,并对其颈内动脉进行连续取材,光镜观察斑块形态,选取稳定及不稳定斑块各20块进行免疫组织化学染色,观察二者氧化型低密度脂蛋白含量的差异和分布情况。并通过图像分析系统对纤维帽厚度以及氧化型低密度脂蛋白阳性区域进行定量。结果8例缺血性脑血管病组共121个颈内动脉取材块中,不稳定斑块占21.5%(26121);稳定斑块为78.5%(95121)。纤维帽厚度在不稳定组和稳定组分别为0.2±0.1mm和0.5±0.2mm,差异有显著性意义(P<0.01)。免疫组织化学染色显示不稳定斑块和稳定斑块中均有氧化型低密度脂蛋白表达,但不稳定斑块阳性面积明显多于稳定斑块,分别为19.4±3.3和14.3±2.5(P<0.01)。结论缺血性脑血管病患者颈内动脉斑块由稳定和不稳定斑块组成,不稳定纤维帽较薄而且斑块内氧化型低密度脂蛋白阳性区域明显多于稳定斑块,提示氧化型低密度脂蛋白可能是斑块不稳定的重要因素。