| Part oneConventional ultrasound characteristics of vulnerable carotid plaqueObjective Carotid artery plaque was examined by conventional ultrasound and its characteristics of vulnerable carotid plaque was analyzed.Methods A total of 276 patients were observed by conventional ultrasound and their carotid artery plaque characteristics,included the position of the plaque(internal and external carotid artery,common carotid artery,and carotid bulb),length,thickness,morphology(smooth,irregular,ulcerated),echogenicity(hypoechoic,isoechoic,hyperechoic,and mixed-echoic),and the degree of carotid stenosis(mild,moderate,and severe).According to the results of CT or MRI,patients were divided into ischemic stroke group and non-stroke group.SPSS 22.0 statistical software was used to analyze the differences in conventional ultrasound characteristics of plaques between the two groups.Results There were statistically significant differences in plaques echogenicity,plaques morphology,plaques length,and the degree of carotid stenosis between the two groups(all P<0.05).Logistic regression analysis showed that the ulcerated plaque,severe carotid stenosis,and the hypoechoic plaque were all independent risk indicators for vulnerable plaque.There were no significant differences in the location,thickness,single/multiple of the plaque,and general clinical data between the two groups(all P>0.05).Part twoCEUS assessment of carotid plaque vulnerabilityObjective CEUS was performed on appropriate carotid plaques screened by conventional ultrasound,and the CEUS characteristics of vulnerable plaques were summarized.Methods The CEUS characteristics of plaques in 230 patients were observed,included the direction of blood perfusion in the plaque(from inside to outside,from outside to inside)and the main enhancement sites in the plaque(shoulder,base,and core).Meanwhile,CEUS semi-quantitative visual grading of neovascularization in the plaque was used.According to the results of CT or MRI,patients were divided into ischemic stroke group and non-stroke group.SPSS 22.0 statistical software was used to analyze the differences in the CEUS characteristics of plaques between the two groups.Results In terms of the CEUS semi-quantitative visual grading of neovascularization and the main enhancement sites in the plaque between the two groups,the differences were statistically significant(all P<0.05).In ischemic stroke group,the CEUS visual grading of neovascularization in plaques was mostly grading2 or grading 3 and the main enhancement sites in the plaque was the shoulder or core.There was no statistically significant difference in the direction of contrast microbubbles perfusion of the plaque(P>0.05).But in ischemic stroke group,the proportion of contrast microbubbles perfusion direction of the plaque "from inside to outside" was higher than that of non-stroke group.Part threeThe CEUS classification of carotid plaque combined with the Fazekas classification of white matter lesions predicts the risk of ischemic strokeObjective To explore the clinical value of CEUS visual grading of neovascularization in plaques combined with Fazekas classification of white matter lesions(WML)in predicting the occurrence of ischemic stroke.Methods 170 patients were enrolled into the study,they all underwent plaques CEUS and brain MRI.According to the MRI results,they were divided into ischemic stroke group and non-stroke group.Based on the Logistic regression model and ROC curve,the CEUS classification of carotid plaques combined with the Fazekas classification of WML was used to predict the risk of ischemic stroke.Results The CEUS visual grading of neovascularization in plaques and the Fazekas classification of WML were linearly positively correlated with the occurrence of ischemic stroke(r=0.65,0.55,all P<0.05).Logistic regression analysis showed that CEUS visual grading of neovascularization in plaques and Fazekas classification of WML were independent risk predictors of ischemic stroke(all P<0.01).When CEUS grade ≥ 2 was used as the critical value for predicting ischemic stroke,the sensitivity and specificity were 82% and 75%;when Fazekas grade ≥Ⅱ was used as the critical value for predicting stroke,the sensitivity and specificity were 63% and 81%;when CEUS grading ≥ 2 combined WML Fazekas grading ≥Ⅱ were used as the diagnostic criteria to predict the occurrence of ischemic stroke,the sensitivity and specificity were 85% and 87%.Conclusion:(1)When the conventional ultrasound of carotid plaque has characteristic of ulcerated plaque,hypoechoic plaque,or severe carotid artery stenosis,it indicates that the plaque may be vulnerable;(2)When CEUS grading of neovascularization in plaques is higher,the contrast microbubbles perfusion direction is "from inside to outside",and the main enhancement part of the plaque is the shoulder or core,it indicates that the vulnerability of the plaque increases;(3)CEUS grading of neovascularization combined with WML Fazekas classification can help to predict the risk of ischemic stroke in patients. |
