From the Department of Radiology (V.R., I.C., A.C.-K.)
From the Department of Radiology (V.R., I.C., A.C.-K.).
AJNR Am J Neuroradiol. 2019 Jun;40(6):1022-1028. doi: 10.3174/ajnr.A6056. Epub 2019 May 9.
Various ultrasonographic features of carortid plaques have been associated with the occurence of stroke, highlighting the need for multi-parametric assessment of plaque's vulnerability. Our aim was to compare ultrasonographic multiparametric indices using color Doppler imaging and contrast-enhanced sonography between symptomatic and asymptomatic carotid plaques.
This was a cross-sectional observational study recruiting 54 patients (72.2% male; median age, 61 years) undergoing sonography and contrast-enhanced sonography. Patients were included if a moderately or severely stenotic internal carotid artery plaque was detected, with the plaque being considered symptomatic if it was ipsilateral to a stroke occuring within the last 6 months. A vulnerability index, previously described by Kanber et al, combined the degree of stenosis, gray-scale median, and a quantitative measure of surface irregularities (surface irregularity index) derived from color Doppler imaging and contrast-enhanced ultrasonography, resulting in 2 vulnerability indices, depending on the surface irregularity index used. Mann-Whitney and tests were used to compare variables between groups, and receiver operating characteristic curves were used to compare diagnostic accuracy.
Sixty-two plaques were analyzed (50% symptomatic), with a mean degree of stenosis of 68.9%. Symptomatic plaques had a significantly higher degree of stenosis (mean, 74.7% versus 63.1%; < .001), a lower gray-scale median (13 versus 38; = .001), and a higher Kanber vulnerability index based both on color Doppler imaging (median, 61.4 versus 16.5; < .001) and contrast-enhanced ultrasonography (median, 88.6 versus 25.2; < .001). The area under the curve for the detection of symptomatic plaques was 0.772 for the degree of stenosis alone, 0.783 for the vulnerability index-color Doppler imaging, and 0.802 for the vulnerability index-contrast-enhanced ultrasonography, though no statistical significance was achieved.
Symptomatic plaques had a higher degree of stenosis, lower gray-scale median values, and higher values of the Kanber vulnerability index using both color Doppler imaging and contrast-enhanced ultrasonography for plaque surface delineation.
颈动脉斑块的各种超声特征与中风的发生有关，这突出表明需要对斑块的易损性进行多参数评估。我们的目的是比较使用彩色多普勒成像和对比增强超声的颈动脉斑块的超声多参数指数，比较症状性和无症状性颈动脉斑块之间的差异。
这是一项横断面观察性研究，招募了 54 名患者（72.2%为男性；中位年龄为 61 岁）进行超声和对比增强超声检查。如果检测到中度或重度狭窄的颈内动脉斑块，且斑块位于过去 6 个月内同侧发生的中风同侧，则将该斑块视为症状性斑块。坎伯尔等人之前描述的易损性指数结合了狭窄程度、灰度中位数和源自彩色多普勒成像和对比增强超声的表面不规则性的定量测量（表面不规则性指数），结果产生了 2 个易损性指数，具体取决于所使用的表面不规则性指数。使用曼-惠特尼 U 检验和 t 检验比较组间变量，使用受试者工作特征曲线比较诊断准确性。
共分析了 62 个斑块（50%为症状性），平均狭窄程度为 68.9%。症状性斑块的狭窄程度明显更高（平均为 74.7%比 63.1%；<.001），灰度中位数更低（13 比 38；=.001），基于彩色多普勒成像（中位数为 61.4 比 16.5；<.001）和对比增强超声（中位数为 88.6 比 25.2；<.001）的坎伯尔易损性指数也更高。单独使用狭窄程度、彩色多普勒成像的易损性指数和对比增强超声的易损性指数检测症状性斑块的曲线下面积分别为 0.772、0.783 和 0.802，但未达到统计学意义。
症状性斑块的狭窄程度更高，灰度中位数值更低，并且使用彩色多普勒成像和对比增强超声进行斑块表面描绘的坎伯尔易损性指数更高。
