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目的:分析150例颈动脉粥样斑块病例,探讨其MDCTA表现及其临床流行病学分布特征。方法:经大范围MDCTA检查的颈动脉粥样斑块150例,所有病例均行彩色多谱勒超声检查,29例行DSA检查。应用横断面图像寻找斑块,根据病变的特点行2D、3D后处理,探讨其分布、形态、狭窄程度、钙化、不规则及溃疡等规律。根据斑块的钙化和纤维帽的完整性作为斑块风险性的评价指标,狭窄程度的判断采用NASCET标准。结果:150例病例中共发现317处斑块,其中,颈动脉起始部斑块37例,颈总动脉28例,颈动脉分叉部173例,颈内动脉44例,颈外动脉35例。轻、中、重狭窄及闭塞的发病率分别为30.95%、49.41%、16.96%及3.87%。分叉段斑块钙化率为64.7%,分叉段以外区域为23.9%。分叉段斑块不规则和溃疡的发病率为16.8%,分叉段以外为15.95%。分叉段狭窄程度以轻中度狭窄为主;分叉段以外以中重度狭窄比例高。结论:颈动脉不同区域粥样斑块的分布、形态、钙化和狭窄程度差异存在显著性意义,高风险斑块发病率相似,局限于分叉段的颈动脉检查可能漏诊高风险斑块。
OBJECTIVE: To analyze 150 cases of carotid atherosclerotic plaque and investigate their MDCTA manifestations and clinical epidemiological distribution. Methods: A total of 150 cases of carotid atherosclerotic plaques were examined by MDCTA. All cases underwent color Doppler sonography and 29 cases underwent DSA. Applying the cross-sectional images to find the plaques, according to the characteristics of the lesion underwent 2D and 3D post-processing, to explore its distribution, morphology, stenosis, calcifications, irregularities and ulcers and other laws. According to plaque calcification and the integrity of the fibrous cap as plaque risk assessment index, the degree of stenosis to determine the use of NASCET standards. Results: A total of 317 plaques were found in 150 cases, including 37 cases of carotid artery plaque, 28 cases of common carotid artery, 173 cases of carotid bifurcation, 44 cases of internal carotid artery and 35 cases of external carotid artery. The rates of mild, moderate, severe stenosis and occlusion were 30.95%, 49.41%, 16.96% and 3.87% respectively. The bifurcation plaque calcification rate was 64.7% and the area outside the bifurcation segment was 23.9%. The incidence of irregular and ulcerous plaques in bifurcated segments was 16.8% and 15.95% outside of the bifurcated segments. Bifurcation stenosis to mild to moderate stenosis; bifurcation segment to moderate to severe stenosis ratio. Conclusion: There are significant differences in the distribution, morphology, calcification and stenosis of atherosclerotic plaques in different regions of the carotid artery. The incidence of high-risk plaques is similar. Carotid artery confinement in the bifurcation segment may miss the high-risk plaque.