Study On The Stability Of Carotid Atherosclerotic Plaque By High Resolution Magnetic Resonance Imaging And Contrast-enhanced Ultrasound

Objective: To study the role of HRMRI and CEUS in the evaluation of vulnerable carotid plaque,and compare the value of both in evaluating the stability of carotid plaque;Combined with the characteristics of CISS cerebral infarction classification,to explore the correlation between AHA plaque classification and common cerebral infarction,and to analyze the distribution characteristics and clinical risk factors of carotid vulnerable plaque.Methods: 40 patients with acute ischemic stroke hospitalized in the Department of Neurology of our hospital from November 2019 to November 2020 were selected as the experimental group,and 31 patients with carotid plaque diagnosed by carotid artery color Doppler ultrasound were selected as the control group.HRMRI and CEUS were performed in the two groups respectively.The general clinical data,high-resolution magnetic resonance image and contrast-enhanced ultrasound image of carotid artery were collected.The improved AHA plaque classification was used for MRI images,and the contrast-enhanced ultrasound grading standard was used for contrast-enhanced ultrasound results.The detection of vulnerable carotid plaques by HRMRI and CEUS was compared between the two groups;The experimental group was divided into three groups according to the etiological classification of CISS cerebral infarction: The plaque of carrier artery blocked the perforator artery group,arterial embolization group and hypoperfusion / obstruction of embolectomy group,the correlation between cerebral infarction classification and AHA plaque classification was discussed and the distribution characteristics of vulnerable plaque and stable plaque in the experimental group were analyzed;According to the stability of the plaque,the patients in the experimental group and the control group were divided into vulnerable plaque group and stable plaque group,and the related risk factors were analyzed.Results: 1.There was no significant difference in clinical baseline data and risk factors between the two groups(P > 0.05);In the experimental group,47 stable plaques and 59 vulnerable plaques were detected by HRMRI(the detection rate of vulnerable plaques was 55.7%);56 stable plaques and 50 vulnerable plaques were detected by CEUS(the detection rate of vulnerable plaques was 47.2%);In the control group,41 stable plaques and 24 vulnerable plaques were detected by HRMRI(the detection rate of vulnerable plaques was 36.9%);CEUS detected 45 stable plaques and20 vulnerable plaques(the detection rate of vulnerable plaques was 30.8%);There was significant difference in the detection rate of vulnerable plaques between HRMRI and CEUS(55.7% vs 36.9%,47.2% vs 30.8%)(P < 0.05);2.In the 106 carotid plaques in the experimental group,59 vulnerable plaques(type IV-V,VI)and 47 stable plaques(type I-II,III,VII,VIII)were detected by HRMRI,and the detection rate of vulnerable plaques was 55.7%;50 vulnerable plaques(grade I,II)and 56 stable plaques(grade 0)were detected by CEUS,and the detection rate of vulnerable plaques was 47.2%.There was significant difference between HRMRI and CEUS(P=0.005,kappa=0.269),and HRMRI had a higher detection rate of vulnerable plaques;3.There was no significant difference in carotid artery distribution between vulnerable plaque and stable plaque in the experimental group(P > 0.05),and the common carotid artery bifurcation and the initial segment of internal carotid artery were the most common;4.40 patients with acute cerebral infarction in the experimental group,excluding 2cases of perforating artery infarction type and 1 case of cardiogenic embolism type,a total of 37 cases of large artery atherosclerotic cerebral infarction,excluding 1 case of artery artery embolism combined with decreased thrombus clearance type,the remaining 36 cases were included in the study,including 14 cases of carrier artery plaque occlusion perforating artery type,9 cases of artery artery embolism type,13 cases of hypoperfusion / thrombus clearance type,There was no significant difference in AHA classification among the three groups(P > 0.05);5.Single factor analysis showed that homocysteine(p=0.00),total cholesterol(p=0.00),low density lipoprotein(p=0.00),and hypertension(p=0.047)were the risk factors for the formation of vulnerable plaque;Multivariate regression analysis showed that homocysteine(OR: 0.708,95% Cl: 0.603-0.830;P=0.000)and LDL cholesterol(OR: 0.347,95% Cl: 0.180-0.670;P=0.002)was an independent risk factor for vulnerable plaque of carotid artery.Conclusion: HRMRI and CEUS can effectively distinguish vulnerable plaques,and the detection rate of vulnerable plaques on HRMRI is higher than that on CEUS;There is no significant difference in the location and distribution of vulnerable plaques and stable plaques in the carotid artery,and they are mostly located in the bifurcation of common carotid artery and the initial segment of internal carotid artery;There is no significant correlation between the common etiological types of acute cerebral infarction and the types of AHA plaques;High levels of homocysteine and low-density lipoprotein White cholesterol is independently associated with carotid vulnerable plaque formation.