Comparative Study Of Pathological And Non-invasive Imaging Of Carotid Plaque Stability

Stroke has a high morbidity and mortality rate of the disease in China and all humanity.Has been reported, 19%-35% of pathogenesis of stroke coming from carotid arteriosclerosis who caused intracranial corresponding circulation disorder. Therefore,vulnerable plaque in the carotid bifurcation is an important risk factor for(recurrent)stroke and is used in therapeutic decision making,which is important to be detected.Studies have shown that,about assessing carotid plaque stability, various imaging have their own advantages and disadvantages, but the gold standard is still the pathological assessment. This study was based on pathology assessment as the gold standard,for correlation analysis about all kinds of unstable plaque composition and clinical symptoms and signs, and related noninvasive imaging(conventional Doppler B-mode ultrasound, arterial CT angiography, neck enhanced MRI),Which is better to assess carotid plaque stability. We aim to explore the more precise diagnosis program about the stability of carotid atherosclerotic plaque to contribute to clinical treatment.PartⅠ:The Association Between The Stability of Carotid Atherosclerotic Plaque and the Symptoms of Cerebral IschemiaObjective To evaluate the association between the symptoms of cerebral ishcemia and components of carotid atherosclerosis plaque by using the methods of pathology,and further explore the histology factors of clinical symptoms.Materials and Methods 56 patients with carotid artery stenosis were recruited fromJune,2014 to October, 2015, and were divided into two groups based on their symptom of cerebral ischemia. Datas of carotid artery stenosis,the symptoms of cerebral ischemia and the pathological components of carotid plaque were also collected at the same time. Correlation statistical methods were used to determine the association of clinical symptoms of cerebral ischemia and plaque components.Results 56 complete carotid atherosclerotic plaques(8 stable plaques and 48 unstable plaques) come from 56 patients(65.9 ± 8.4 years) with carotid artery stenosis. The group of symptoms of cerebral ischemia have 36 people, and asymptomatic group have 20 people. Hemorrhage appears symptomatic plaque significantly higher than the asymptomatic group(83.3% vs 60%, P <0.05). Multivariate analysis showed that hemorrhage plaques are highest impacting patients with or without symptoms and TIA [odds ratio(OR) respectively 3.636, 8.674], ulcer ingredients is a highest degree of influence on a transient unconsciousness(OR = 6.071), thrombosis highly affect a transient limb paralysis or numbness(OR = 7.495).Conclusions Whether the cerebral ischemic symptoms clinically are significantly relevant with carotid plaques with hemorrhage, ulcers, thrombosis,and the integrity of the fibrous cap; the examination of the carotid plaques of asymptomatic patients whoes part of plaques is instability, is indispensable.Part Ⅱ:Comparative study of Non-invasive Imaging(Ultrasonography、CT、MRI)Evaluation On The Stability Of Carotid Atherosclerotic PlaqueObjective:This study will discuss the accuracy of the ultrasound(CEUS companywith convetional ultrasound), CT and MRI assessing of the stability of carotid plaques, and carries on the comparative analysis of the accuracy of three kinds of inspection.Materials and Methods From June 2013 to October 2015 period, we group patients with carotid stenosis to get complete line of carotid atherosclerotic plaques after carotid endarterectomy(CEA).And the pathological specimens were analyzed for gross and microscopic pathology analysis, about the diagnosis of each composition and the stability. We Collected the diagnostic results of plaque components and stability of Doppler B-mode ultrasound, carotid CTA, enhanced MRI examinatio. In plaque pathology as the gold standard,we study the sensitivity, specificity and diagnostic accuracy of diagnostic of three imaging. Comparative analysis of three methods would be carried out to know strengths and weaknesses of them.Results 60 complete carotid atherosclerotic plaques come from patients with carotid artery stenosis in 58 cases(66.2 ± 8.3 years). The diagnostic accuracy of vulnerable plaque of ultrasound, CT, MRI are 51.7%, 16.7%, 81.7%. In the thin fibrous cap assessment, ultrasound and CT examination can not be achieved, the diagnostic accuracy of MRI examination is 63.3%, reflecting the obvious advantage. In the assessment of completeness of fibrous cap and thrombosis, CT examination can not be achieved, and the diagnostic accuracy of ultrasound and MRI is almost equal, but the sensitivity of MRI is relatively high. Diagnosis of ulcer formation of three diagnostic rates were 63.3%, 70.0%, 73.3%, sensitivity of MRI is relatively high.Under the diagnosis of plaque hemorrhage, CT examination can not be achieved, the diagnosis rate of ultrasound and MRI was 25% and 60% respectively, but lower specificity of MRI diagnosis, then it contribute to false positives.And for significant hemorrhage, The diagnostic sensitivity and specificity of MRI are more high then the diagnosis of all plaque hemorrhage. The compliance rates of three examination’sdiagnosis about calcification are 80%, 80% and 71.7%, and the sensitivity of ultrasound diagnosis is higher, the higher specificity of MRI. The compliance rates of three examination’s diagnosis about calcified plaque is 63%, 70%, 86.7%.Conclusions Three kinds of imaging of carotid artery plaque stability assessment have their own advantages and disadvantages, in the overall stability assessment of the compliance rate, enhanced MRI is highest, followed by conventional ultrasound.CTA can give some reference to clinical about evaluation in ulcer.