Cires-Drouet Rafael S, Mozafarian Mahvash, Ali Amir, Sikdar Siddhartha, Lal Brajesh K
Center for Vascular Diagnostics, Division of Vascular Surgery, University of Maryland School of Medicine, 22 South Greene Street, S10-B00, Baltimore, MD 21201.
Center for Vascular Diagnostics, Division of Vascular Surgery, University of Maryland School of Medicine, 22 South Greene Street, S10-B00, Baltimore, MD 21201; Department of Bioengineering, George Mason University, Fairfax, VA.
Semin Vasc Surg. 2017 Mar;30(1):44-53. doi: 10.1053/j.semvascsurg.2017.04.010. Epub 2017 Apr 27.
Duplex ultrasonography has a well-established role in the assessment of the degree of stenosis caused by carotid atherosclerosis. This assessment is derived from Doppler velocity changes induced by the narrowing lumen of the artery. New research into the mechanisms for plaque rupture and atheroembolic stroke indicates that the degree of narrowing is an imperfect predictor of stroke risk, and that other factors, such as plaque composition and remodeling and biomechanical forces acting on the plaque, can play a role. New advances in ultrasound imaging technology have made it possible to investigate these measures of plaque vulnerability to identify pre-embolic unstable carotid plaques. Efforts have been made to quantify the morphologic appearance of the plaque in B-mode images and to correlate them with histology. Additional research has resulted in the first generation of clinically available 3-dimensional ultrasound transducers that reduce operator-dependence and variability. Finally, ultrasonography provides real-time imaging and physiologic information that can be utilized to measure disruptive forces acting on carotid plaques. We review some of these exciting developments in ultrasonography and discuss how these may impact clinical practice.
双功超声检查在评估颈动脉粥样硬化所致狭窄程度方面具有确立已久的作用。这种评估源自动脉狭窄管腔引起的多普勒速度变化。对斑块破裂和动脉粥样硬化栓塞性卒中机制的新研究表明，狭窄程度是卒中风险的不完美预测指标，其他因素，如斑块成分、重塑以及作用于斑块的生物力学力，也可能起作用。超声成像技术的新进展使得研究这些斑块易损性指标以识别栓塞前不稳定的颈动脉斑块成为可能。人们已努力量化B模式图像中斑块的形态外观，并将其与组织学相关联。进一步的研究催生了第一代临床可用的三维超声换能器，减少了对操作者的依赖和变异性。最后，超声检查提供实时成像和生理信息，可用于测量作用于颈动脉斑块的破坏力。我们回顾超声检查中的一些令人兴奋的进展，并讨论这些进展可能如何影响临床实践。
