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目的应用超声造影技术评价颈动脉粥样硬化斑块内血管新生,应用PET/CT技术评价颈动脉粥样硬化斑块内巨噬细胞炎症活性,整体评估颈动脉粥样硬化斑块的稳定性。方法运用超声造影技术对17例颈动脉粥样硬化患者的21个斑块进行斑块内新生血管检测,根据斑块性质分为软斑+混合斑组(14个)和硬斑+钙化斑组(7个),比较组间斑块相对管腔的最大增强强度(IMAX)及最大增强密度(DMAX)。同期行颈部PET/CT检查,比较组间相应位置颈动脉斑块处反映18F-FDG摄取的平均标准化摄取值(SUVmean)。并对超声造影与PET/CT的检查结果进行对比分析。结果软斑+混合斑组颈动脉粥样硬化斑块的DMAX值(4.26±3.65)明显高于硬斑+钙化斑组(1.41±1.47)(P<0.05)。软斑+混合斑组颈动脉粥样硬化斑块内的IMAX值(26.83±19.61)高于硬斑+钙化斑组(24.73±29.85),软斑+混合斑组颈动脉粥样硬化PET/CT检查的SUVmean值(1.70±0.45)高于硬斑+钙化斑组(1.47±0.12),但无统计学差异。超声造影的IMAX、DMAX结果与PET的定量指标SUVmean间无关联(P>0.05)。结论超声造影可以敏感地显示斑块内新生血管的增强情况,PET/CT可以显示颈内动脉粥样硬化斑块炎症程度,两种影像技术可以从不同角度观察和评价斑块的稳定性。
Objective To evaluate the angiogenesis in carotid atherosclerotic plaque by using contrast-enhanced ultrasound and assess the inflammatory activity of macrophages in carotid atherosclerotic plaque by PET / CT and evaluate the stability of carotid atherosclerotic plaque as a whole. Methods Twenty-one plaques of 17 patients with carotid atherosclerosis were examined by using contrast-enhanced ultrasound in plaque neovascularization. According to plaque characteristics, they were divided into soft plaque + mixed plaque group (14) and sclerotic plaque + calcified plaque group (7). The maximum enhancement intensity (IMAX) and maximum enhancement density (DMAX) of the plaque relative to the lumen were compared between groups. During the same period, neck PET / CT examination was performed to compare mean normalized uptake values (SUVmean) of 18F-FDG uptake in carotid plaques at the corresponding locations. The contrastive analysis between the results of ultrasound and PET / CT was made. Results The DMAX value of carotid atherosclerotic plaque was 4.26 ± 3.65 in soft plaque + mixed plaque group (1.41 ± 1.47) (P <0.05). The IMAX of carotid atherosclerotic plaque in soft plaque plus mixed plaque was (26.83 ± 19.61) higher than that in plaques + calcified plaque (24.73 ± 29.85) SUVmean values (1.70 ± 0.45) were higher than those of sclerotiorium + calcified plaque (1.47 ± 0.12), but no statistical difference was found. There was no correlation between IMAX and DMAX of ultrasound contrast and SUVmean, a quantitative index of PET (P> 0.05). Conclusions Contrast-enhanced ultrasound (CEUS) can detect the enhancement of neovascularization in plaque. PET / CT can show the degree of inflammation in atherosclerotic plaque in the carotid artery. The two imaging techniques can observe and evaluate the plaque stability from different angles.