Ricotta J J, Bryan F A, Bond M G, Kurtz A, O'Leary D H, Raines J K, Berson A S, Clouse M E, Calderon-Ortiz M, Toole J F
Bowman Gray School of Medicine, Chapel Hill, N.C.
J Vasc Surg. 1987 Nov;6(5):512-20.
The ability of high-resolution ultrasound, angiography, and pathologic examination of endarterectomy specimens to identify and quantitate atherosclerosis was compared in a five-center study. The carotid bifurcation in 900 patients was evaluated by angiography and ultrasound. In 216 cases, high-quality endarterectomy specimens were available for comparison with the preoperative images. All comparisons were made in a blinded fashion. Results indicate that ultrasound is able to differentiate angiographically normal from abnormal arteries with a sensitivity of 88% (1077 of 1233 arteries) and accuracy of 79% (1251 of 1578 arteries). Angiographic stenoses equal to or greater than 50% diameter were accurately identified by ultrasound imaging in 72% (1133 of 1578 arteries) of cases, and this was improved by the addition of other functional data (i.e., Doppler spectral analysis and oculoplethysmography). There was only modest correlation of absolute measurements of lesion width, minimal lumen, and standard lumen by the two imaging techniques (r = 0.28 to 0.55). Ultrasound measurements of lesion width were on the average 2 mm greater than those of angiography. The lumen averaged 1.5 mm larger when measured by ultrasound techniques. In the subset in which data were available from endarterectomy specimens, ultrasound showed the best correlation with lesion width (mean difference -1.1 mm) and angiography correlated best with minimal lumen (mean difference -0.1 mm). Neither examination consistently identified ulcerated plaques. Although ultrasound imaging alone has limited usefulness in quantitating luminal stenosis, this can be improved by the use of Doppler spectral analysis and oculoplethysmography. Ultrasound is superior to angiography for quantifying atherosclerotic plaque (lesion width) and will be an important tool for further study of atherosclerotic lesions.
在一项五中心研究中，对高分辨率超声、血管造影以及动脉内膜切除术标本的病理学检查识别和量化动脉粥样硬化的能力进行了比较。对900例患者的颈动脉分叉处进行了血管造影和超声评估。在216例病例中，可获得高质量的动脉内膜切除术标本以与术前图像进行比较。所有比较均采用盲法进行。结果表明，超声能够以88%的敏感性（1233条动脉中的1077条）和79%的准确性（1578条动脉中的1251条）区分血管造影正常与异常的动脉。超声成像在72%（1578条动脉中的1133条）的病例中准确识别出直径狭窄等于或大于50%的血管造影狭窄，并且通过添加其他功能数据（即多普勒频谱分析和眼体积描记法）这一情况得到了改善。两种成像技术对病变宽度、最小管腔和标准管腔的绝对测量值之间仅有适度的相关性（r = 0.28至0.55）。超声测量的病变宽度平均比血管造影测量的大2毫米。用超声技术测量时，管腔平均大1.5毫米。在可获得动脉内膜切除术标本数据的子集中，超声与病变宽度的相关性最佳（平均差异 -1.1毫米），而血管造影与最小管腔的相关性最佳（平均差异 -0.1毫米）。两种检查均不能始终如一地识别出溃疡性斑块。尽管单独的超声成像在量化管腔狭窄方面作用有限，但通过使用多普勒频谱分析和眼体积描记法可以得到改善。在量化动脉粥样硬化斑块（病变宽度）方面，超声优于血管造影，并且将成为进一步研究动脉粥样硬化病变的重要工具。
