使用组织学斑块易损性特征对非侵入性体内复合超声应变成像进行验证
Validation of Noninvasive In Vivo Compound Ultrasound Strain Imaging Using Histologic Plaque Vulnerability Features.
作者信息
Hansen Hendrik H G, de Borst Gert Jan, Bots Michiel L, Moll Frans L, Pasterkamp Gerard, de Korte Chris L
机构信息
From the Medical Ultrasound Imaging Center, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands (H.H.G.H., C.L.d.K.); and Department of Vascular Surgery (G.J.d.B., F.L.M.), Julius Center for Health Sciences and Primary Care (M.L.B.), and Laboratory of Experimental Cardiology and Laboratory of Clinical Chemistry (G.P.), University Medical Center Utrecht, The Netherlands.
出版信息
Stroke. 2016 Nov;47(11):2770-2775. doi: 10.1161/STROKEAHA.116.014139. Epub 2016 Sep 29.
BACKGROUND AND PURPOSE
Carotid plaque rupture is a major cause of stroke. Key issue for risk stratification is early identification of rupture-prone plaques. A noninvasive technique, compound ultrasound strain imaging, was developed providing high-resolution radial deformation/strain images of atherosclerotic plaques. This study aims at in vivo validation of compound ultrasound strain imaging in patients by relating the measured strains to typical features of vulnerable plaques derived from histology after carotid endarterectomy.
MATERIALS AND METHODS
Strains were measured in 34 severely stenotic (>70%) carotid arteries at the culprit lesion site within 48 hours before carotid endarterectomy. In all cases, the lumen-wall boundary was identifiable on B-mode ultrasound, and the imaged cross-section did not move out of the imaging plane from systole to diastole. After endarterectomy, the plaques were processed using a validated histology analysis technique.
RESULTS
Locally elevated strain values were observed in regions containing predominantly components related to plaque vulnerability, whereas lower values were observed in fibrous, collagen-rich plaques. The median strain of the inner plaque layer (1 mm thickness) was significantly higher (P<0.01) for (fibro)atheromatous (n=20, strain=0.27%) than that for fibrous plaques (n=14, strain=-0.75%). Also, a significantly larger area percentage of the inner layer revealed strains above 0.5% for (fibro)atheromatous (45.30%) compared with fibrous plaques (31.59%). (Fibro)atheromatous plaques were detected with a sensitivity, specificity, positive predictive value, and negative predictive value of 75%, 86%, 88%, and 71%, respectively. Strain did not significantly correlate with fibrous cap thickness, smooth muscle cell, or macrophage concentration.
CONCLUSIONS
Compound ultrasound strain imaging allows differentiating (fibro)atheromatous from fibrous carotid artery plaques.
背景与目的
颈动脉斑块破裂是中风的主要原因。风险分层的关键问题是早期识别易破裂斑块。一种非侵入性技术——复合超声应变成像技术被开发出来，可提供动脉粥样硬化斑块的高分辨率径向变形/应变图像。本研究旨在通过将测量的应变与颈动脉内膜切除术后组织学得出的易损斑块的典型特征相关联，对复合超声应变成像技术在患者体内进行验证。
材料与方法
在颈动脉内膜切除术前行48小时内，在34条严重狭窄（>70%）的颈动脉罪犯病变部位测量应变。所有病例在B型超声上均可识别管腔-壁边界，且成像横截面在收缩期至舒张期未移出成像平面。内膜切除术后，使用经过验证的组织学分析技术对斑块进行处理。
结果
在主要包含与斑块易损性相关成分的区域观察到局部应变值升高，而在纤维性、富含胶原的斑块中观察到较低的值。（纤维）粥样斑块（n = 20，应变 = 0.27%）的内膜斑块层（厚度1 mm）的中位应变显著高于纤维斑块（n = 14，应变 = -0.75%）（P < 0.01）。此外，与纤维斑块（31.59%）相比，（纤维）粥样斑块内层显示应变高于0.5%的面积百分比显著更大（45.30%）。检测（纤维）粥样斑块的灵敏度、特异度、阳性预测值和阴性预测值分别为75%、86%、88%和71%。应变与纤维帽厚度、平滑肌细胞或巨噬细胞浓度无显著相关性。
结论
复合超声应变成像技术可区分颈动脉纤维斑块与（纤维）粥样斑块。
Zotero 插件