Zachrisson H, Svensson C, Dremetsika A, Eriksson P
Department of Clinical Physiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
Department of Rheumatology, Department of Clinical and Experimental Medicine, County Council of Östergötland, Linköping University and Department of Rheumatology, Linköping, Sweden.
Clin Physiol Funct Imaging. 2018 Jul;38(4):586-594. doi: 10.1111/cpf.12450. Epub 2017 Aug 9.
The aim of this study was to evaluate an extended protocol of the large vessels using high-frequency duplex ultrasound (DUS) for detection of vessel wall inflammation.
Fifty-eight patients performed a DUS examination where arteritis could not be excluded. All DUS examinations were performed using ACUSON S2000 TM ultrasound system (Siemens Medical Solutions USA, Inc.). High-frequency linear transducers were used (18L6 MHz, 9L4MHz) or curve linear for the aortic arch (6C2 MHz). Carotid, vertebral, central neck arteries (subclavian, axillary, innominate) arteries, aortic arch and femoral arteries were studied. Circumferential, homogenous wall thickening, with or without a hyperechogenic stripe lining the innermost layer, were regarded as typical signs of arteritis. Intima-media thickness (IMT) was measured in the patients and a normal control group. The latest clinical updated diagnosis was assessed at least 6 months after DUS.
The DUS findings showed normal vessels (n = 14), arteritis and atherosclerosis (n = 13), atherosclerosis (n = 15) and arteritis (n = 16). The latter group had a significant increased IMT in the common femoral artery and the common carotid artery (mean 1·0 ± SD 0·3 mm versus 0·6 ± 0·2 mm in the normal group (n = 37), P<0·00001, 1·2 ± 0·5 mm versus 0·8 ± 0·2 mm in the normal group (n = 40), P<0·00001). In the groups with sonographic signs implying arteritis (n = 29), 20 patients had a clinical diagnosis of arteritis, whereas eight patients had another main diagnosis such as malignancy/other inflammatory or infectious disease complicated by inflammation of the vessel wall. One patient had multiple diagnoses and was not possible to classify.
An extended ultrasound protocol for central neck and leg arteries could be of value for diagnosis of arteritis. In case of atypical vessel wall inflammation, other main diagnoses should be considered.
本研究旨在评估使用高频双功超声（DUS）对大血管进行扩展检查方案以检测血管壁炎症。
58例患者接受了DUS检查，这些患者不能排除动脉炎。所有DUS检查均使用ACUSON S2000 TM超声系统（美国西门子医疗解决方案公司）进行。使用高频线性换能器（18L6 MHz、9L4MHz）或用于主动脉弓的曲线线性换能器（6C2 MHz）。研究了颈动脉、椎动脉、颈部中央动脉（锁骨下动脉、腋动脉、无名动脉）、主动脉弓和股动脉。圆周性、均匀的管壁增厚，无论最内层是否有高回声带，均被视为动脉炎的典型体征。对患者和正常对照组测量内膜中层厚度（IMT）。在DUS检查后至少6个月评估最新的临床更新诊断。
DUS检查结果显示血管正常（n = 14）、动脉炎合并动脉粥样硬化（n = 13）、动脉粥样硬化（n = 15）和动脉炎（n = 16）。后一组患者股总动脉和颈总动脉的IMT显著增加（正常组（n = 37）平均为1.0 ± 标准差0.3 mm，而正常组为0.6 ± 0.2 mm，P<0.00001；正常组（n = 40）为1.2 ± 0.5 mm，而正常组为0.8 ± 0.2 mm，P<0.00001）。在有超声征象提示动脉炎的组（n = 29）中，20例患者临床诊断为动脉炎，而8例患者有其他主要诊断，如恶性肿瘤/其他炎症或感染性疾病合并血管壁炎症。1例患者有多种诊断，无法分类。
针对颈部中央动脉和腿部动脉的扩展超声检查方案可能对动脉炎的诊断有价值。在出现非典型血管壁炎症的情况下，应考虑其他主要诊断。
