超聲聲學(xué)造影評(píng)價(jià)頸動(dòng)脈粥樣硬化斑塊新生血管形成及穩(wěn)定性

1、Correlation of Carotid Plaque Neovascularization Detected by Contrast-Enhanced Ultrasound Imaging With Clinical Symptoms,You-Bin Deng, MD, 鄧又斌Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China

2、 武漢同濟(jì)醫(yī)院,Mechanisms of vessel wall neovascularization in atherosclerosisDoyle B et al. JACC 2007; 49:2073,Possible roles for microvessels in disease progression include the supply of cellular and soluble lesion com

3、ponents, enhancement of intraplaque gas exchange, anddelivery of metabolic substrates to the plaque core.Doyle B et al. JACC 2007; 49:2073,Neovascularization in Stable and Unstable Coronary Plaques,Kolodgie FD et al.

4、 JACC 2007;49:2093,Plaque neovascularization and clinical symptoms,Fleiner M et al. Circulation 2004;110:2843,Number of microvessels identified from plaques of symptomatic and asymptomatic patients.,McCarthy MJ et al.

5、 J Vasc Surg 1999;30:261,Vessel Density at Histology According to Plaque Contrast-Agent Enhancement,Coli S et al. JACC 2008;52:223,Vulnerable patients have vulnerable plaques Plaque neovascularization is the remarkabl

6、y consistent feature of vulnerable plaque in cerebrovascular patients Contrast-enhanced carotid ultrasound imaging is promising and may serve to detect the neovascularization within the atherosclerotic plaque in vivo.C

7、arotid plaque contrast-agent enhancement with sonographic agent correlates with histological density of neovessels within the carotid plaque The association between the carotid plaque enhancement with contrast agent mic

8、robubbles and clinical symptoms is not fully understood.,Study Population,研究方法,,GE Log9超聲診斷儀9L探頭：頻率為6MHz機(jī)械指數(shù)：0.13,104例患者,快速靜脈注射SonoVue 1.5 ml,,,實(shí)時(shí)觀察頸動(dòng)脈腔及斑塊內(nèi)造影劑顯影情況,,Grade 1: no enhancement within the plaque or enhancem

9、ent confined to plaque adventitial side and/or shoulderGrade 2: enhancement reaching plaque core/or extensive contrast agent enhancement throughout the plaque.,Grading of Contrast-Agent Enhancement by Visual Interpretat

10、ion,Grading of Contrast-Agent Enhancement by Quantitative Analysis,Enhanced intensity in the plaqueRatio of the enhanced intensity in the plaque to that in the carotid artery lumen,Receiver Operating Characteristic Curv

11、e Analysis,The sensitivity and specificity for enhanced intensity in the plaque (cutoff value: 10.0 dB) were 74% and 62%, respectively and those for ratio of enhanced intensity in the plaque to that in the carotid artery

12、 lumen (cutoff value: 0.46) were 74% and 75%, respectively.,No 2984, M, 71 yrs,Standard and contrast-enhanced carotid ultrasound images in a 78-year-old man who experienced serial transient ischemic attack 2 days before

13、examination.,No 2274, F, 74 yrs,,雙側(cè)頸總動(dòng)脈可見多處斑塊，患者最近有TIA病史，注射Sonovue 2ml造影劑后，左側(cè)一斑塊顯影，回聲增強(qiáng)。,,No 2290, M, 51 yrs,雙側(cè)頸總動(dòng)脈可見多處斑塊，患者三天前發(fā)生腦梗死，有高血壓病史，注射Sonovue 2ml造影劑后，右側(cè)一斑塊顯影，回聲增強(qiáng)，斑塊后方可見豐富的滋養(yǎng)血管。,No 2295, M, 64 yrs,冠心病患者，有高血壓病史，雙側(cè)

14、頸總動(dòng)脈可見多處斑塊，注射Sonovue 2ml造影劑后，左側(cè)一斑塊顯影，回聲增強(qiáng)。,No 2330, M, 53 yrs,雙側(cè)頸動(dòng)脈竇可見斑塊，患者發(fā)作性右側(cè)肢體無力20天，注射Sonovue 1.5ml造影劑后，左側(cè)頸動(dòng)脈竇處的后方一斑塊全部顯影，前方的斑塊周邊顯影。,In conclusion, contrast-enhanced carotid ultrasound imaging provided us a way for t

15、he direct visualization of neovascularization within the plaque. Patients with recent transient ischemic attack and/or cerebrovascular ischemic stroke had more intense contrast-agent enhancement in the plaque than those