基于超聲造影的聲觸診組織成像量化技術(shù)檢測(cè)動(dòng)脈斑塊穩(wěn)定性的應(yīng)用研究
發(fā)布時(shí)間:2018-06-24 來(lái)源: 散文精選 點(diǎn)擊:
[摘要] 目的 應(yīng)用聲觸診組織成像量化技術(shù)(VTQ)對(duì)人頸動(dòng)脈硬化斑塊進(jìn)行質(zhì)地硬度測(cè)量,以超聲造影作為比較,探討VTQ檢測(cè)動(dòng)脈斑塊穩(wěn)定性的臨床價(jià)值。方法 方便選取2015年1月—2016年12月該院住院患者80例,應(yīng)用VTQ技術(shù)對(duì)常規(guī)超聲診斷的97個(gè)頸動(dòng)脈斑塊進(jìn)行內(nèi)部質(zhì)地的剪切波速度(SWV)測(cè)定,然后對(duì)97個(gè)斑塊進(jìn)行超聲造影(2D-CEUS),根據(jù)2D-CEUS強(qiáng)化特點(diǎn),出現(xiàn)明顯強(qiáng)化的39個(gè)斑塊診斷為易損斑塊,輕度強(qiáng)化及無(wú)強(qiáng)化的58個(gè)斑塊診斷為穩(wěn)定斑塊,比較易損斑塊及穩(wěn)定斑塊的SWV值并做出ROC曲線。結(jié)果 ①易損斑塊SWV值明顯低于穩(wěn)定斑塊,差異有統(tǒng)計(jì)學(xué)意義(P<0.05 );②根據(jù)ROC曲線下最大面積0.859時(shí),SWV=2.54 m/s為診斷節(jié)點(diǎn)值,VTQ診斷易損斑塊的敏感度和特異度分別為72.4%、84.6%。結(jié)論 聲觸診組織成量化技術(shù)可以定量測(cè)定動(dòng)脈斑塊的質(zhì)地,從而預(yù)測(cè)頸動(dòng)脈斑塊的穩(wěn)定性。
[關(guān)鍵詞] 聲觸診組織成像量化技術(shù);超聲造影;動(dòng)脈斑塊
[中圖分類號(hào)] R445 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 1674-0742(2018)01(c)-0182-03
[Abstract] Objective This paper tries to evaluate the hardness of human atherosclerotic plaque by using acoustic palpation Tissue Imaging Quantitative Technology (VTQ), and to compare the clinical value of VTQ in detecting arterial plaque stability by contrast-enhanced ultrasound. Methods A total of 80 inpatients from January 2015 to December 2016 in this hospital were conveniently eolled. The VTQ technique was used to determine the shear wave velocity (SWV) of 97 carotid plaques in routine ultrasound diagnosis. Then 97 plaques were implemented ultrasound imaging (2D-CEUS). According to 2D-CEUS enhancement features, 39 plaques with obvious enhancement were diagnosed as vulnerable plaque. 58 plaques with mild and no enhancement were diagnosed as stable plaques, which were easier to diagnose SWV values of plaque and plaque stability and make ROC curves. Results ①The SWV of vulnerable plaque was significantly lower than that of stable plaque (P<0.05);②With the maximum area of 0.859 under ROC curve, SWV=2.54 m/s was the value of diagnostic node, the sensitivity and specificity of vulnerable plaques by VTQ diagnosis were 72.4% and 84.6% respectively. Conclusion The acoustic palpation tissue quantification technique can quantitatively determine the texture of arterial plaque to predict the stability of carotid plaque.
[Key words] Acoustic palpation tissue imaging quantification technique; Contrast-enhanced ultrasound; Arterial plaque
心腦血管疾病死亡率及致殘率高,并發(fā)癥多,是一種嚴(yán)重威脅人類健康的疾病,而動(dòng)脈易損斑塊是引起心腦血管意外的主要原因[1],該研究方便選取2015年1月—2016年12月間收治的80例患者,采用聲觸診組織成像量化技術(shù)(VTQ)定量檢測(cè)斑塊的內(nèi)部質(zhì)地,旨在尋找一種方便、快捷、無(wú)創(chuàng)的手段診斷易損斑塊,為臨床早期預(yù)防及治療易損斑塊提供一定的理論依據(jù)。報(bào)道如下。
1 資料與方法
1.1 一般資料
方便選取該院高血壓科、心內(nèi)科及腦病科住院患者80例,其中女性25例,男性55例,年齡37~87歲,平均年齡(61.5±9.8)歲。納入標(biāo)準(zhǔn):經(jīng)臨床確診存在頸動(dòng)脈斑塊;排除標(biāo)準(zhǔn):存在造影劑過(guò)敏史。
1.2 儀器與方法
使用SIEMENS ACUSON S2000型彩色多普勒超聲診斷儀,Multi-D9L4線陣探頭,探頭頻率:8 MHz,檢查方法:由1名從事超聲造影及超聲彈性成像工作5年以上經(jīng)驗(yàn)的醫(yī)師進(jìn)行常規(guī)超聲及聲觸診組織成像量化技術(shù)(VTQ)檢查,患者平臥位頭部偏轉(zhuǎn)充分暴露頸部,先對(duì)頸動(dòng)脈進(jìn)行常規(guī)超聲檢查,記錄所發(fā)現(xiàn)斑塊的數(shù)目、位置、大小、形態(tài)、內(nèi)部回聲,然后對(duì)斑塊進(jìn)行彩色多普勒檢查(CDFI),彩色取樣框包繞斑塊周圍1.5 cm范圍,記錄斑塊周邊及內(nèi)部血流情況。第三步調(diào)節(jié)儀器條件,清晰顯示目標(biāo)斑塊最大切面,啟動(dòng)VTQ模式對(duì)目標(biāo)斑塊進(jìn)行剪切波速度(SWV)測(cè)定,每次測(cè)量前囑患者屏氣,使取樣框盡量包繞整個(gè)斑塊,同一斑塊連續(xù)測(cè)量5次,取SWV平均值,每次測(cè)量留圖存盤。對(duì)所有斑塊完成VTQ檢查后進(jìn)入造影模式(CPS)調(diào)節(jié)儀器的各類參數(shù),準(zhǔn)備好造影條件,隨后進(jìn)行2D-CEUS檢查,造影劑的注射由1名具有2年以上配合超聲造影檢查的護(hù)士,使用聲諾維(Sono Vue)造影劑,使用前注入5 mL 0.9%氯化鈉溶液進(jìn)行稀釋,充分混均至乳白色懸濁液后抽出2.4 mL,于肘正中靜脈團(tuán)注后追加5 mL生理鹽水沖管,護(hù)士注射造影劑同時(shí)檢查醫(yī)師開(kāi)始采用儀器計(jì)時(shí),進(jìn)行全程存儲(chǔ)圖像,實(shí)時(shí)不間斷的觀察斑塊的增強(qiáng)變化,在動(dòng)脈相、門脈相及延遲相觀察病灶斑塊的強(qiáng)化與退出情況,造影結(jié)束后由2名從事超聲造影工作5年以上的醫(yī)師對(duì)動(dòng)態(tài)錄像進(jìn)行觀察,對(duì)其進(jìn)行整理分析。
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