Application Value Of High-resolution Vessel Wall Imaging In The Study Of Carotid Atherosclerosis

In this study,high-resolution vessel wall imaging technology is used to conduct indepth research on carotid artery stenosis assessment,identification of vulnerable features and component of carotid plaques.The paper is divided into two parts,the summary is as follows:Part One: Comparative analysis of multimodal imaging technology on carotid artery stenosis rate and plaque vulnerability characteristics.Objective: To compare the consistency of high-resolution vessel wall imaging and computed tomographic angiography in the measurement of carotid artery stenosis rate,and to compare the consistency of high-resolution vessel wall imaging and ultrasound in the diagnosis of carotid plaque vulnerable features.Materials and methods: In this study,26 patients with stenotic carotid artery and carotid plaques diagnosed by CTA admitted to the Department of Neurosurgery of Affiliated Hospital of Inner Mongolia Medical University were included as the research object,and the 50 stenosis carotid arteries of 26 patients were examined by HR-VWI and CTA respectively,then the stenosis rate was measured and the consistency was contrasted;31 carotid plaques of 26 patients were examined by HR-VWI and ultrasound,and the number of plaques with vulnerable characteristics was counted to compare consistency.Results:(1)The measurement results of researcher A show that: Bland-Altman difference graph and ratio graph both show that 8%(4/50)points are outside the 95% agreement limit,and the difference range and ratio range are clinically acceptable.HR-VWI and CTA measure the carotid artery stenosis rate with high consistency.(2)The measurement results of researcher B show that the Bland-Altman difference graph shows that an average of 6%(3/50)points are outside the 95% agreement limit,and the ratio graph shows that an average of 2%(1/50)points are95% consistent.Outside the sex limit,the difference range and ratio range are clinically acceptable,and the carotid artery stenosis rate measured by HR-VWI and CTA is highly consistent.(3)The measurement results of investigator A and investigator B are highly repeatable,and the intraclass correlation coefficient and 95% agreement limit were showed that: HR-VWI = 0.944(0.901,0.968),CTA = 0.959(0.929,0.977).(4)There is no difference in the positive results of ulcers and calcification between HR-VWI and the ultrasound,and there are differences in the positive results of large necrotic core,hemorrhage and neovascularization.The detection rate of HR-VWI for large necrotic core and intraplaque hemorrhage(52%,48%)is significantly higher than ultrasound(26%,10%),and ultrasound has a higher positive rate of neovascularization(71%).Conclusion: In combination with clinical practice,it can be considered that for most patients,as for the carotid artery stenosis rate,the HR-VWI measurement result is not significantly different from the CTA measurement result,and the two examination techniques can be used clinically;HR-VWI and US are identifying the vulnerable characteristics of carotid plaques has its own advantages and disadvantages,but they all have irreplaceable clinical value.In clinical application,examination methods should be selected based on the actual needs of patients,and disease characteristics should be identified in a comprehensive and multi-level manner,so as to provide the basis for clinical diagnosis and treatment to the greatest extent while reducing the burden on patients.Part Tow: High-resolution vessel wall imaging and histopathological analysis of carotid plaque composition.Objective: To investigate the accuracy of high-resolution vessel wall imaging in identifying the components of carotid artery plaque.Materials and methods: Thirty patients who underwent carotid endarterectomy from December 2019 to October 2020 in the Department of Neurosurgery of our University were enrolled,then using the MR-VPD software to analyze the main components of carotid artery plaque,and compare with the pathological results after CEA to evaluate the accuracy of HR-VWI in identifying different components of carotid artery plaques.Results:(1)The sensitivity,specificity and the diagnosis coincidence rate of HR-VWI in diagnosing lipid-rich necrotic core were 89.7%,100.0% and 90.0% respectively,and the area under the ROC curve was 0.948.(2)The sensitivity,specificity and the diagnosis coincidence rate of HR-VWI in diagnosing intraplaque hemorrhage were 85.7%,77.8% and 83.3% respectively,and the area under the ROC curve was 0.770.(3)The sensitivity,specificity and the diagnosis coincidence rate of HR-VWI in diagnosing fibrous cap rupture were 53.8%,75.0% and 56.7% respectively,and the area under the ROC curve was 0.644.(4)The sensitivity,specificity and the diagnosis coincidence rate of HR-VWI for diagnosing largescale calcification in plaque were 75.0%,20.0% and 56.7%respectively,and the area under the ROC curve was 0.525.(5)The sensitivity,specificity and the diagnosis coincidence rate of HR-VWI for diagnosing small calcifications diffuse in plaques were 73.9%,14.3% and 60.0%respectively,and the area under the ROC curve was 0.441.Conclusion: HR-VWI has high sensitivity and specificity in diagnosing the internal components of carotid plaques,it can effectively detect high-risk plaques in patients,and providing useful thinking about the efficacy of clinical medical drugs or surgical methods.