超微血流成像联合超声造影评价颈动脉斑块新生血管的临床研究

Clinical Study of the Evaluation of Neovascularization in Carotid Artery Plaques Using Superb Microvascular Imaging Combined with Contrast-Enhanced Ultrasound

摘要: 目的：探讨超微血流成像(SMI)与超声造影(CEUS)及其联合应用对颈动脉斑块内新生血管及斑块易损性的诊断效能。方法：选取2021年8月至2024年1月在新疆医科大学第一附属医院昌吉分院神经科接受颈动脉内膜剥脱术(CEA)的患者共计24人，术前行SMI及CEUS检查评分，以术后组织学结果为金标准，通过统计分析颈动脉斑块易损性与超声分级，评价SMI联合CEUS对颈动脉斑块内新生血管及易损性的诊断效能。结果：共获取较完整颈动脉斑块22枚，组织学结果为易损斑块17枚，稳定斑块4枚。CEUS与SMI诊断颈动脉斑块易损性的灵敏度、特异度及准确率分别为94.1%、60%、86.3%和82.4%、80%、81.8%。CEUS联合SMI诊断颈动脉斑块易损性的灵敏度、特异度及准确率分别为94.1%、80%、90.9%。CEUS、SMI及CEUS联合SMI诊断易损斑块的ROC曲线下面积分别为0.771，0.812和0.871。CEUS联合SMI对颈动脉斑块易损性的诊断效能均高于单独使用CEUS或SMI，差异有统计学意义(P < 0.05)。结论：CEUS联合SMI诊断颈动脉斑块易损性可明显提高诊断效能，为临床提供更可靠的斑块易损性评价，具有重要的应用价值。

Abstract: Objective: The study aims to explore the diagnostic efficiency of superb microvascular imaging (SMI) and contrast-enhanced ultrasound (CEUS), as well as their combined application, in assessing neovascularization and vulnerability of carotid artery plaques. Methods: Selecting 24 patients who underwent carotid endarterectomy (CEA) at the Neurology Department of Xinjiang Medical University First Affiliated Hospital Changji Branch from August 2021 to January 2024. SMI and CEUS examinations were performed before surgery, and the results were compared with histopathological findings to evaluate the diagnostic efficacy of SMI combined with CEUS in identifying neovascularization and vulnerability within carotid artery plaques. Results: A total of 22 complete carotid artery plaques were obtained, of which 17 were classified as vulnerable plaques and 4 as stable plaques based on histopathological evaluation. The sensitivity, specificity, and accuracy of CEUS in diagnosing plaque vulnerability were 94.1%, 60%, and 86.3%, respectively. For SMI, the corresponding values were 82.4%, 80%, and 81.8%. When combined, the sensitivity, specificity, and accuracy were 94.1%, 80%, and 90.9%, respectively. The area under the receiver operating characteristic (ROC) curve for CEUS, SMI, and the combination of CEUS and SMI were 0.771, 0.812, and 0.871, respectively. The diagnostic efficacy of CEUS combined with SMI was significantly higher than that of using CEUS or SMI alone, with statistical significance (P < 0.05). Conclusion: The combined use of CEUS and SMI significantly improves the diagnostic efficacy in assessing the vulnerability of carotid artery plaques, providing a more reliable evaluation and demonstrating significant clinical value.