Yang De-Bin, Zhou Jie, Feng Lan, Xu Rong, Wang Ying-Chun
Department of Ultrasonic Imaging, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai 201800, China.
World J Clin Cases. 2019 Apr 6;7(7):839-848. doi: 10.12998/wjcc.v7.i7.839.
Unstable carotid atherosclerotic plaques are prone to cause ischemic stroke. Contrast-enhanced ultrasound (CEUS) is the primary method of assessing plaque stability, but CEUS cannot be a method for screening for unstable plaque. The emergence of superb micro-vascular imaging (SMI) offers the possibility of clinically screening for unstable plaque.
To investigate the value of SMI in predicting ischemic stroke in patients with carotid atherosclerotic plaques.
Patients with carotid atherosclerotic plaques (luminal stenosis of 50%-70%) were enrolled into the present study. All patients received conservative medication. The patient's clinical baseline data, serological data, CEUS and SMI data were analyzed. All patients underwent a 3-year follow-up. The follow-up endpoint was the occurrence of ischemic stroke and patients were divided into stroke group and non-stroke group according to whether the prognosis occurred or not. Subsequently, the difference in clinical data was compared, the correlation of SMI and CEUS was analyzed, and multiple Cox regression and receiver operating characteristic curve were applied to investigate the value of SMI and CEUS in predicting cerebral arterial thrombosis in three years.
In this study, 43 patients were enrolled in the stroke group and 82 patients were enrolled in the non-stroke group. Cox regression revealed that SMI level ( = 0.013) and enhancement intensity ( = 0.032) were the independent factors influencing ischemic stroke. There was a positive correlation between SMI level and enhancement intensity ( = 0.737, = 0.000). The area under curve of SMI level predicting ischemic stroke was 0.878. The best diagnostic point was ≥ level II, and its sensitivity and specificity was 86.05% and 79.27%. The area under curve of enhancement intensity predicting ischemic stroke was 0.890. The best diagnostic point was 9.92 db, and its sensitivity and specificity was 88.37% and 89.02%. As the SMI level gradually increased, the incidence of ischemic stroke increased gradually ( = 108.931, = 0.000).
SMI can be used as a non-invasive method of screening for unstable plaques and may help prevent ischemic stroke.
不稳定的颈动脉粥样硬化斑块易引发缺血性脑卒中。超声造影（CEUS）是评估斑块稳定性的主要方法，但CEUS不能作为筛查不稳定斑块的方法。超微血管成像（SMI）的出现为临床筛查不稳定斑块提供了可能。
探讨SMI在预测颈动脉粥样硬化斑块患者缺血性脑卒中方面的价值。
纳入颈动脉粥样硬化斑块（管腔狭窄50%-70%）患者。所有患者均接受保守药物治疗。分析患者的临床基线数据、血清学数据、CEUS和SMI数据。所有患者均进行3年随访。随访终点为缺血性脑卒中的发生，根据预后情况将患者分为卒中组和非卒中组。随后，比较临床数据的差异，分析SMI与CEUS的相关性，并应用多因素Cox回归和受试者工作特征曲线研究SMI和CEUS在预测3年内脑动脉血栓形成方面的价值。
本研究中，卒中组纳入43例患者，非卒中组纳入82例患者。Cox回归显示，SMI水平（=0.013）和增强强度（=0.032）是影响缺血性脑卒中的独立因素。SMI水平与增强强度呈正相关（=0.737，=0.000）。SMI水平预测缺血性脑卒中的曲线下面积为0.878。最佳诊断点为≥Ⅱ级，其灵敏度和特异度分别为86.05%和79.27%。增强强度预测缺血性脑卒中的曲线下面积为0.890。最佳诊断点为9.92 db，其灵敏度和特异度分别为88.37%和89.02%。随着SMI水平逐渐升高，缺血性脑卒中的发生率逐渐增加（=108.931，=0.000）。
SMI可作为一种无创筛查不稳定斑块的方法，可能有助于预防缺血性脑卒中。
