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目的前瞻性研究彩色多普勒血流显像(CDFI)评估颈动脉粥样硬化斑块易损性的可行性。方法33例(36例次)行颈动脉内膜剥脱术(CEA)患者术前均行CDFI、高分辨率核磁共振成像(HRMRI)、CT血管造影(CTA)、CT灌注成像(CTP)和(或)数字减影血管造影(DSA)检查,术后观察粥样硬化斑块形态并行HE染色。将术前CDFI结果分别与相应层面HRMRI及术后病理学结果对照,CDFI设定易损斑块标准:低回声、中等偏低回声不均质斑块;斑块形态不规则、纤维帽不完整或斑块内见血流信号。CDFI设定稳定斑块标准:斑块表面光滑、纤维帽完整、中等回声及强回声均质斑块。结果 CDFI与病理学比较评估易损斑块的敏感性为93.3%,特异性为83.3%,阳性预测值为96.6%,阴性预测值为71.4%;HRMRI与病理学比较评估易损斑块的敏感性为90%,特异性为83.3%,阳性预测值为96.4%,阴性预测值为62.5%。CDFI与HRMRI评估斑块易损性具有良好的一致性(Kappa=0.915,P<0.01)。结论 CDFI可以准确识别易损斑块,为临床诊断及治疗提供可靠依据。
Objective To prospectively study the feasibility of assessing the vulnerability of carotid atherosclerotic plaques by color Doppler flow imaging (CDFI). Methods Thirty-three patients (36 cases) underwent carotid endarterectomy (CEA) before operation underwent CDFI, HRMRI, CT angiography, CT perfusion imaging, Or) digital subtraction angiography (DSA) examination, postoperative observation of atherosclerotic plaque morphology and HE staining. The preoperative CDFI results were compared with the corresponding level of HRMRI and postoperative pathological results, CDFI set vulnerable plaque criteria: hypoechoic, moderately hypoechoic inhomogeneous plaques; irregular plaque morphology, fiber cap is not complete Or see the blood flow within the plaque signal. CDFI set a stable plaque criteria: plaque surface smooth, fiber cap integrity, moderate echo and strong echo homogeneous plaque. Results The sensitivity and specificity of CDFI in evaluating vulnerable plaque were 93.3%, 83.3%, 96.6% and 71.4%, respectively. HRMRI was more sensitive to pathology than susceptible plaque Sex was 90%, specificity was 83.3%, positive predictive value was 96.4%, negative predictive value was 62.5%. There was a good agreement between CDFI and HRMRI in assessing plaque vulnerability (Kappa = 0.915, P <0.01). Conclusion CDFI can accurately identify vulnerable plaque and provide a reliable basis for clinical diagnosis and treatment.