超声影像特征在预测颈动脉斑块内出血中的价值研究

A Study on the Value of Ultrasound Imaging Features in Predicting Intraplaque Hemorrhage in Carotid Arteries

摘要: 目的：本研究旨在评估超声影像学特征，包括斑块溃疡(PU)、临近腔黑区(JBA)和标准化壁指数(NWI)在预测颈动脉动脉粥样硬化斑块中的斑块内出血(IPH)方面的价值，以高分辨率磁共振血管壁成像(HRMR-VWI)作为参考标准。方法：本研究对56名患者的70个颈动脉斑块进行回顾性分析，这些患者均接受了常规超声、对比增强超声(CEUS)和HRMR-VWI检查。记录了斑块的超声特征，包括斑块回声特性、PU、JBA、NWI和管腔狭窄情况。采用逻辑回归分析和受试者工作特征(ROC)曲线分析评估这些特征对IPH的诊断和预测价值。结果：PU、JBA和NWI被确认为IPH的独立风险因素，其比值比(OR)分别为7.43 (95% CI: 2.15~25.67, P = 0.002)、4.90 (95% CI: 1.42~16.92, P = 0.012)和2.55 (95% CI: 1.19~5.45, P = 0.016)。在各个单独的预测因子中，NWI表现出了最高的诊断性能(AUC: 0.78, 95% CI: 0.67~0.89)。PU、JBA和NWI联合诊断模型显著提高了性能，AUC为0.86 (95% CI: 0.77~0.95)，敏感性为81.82%，特异性为78.38%。结论：超声影像学特征，尤其是PU、JBA和NWI，在预测颈动脉斑块中的IPH方面具有重要价值。这些指标的联合分析显著提高了诊断准确性。研究结果突出了超声作为一种具有成本效益、无创的工具，在早期识别IPH和评估中风风险方面的潜力。

Abstract: Objective: The purpose of this study is to evaluate the value of ultrasound imaging features, including plaque ulcer (PU), adjacent cavity black area (JBA) and standardized wall index (NWI), in predicting intra-plaque hemorrhage (IPH) in carotid atherosclerotic plaques, with high-resolution magnetic resonance angiography (HRMR-VWI) as the reference standard. Methods: 70 carotid plaques in 56 patients were retrospectively analyzed. These patients were examined by conventional ultrasound, contrast-enhanced ultrasound (CEUS) and HRMR-VWI. The ultrasonic characteristics of plaque were recorded, including the echo characteristics of plaque, PU, JBA, NWI and lumen stenosis. Logistic regression analysis and ROC curve analysis were used to evaluate the diagnostic and predictive value of these characteristics for IPH. Results: PU, JBA and NWI were identified as independent risk factors of IPH, and their odds ratios (OR) were 7.43 (95% CI: 2.15~25.67, P = 0.002), 4.90 (95% CI: 1.42~16.92, P = 0.012) and respectively. Among the individual predictors, NWI showed the highest diagnostic performance (AUC: 0.78, 95% CI: 0.67~0.89). The combined diagnosis model of PU, JBA and NWI significantly improved the performance, with AUC of 0.86 (95% CI: 0.77~0.95), sensitivity of 81.82% and specificity of 78.38%. Conclusion: Ultrasound imaging features, especially PU, JBA and NWI, are of great value in predicting IPH in carotid plaque. The combined analysis of these indexes significantly improved the diagnostic accuracy. The results highlight the potential of ultrasound as a cost-effective and non-invasive tool in early identification of IPH and assessment of stroke risk.