超声造影对不同回声类型颈动脉斑块内新生血管的分析

发布时间：2018-05-31 02:06

本文选题：超声造影 + 灰阶中位数　；参考：《福建医科大学》2015年硕士论文

【摘要】：【目的】本课题是应用超声造影成像(contrast-enhanced ultrasound,CEUS)技术获得不同回声类型颈动脉粥样硬化斑块的超声造影动态图、造影增强强度视觉评分和造影参数,分析不同回声类型斑块与脑血管事件发生率之间的相关性,为无创定量评估颈动脉粥样硬化斑块的稳定性提供影像学依据。【方法】1、选择2013年9月至2014年12月于我院行颈部血管超声检查的患者64个斑块,来源于39例患者,男性31例,女性8例,平均年龄66.8±7.4岁。2、采用东芝Aplio500超声诊断仪,9L线阵探头,频率6-8MHz。对颈动脉粥样硬化斑块行常规超声及超声造影检查,获得斑块的二维灰阶图及超声造影动态图。3、根据斑块的超声造影动态图获得斑块的造影增强强度视觉评分、造影参数。利用计算机辅助程序获得各斑块的灰阶中位数值(gray-scale median,GSM)。4、根据Gray-weale等[1]提出的分类方法将颈动脉粥样硬化斑块分成四组。分析四组斑块的造影增强强度视觉评分、造影参数及GSM值的差异。5、分析斑块的超声造影参数与斑块的GSM值之间的相关性及不同灰阶斑块脑血管事件的发生率。【结果】1、四组斑块的GSM值组间两两比较:四组斑块的GSM值之间的差异具有统计学意义(F=29.365,P0.001),组间两两比较:不均质低回声斑块组与均质高回声斑块组差异没有统计学意义(P=0.245),余组间差异有统计学意义(P0.05)。2、四组斑块的造影动态图表现及视觉评分结果:不同回声类型的颈动脉粥样硬化斑块之间的超声造影视觉评分增强分级中的增强强度值之间的差异具有统计学意义(c2=17.951,P0.001),颈动脉斑块的回声越低超声造影视觉评分增强越明显。均质与不均质低回声斑块组的增强显影评分多为2分、3分,分别约占66.7%(14/21)、92.3%(12/13),但1个均质低回声斑块表现为不增强;而均质与不均质高回声斑块组的增强显影评分多为1分,分别约占58.8%(10/17),46.2%(16/30)。3、四组斑块的超声造影参数组间两两比较:四组斑块的超声造影增强强度值(c2=29.025,P0.001)、增强密度值(c2=30.871,P0.001)之间的差异均具有统计学意义。组间两两比较:均质低回声斑块组与均质高回声斑块组及不均质高回声斑块组之间的差异具有统计学意义(P0.05);不均质低回声斑块与均质高回声斑块组及不均质高回声斑块组之间的差异具有统计学意义(P0.05);余组间无明显统计学差异。4、超声造影视觉评分增强分级的定量参数组间两两比较:不同分值的超声造影增强强度值之间的差异具有统计学意义(c2=23.709,P0.001),组间两两比较:视觉评分为1分与视觉评分为2分、3分的超声造影增强强度值之间的差异具有统计学意义(P0.05);余组间无明显统计学差异。5、斑块的增强强度与斑块的GSM值呈负相关(r=-0.376,P=0.000),相关性显著;斑块的增强密度与斑块的GSM值呈负相关(r=-0.252,P=0.000),相关性显著。6、低回声斑块组脑血管事件发生率约92.9%(13/14),未发生脑血管事件约7.1%(1/14),高回声斑块组脑血管事件发生率约60%(9/15),未发生脑血管事件约40%(6/15)。【结论】1、不同灰阶斑块具有不同特征的造影动态图。2、不同回声类型的颈动脉粥样硬化斑块具有不同的GSM值。3、颈动脉粥样硬化斑块的超声造影增强强度评分和造影参数值二者可间接反映不同灰阶斑块内新生血管的增生情况。4、斑块的超声造影参数值与斑块的GSM值呈负相关,低回声斑块组脑血管事件发生率高。说明斑块的回声越低,GSM值越低,超声造影增强强度值及增强密度值则越高,间接提示斑块内新生血管生成越多,斑块稳定性就越差,脑血管事件的发生率也就越高。5、超声造影联合GSM技术能更加客观地定量评估不同回声类型的颈动脉粥样硬化斑块内新生血管的生成情况。由于研究组例数少,所得结论还需要扩大样本量做进一步的研究。
[Abstract]:[Objective] this topic is the application of ultrasound contrast imaging (contrast-enhanced ultrasound, CEUS) technology to obtain different echo types of carotid atherosclerotic plaque dynamic ultrasound imaging, contrast enhancement intensity visual score and contrast parameters, analysis of the correlation between different echo type plaque and the incidence of cerebrovascular events, for noninvasive Quantitative evaluation of carotid atherosclerotic plaque stability provides imaging basis. [Methods] 1, 64 plaques were selected from September 2013 to December 2014 in our hospital with cervical vascular ultrasound examination, from 39 patients, 31 males and 8 women, with an average age of 66.8 + 7.4 years.2, using a Toshiba Aplio500 ultrasonic diagnostic instrument, 9L linear array probe, frequency Rate 6-8MHz. for carotid atherosclerotic plaques were examined by conventional ultrasound and ultrasound contrast. The two-dimensional gray scale of plaque and.3 were obtained. The visual score of the plaque enhancement intensity was obtained according to the dynamic map of the plaque, and the contrast parameters were obtained by the computer aided program (gray-s Cale median, GSM).4, divided the carotid atherosclerotic plaque into four groups according to the classification method proposed by Gray-weale and [1]. The contrast enhancement intensity visual score of the four groups of plaques, the difference of contrast parameters and the difference of GSM value were analyzed, and the correlation between the contrast parameters of the plaque and the GSM value of the plaque and the different gray scale plaque of the cerebral vascular events were analyzed. [results] [results] 1, 22 of the GSM values between the four groups were compared: the difference between the GSM values of the four groups was statistically significant (F=29.365, P0.001), and the difference between the groups was 22: the difference of the heterogeneous hypoechoic plaque group and the homogeneous hyperechoic plaque group was not statistically significant (P0.05) (P0.05).2, and the four groups were statistically significant (P=0.245). Dynamic images of plaque and the results of visual score: the difference between enhanced intensity values in the enhanced classification of carotid atherosclerotic plaques of different echo types was statistically significant (c2=17.951, P0.001), the lower the echo of carotid plaques, the greater the enhanced visual score of contrast-enhanced ultrasonography. The enhanced development score of the inhomogeneous hypoechoic plaque group was 2, 3, about 66.7% (14/21) and 92.3% (12/13), but the 1 homogeneous hypoechoic plaques were not enhanced, while the enhanced development score of the homogeneous and heterogeneous hyperechoic plaque group was 1, about 58.8% (10/17), 46.2% (16/30).3, and in the four group of atherosclerotic plaques 22 comparison: the contrast enhanced intensity value (c2=29.025, P0.001) and enhanced density (c2=30.871, P0.001) of the four groups were all statistically significant. The differences between the groups of the homogeneous hypoechoic plaque group and the homogeneous hyperechoic plaque group and the heterogeneous hyperechoic plaque group were statistically significant (P0.05). The difference between the homogeneous hypoechoic plaque and the homogeneous hyperechoic plaque group and the heterogeneous hyperechoic plaque group was statistically significant (P0.05), and there was no significant difference between the remaining groups.4. The comparison between the quantitative parameters of the enhanced classification of the visual score was 22: the difference between the contrast-enhanced intensities of contrast-enhanced ultrasound was statistically significant. Study meaning (c2=23.709, P0.001), 22 comparison between groups: visual score was 1 and visual score was 2, and the difference of enhanced intensity value between 3 points was statistically significant (P0.05); there was no significant difference between the remaining groups.5, the enhancement intensity of plaque was negatively correlated with the GSM value of plaque (r=-0.376, P=0.000), and the correlation was significant; plaque was significant; plaque The enhanced density was negatively correlated with the GSM value of the plaque (r=-0.252, P=0.000), the correlation was significant.6, the incidence of cerebrovascular events in the hypoechoic plaque group was about 92.9% (13/14), no cerebral vascular events were about 7.1% (1/14), the incidence of cerebrovascular events in the hyperechoic plaque group was about 60% (9/15), and the cerebral vascular events were not about 40% (6/15). [Conclusion] 1, different gray scale plaques. Different characteristics of contrast dynamic imaging.2, different echo types of carotid atherosclerotic plaques have different GSM values.3. The contrast enhancement intensity score of carotid atherosclerotic plaque and the value of contrast parameters can indirectly reflect the growth of the neovascularization in different gray scale plaques,.4, the parameters of the plaque and the plaque The GSM value of the block is negatively correlated and the incidence of cerebral vascular events in the hypoechoic plaque group is high. It shows that the lower the echo of the plaque, the lower the GSM value, the higher the contrast enhanced intensity value and the enhanced density value, the more the new angiogenesis in the plaque is, the worse the plaque stability is, the higher the incidence of cerebral vascular events is.5, contrast-enhanced ultrasound combined with G SM technology can more objectively evaluate the formation of neovascularization in carotid atherosclerotic plaques of different echo types. Because the number of cases in the study group is few, the results also need to expand the sample size to do further research.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R445.1;R743

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