Barry R, Pienaar C, Nel C J
Bill Venter Unit for Vascular Surgery, Department of Surgery, University of the Orange Free State, Bloemfontein, South Africa.
Ann Vasc Surg. 1990 Sep;4(5):466-70. doi: 10.1016/S0890-5096(07)60072-7.
A prospective study comparing the accuracy of B-mode ultrasound with evaluation of gross appearance in detecting plaque hemorrhage and ulceration is reported. Ultrasonography was performed on 78 vessels in 66 patients undergoing carotid endarterectomy. Carotid bifurcation atheroma were classified ultrasonographically as smooth, irregular, or ulcerated. Sonolucent areas were considered to be plaque hemorrhage. Analysis of carotid plaques removed at operation included macroscopic and microscopic findings. Duplex Doppler was only 44% sensitive but 78% specific for plaque hemorrhage. If all irregular atheroma were considered ulcerated, the sensitivity of Duplex Doppler was 81% with specificity only 33%. If only lesions with a clearly visualized crater were considered ulcerated, B-mode ultrasound was 85% specific but only 17% sensitive. False B-mode ultrasound diagnoses of ulceration were mainly due to culs-de-sac or pits in fibrotic plaque that looked like ulcers. Ulceration was not noticed on B-mode when there was a two-dimensional problem or calcification with shadowing. False B-mode diagnoses of plaque hemorrhage were due to atheromatous debris, ulcerated plaque hemorrhage, or calcification. Problems still exist in the B-mode ultrasound diagnosis of carotid plaque hemorrhage and ulceration.
本文报道了一项前瞻性研究，比较了B型超声与肉眼外观评估在检测斑块出血和溃疡方面的准确性。对66例行颈动脉内膜切除术患者的78条血管进行了超声检查。将颈动脉分叉处动脉粥样硬化在超声下分为光滑、不规则或溃疡型。无回声区被视为斑块出血。对手术切除的颈动脉斑块进行了宏观和微观分析。双功多普勒对斑块出血的敏感性仅为44%，但特异性为78%。如果将所有不规则动脉粥样硬化都视为溃疡型，双功多普勒的敏感性为81%，但特异性仅为33%。如果仅将有清晰可见溃疡坑的病变视为溃疡型，B型超声的特异性为85%，但敏感性仅为17%。B型超声对溃疡的误诊主要是由于纤维斑块中的盲管或凹坑看起来像溃疡。当存在二维问题或伴有声影的钙化时，B型超声未发现溃疡。B型超声对斑块出血的误诊是由于动脉粥样硬化碎片、溃疡斑块出血或钙化。B型超声在诊断颈动脉斑块出血和溃疡方面仍然存在问题。
