Analysis Of Vulnerability Of Carotid Plaque

Objective : The vulnerability of carotid atherosclerosis(CAS)plaques was compared by using 3.0T high resolution magnetic resonance imaging(HR-MRI)and ultrasound(US)imaging techniques,and the clinical influencing factors of CAS plaques were analyzed,so as to provide clinical basis for the formulation of treatment plan and the prevention of stroke.Methods:A total of 60 inpatients(33 males and 27 females)with carotid artery plaques confirmed by conventional cervical vascular ultrasound were collected,and 40 of them had pathological findings.All the 60 patients underwent high-resolution MRI scanning with multiple sequences,including T1 WI,T2WI,3D-TOF and SNAP sequences,and the corresponding number of degree of vascular stenosis of plaques at different locations of the two methods were counted.The plaque nature and the corresponding degree of vascular stenosis were recorded in 40 pathologically confirmed patients.The differences of the two methods in the diagnosis of lumen stenosis and plaque number were compared.The differences in plaque vulnerability and degree of lumen stenosis were compared.Plaques can be divided into vulnerable plaques and stable plaques according to their components.To compare the consistency of cervical ultrasound,high-resolution magnetic resonance imaging,and pathology in carotid artery vulnerability.Clinical data of 60 patients were collected,including age,gender,body mass index,triglyceride,total cholesterol,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,smoking,hypertension and diabetes history.Logistic regression was used to analyze the relationship between common clinical influencing factors and carotid artery vulnerable plaques.Results:1.In 60 patients,HR-MRI detected 27 cases of mild stenosis,38 cases of moderate stenosis,12 cases of severe stenosis and 2 cases of occlusion.Ultrasound detected 26 mild stenosis,36 moderate stenosis,11 severe stenosis and2 occlusion.Compared with the two methods in evaluating the degree of lumen stenosis,c~2=0.013,P>0.05,the difference was not statistically significant.2.40 patients were pathologically confirmed to have 60 plaques,including 33 vulnerable plaques and 27 stable plaques.Different types of plaques correspond to different degrees of vascular stenosis.In the diagnosis of vascular stenosis degree and plaque vulnerability,c~2=2.142,P>0.05,the difference was not statistically significant.3.HR-MRI detected a total of 79 plaques in 60 patients,including 28 common carotid artery,42 carotid artery bifurcation,and 9 internal carotid artery.Ultrasound detected a total of 75 plaques,including 27 common carotid artery,40 carotid artery bifurcation,and 8 internal carotid artery.Compared with the number of plaques detected by the two methods,c~2=0.022,P>0.05,the difference was not statistically significant.The bifurcation plaques of carotid artery were 53.3%detected by ultrasound and 53.2% detected by high resolution magnetic resonance.4.In terms of the detection of unstable plaques by high-resolution magnetic resonance and pathology,the two detection methods showed good consistency,Kappa=0.930,P<0.05,and the difference was statistically significant.In terms of the detection of unstable plaques by ultrasound and pathology,the consistency between the two methods was general,Kappa=0.544,P<0.05,and the difference was statistically significant.HR-MRI had a sensitivity of 96.9% and a specificity of 96.2% for plaque vulnerability,and US had a sensitivity of 87.1% and a specificity of 66.6% for plaque vulnerability.5.High-density lipoprotein,low-density lipoprotein,smoking and hypertension were the risk factors affecting vulnerable plaques,and the difference was statistically significant(P<0.05).Multivariate Logistic regression analysis showed that high density lipoprotein,low density lipoprotein and smoking were independent influencing factors for the occurrence of vulnerable plaques,and the difference was statistically significant(P<0.05).Conclusion:1.There was no difference between high-resolution MRI and carotid ultrasound in the diagnosis of lumen stenosis.2.Plaque vulnerability and stability were not related to lumen stenosis.3.There was no difference between high-resolution MRI and carotid ultrasound in the detection of plaque number.Both methods detected a higher proportion of plaque at the bifurcation of the carotid artery than at other sites.4.The high resolution MRI and pathology have a good consistency in the diagnosis of plaque vulnerability,while ultrasound and pathology have a general consistency in the diagnosis of plaque vulnerability.High resolution MR is superior to ultrasound in the diagnosis of plaque vulnerability.5.The smoking,LDL-C and HDL-C were independent risk factors for the formation of the vulnerable plaque of carotid artery.