Division of Pharmacology, Vascular and Metabolic Diseases, Department of Internal Medicine, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
Am J Cardiol. 2013 Jul 15;112(2):292-8. doi: 10.1016/j.amjcard.2013.03.028. Epub 2013 Apr 12.
Previous data have indicated that carotid plaque ulceration is a strong predictor of cerebrovascular events. Standard ultrasound and color Doppler ultrasound (CDUS) scans have poor diagnostic accuracy for the detection of carotid plaque ulceration. The aim of the present prospective study was to assess the value of contrast-enhanced ultrasound (CEUS) scans for the detection of carotid plaque ulceration. The Institutional Ethics Committee approved the study protocol, and all patients provided informed consent. The patients had symptomatic stenosis of the internal carotid artery and underwent carotid computed tomographic angiography as part of their clinical evaluation. All patients underwent a CDUS examination in conjunction with CEUS. Carotid plaque ulceration was defined as the presence of ≥1 disruptions in the plaque-lumen border ≥1 × 1 mm. Carotid computed tomographic angiography was used as reference technique. The study population consisted of 20 patients (mean age 64 ± 9 years, 80% men), and 39 carotid arteries were included in the present analysis. Computed tomographic angiography demonstrated that the plaque surface was smooth in 15 (38%), irregular in 7 (18%) and ulcerated in 17 (44%) carotid arteries. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of CDUS for the detection of ulceration was 29%, 73%, 54%, 46%, and 57%, respectively. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of CEUS for the detection of ulceration was 88%, 59%, 72%, 63%, and 87%, respectively. CEUS had superior sensitivity and diagnostic accuracy for the assessment of carotid plaque ulceration compared with CDUS. CEUS improved the intrareader and inter-reader variability for the assessment of carotid plaque ulceration compared with CDUS. In conclusion, CEUS could be an additional method for the detection of carotid plaque ulceration. The role of CDUS for the assessment of carotid plaque ulceration seems limited.
先前的数据表明，颈动脉斑块溃疡是脑血管事件的一个强有力的预测因子。标准的超声和彩色多普勒超声（CDUS）扫描对颈动脉斑块溃疡的检测诊断准确性较差。本前瞻性研究旨在评估对比增强超声（CEUS）扫描对颈动脉斑块溃疡检测的价值。机构伦理委员会批准了研究方案，所有患者均提供了知情同意。患者有症状性颈内动脉狭窄，并进行了颈动脉计算机断层血管造影作为其临床评估的一部分。所有患者均进行了 CDUS 检查结合 CEUS 检查。颈动脉斑块溃疡定义为斑块-管腔边界上≥1 个≥1×1mm 的≥1 个中断。颈动脉计算机断层血管造影被用作参考技术。研究人群包括 20 名患者（平均年龄 64±9 岁，80%为男性），共纳入 39 条颈动脉进行本分析。计算机断层血管造影显示，15 条（38%）颈动脉斑块表面光滑，7 条（18%）颈动脉斑块不规则，17 条（44%）颈动脉斑块溃疡。CDUS 检测溃疡的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为 29%、73%、54%、46%和 57%。CEUS 检测溃疡的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为 88%、59%、72%、63%和 87%。CEUS 对颈动脉斑块溃疡的评估具有更高的敏感性和诊断准确性。CEUS 改善了评估颈动脉斑块溃疡的读者内和读者间可变性，优于 CDUS。总之，CEUS 可能是检测颈动脉斑块溃疡的一种附加方法。CDUS 对颈动脉斑块溃疡评估的作用似乎有限。
