Macioch James E, Katsamakis C Dean, Robin Jason, Liebson Philip R, Meyer Peter M, Geohas Chris, Raichlen Joel S, Davidson Michael H, Feinstein Steven B
Section of Cardiology, Rush-Presbyterian-St Luke's Medical Center, Rush University, Chicago, IL 60612-3833, USA.
Vasc Med. 2004 Feb;9(1):7-12. doi: 10.1191/1358863x04vm522oa.
Previous studies have used standard B-mode ultrasound to quantify the aggregate mean intimal medial thickness (IMT) of the near and far wall of the common carotid artery (CCA). Many investigators have had difficulty in accurately evaluating the near wall IMT secondary to difficulty in discerning the vessel lumen and intima. The purpose of this study is to determine the effect of contrast enhanced ultrasound on IMT measurement when compared with non-enhanced images. Twenty-six patients who had standard carotid ultrasounds completed over a 6-month period were evaluated, with 24 imaged by the same sonographer. Five to six measurements of the near and far walls were obtained over a 1 cm distance, beginning and ending 0.5 cm and 1.5 cm proximal to the carotid bifurcation. The measurements were made with and without the contrast agent Optison (perflutren protein type-A microspheres), which was given as an i.v. bolus (0.5-0.7 cc). Of those imaged by the same sonographer, 40 carotid arteries were examined and a total of 867 measurements were obtained. A total of 10% of the carotid ultrasounds were restudied approximately 1 month after the initial interpretation to assess observer accuracy. The near wall CCA mean (SD) IMT was 0.075 (0.019) cm for left with contrast versus 0.067 (0.023) cm for left without contrast and 0.089 (0.024) cm for right with versus 0.071 (0.022) cm for right without, p < or = 0.0001 both sides. For the far wall of the CCA, the mean (SD) IMT comparison was 0.075 (0.021) cm for left with versus 0.070 (0.016) cm for left without, p = 0.005, and 0.070 (0.023) cm for right with versus 0.070 (0.016) cm for right without, p = 0.68. In conclusion, contrast-enhanced IMT measurement showed a highly statistically significant difference in near carotid wall thickness determinations versus non-contrast values. The thicker measurement is in agreement with previously reported data showing that non-contrast images underestimated near wall common carotid IMT in histologic samples.
以往的研究使用标准B型超声来量化颈总动脉（CCA）近壁和远壁的内膜中层总平均厚度（IMT）。许多研究者在准确评估近壁IMT时遇到困难，原因是难以辨别血管腔和内膜。本研究的目的是确定与未增强图像相比，超声造影对IMT测量的影响。对在6个月期间完成标准颈动脉超声检查的26例患者进行评估，其中24例由同一位超声检查医师进行成像。在距颈动脉分叉近端0.5 cm和1.5 cm处开始和结束的1 cm距离内，对近壁和远壁进行5至6次测量。测量分别在使用造影剂Optison（全氟丙烷人血白蛋白微球）和未使用造影剂的情况下进行，造影剂通过静脉推注（0.5 - 0.7 cc）给予。在由同一位超声检查医师成像的患者中，检查了40条颈动脉，共获得867次测量结果。在初次解读后约1个月，对10%的颈动脉超声检查进行重新研究，以评估观察者的准确性。左侧使用造影剂时CCA近壁平均（标准差）IMT为0.075（0.019）cm，未使用造影剂时为0.067（0.023）cm；右侧使用造影剂时为0.089（0.024）cm，未使用造影剂时为0.071（0.022）cm，两侧p均≤0.0001。对于CCA远壁，使用造影剂时左侧平均（标准差）IMT为0.075（0.021）cm，未使用造影剂时为0.070（0.016）cm，p = 0.005；右侧使用造影剂时为0.070（0.023）cm，未使用造影剂时为0.070（0.016）cm，p = 0.68。总之，与未造影值相比，超声造影增强后的IMT测量在颈动脉近壁厚度测定方面显示出高度统计学显著差异。较厚的测量值与先前报道的数据一致，该数据表明未造影图像低估了组织学样本中颈总动脉近壁的IMT。
