多模态超声评价颈动脉斑块易损性的多因素分析

目的 将二维超声、微血管成像技术、超声造影颈动脉斑块相关的声像图特征及临床卒中的危险因素纳入Logistic回归,明确对缺血性卒中最有影响的斑块特征及危险因素,明确超声联合诊断效能。 

Carotid Plaque Vulnerability Evaluation with Multimode Ultrasound

Objective To investigate the valuable characteristics of vulnerable carotid plaques in predicting
ischemic stroke by multimode ultrasound, and evaluate the diagnostic value of multimode
ultrasound.
Methods A total of 92 patients who underwent carotid ultrasound examination at department of
ultrasound of Beijing Tiantan hospital, capital medical university from August 2016 to October
2017 were included in this study. The multimode ultrasound included routine two-dimensional
ultrasound, contrast-enhanced ultrasonography (CEUS) and superb microvascular imaging (SMI). A
total of 105 plaques were diagnosed, and all patients were divided into symptomatic group and nonsymptomatic
group according to clinical symptoms. The ultrasonographic characteristics of plaques
and the patients’ clinical data were included in univariate analysis, and the statistically significantfactors were then included in Logistic regression analysis. The receiver operating characteristic
(ROC) curve was plotted to test the sensitivity and specificity of predictive diagnosis.
Results Univariate analysis showed that smoking index, serum total cholesterol, low density
lipoprotein, apolipoprotein B, signal enhancement on CEUS, neovascularization on SMI, plaque
surface morphology on CEUS and SMI, calcified nodule location were statistically significant.
The Logistic regression analysis showed that high enhancement on CEUS [odds ratio (OR) 9.610,
95% confidence interval (CI) 2.734-33.779, P <0.001], irregular plaque surface on SMI (OR 4.483,
95%CI 1.323-15.189, P =0.016) and calcified nodule on plaque surface (OR 7.206, 95%CI 1.609-
32.265, P =0.010) were independent risk factors of ischemic stroke. The area under the ROC curve,
the sensitivity and specificity of predicting ischemic stroke for the three factors were 0.723, 75.8%,
67.4%; 0.657, 50.1%, 76.1%; 0.679, 40.7%, and 82.6%, respectively; and that of multifactorial
diagnosis were 0.837, 90.5%, and 62.0%.
Conclusion The characteristics of vulnerable plaques, such as high enhancement on CEUS,
irregular plaque surface on SMI and calcified nodule on plaque surface are independent risk factors
of ischemic stroke. Multimode ultrasound can better detect plaque characteristics, and thus increase
the accuracy of predicting ischemic stroke.