Li Yuanxi, Kwong Dora Lai-Wan, Wu Vincent Wing-Cheung, Yip Shea-Ping, Law Helen Ka-Wai, Lee Shara Wee-Yee, Ying Michael Tin-Cheung
Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China.
Department of Clinical Oncology, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
Quant Imaging Med Surg. 2021 Jun;11(6):2292-2306. doi: 10.21037/qims-20-1012.
This study investigated the feasibility of using a computer-assisted method to evaluate and differentiate the carotid plaque characteristics in radiation-induced and non-radiation-induced carotid atherosclerosis.
This study included 107 post-radiotherapy (post-RT) nasopharyngeal carcinoma (NPC) patients and 110 subjects with cardiovascular risk factors (CVRFs). Each participant had a carotid ultrasound examination, and carotid plaques and carotid intima-media thickness (CIMT) were evaluated with grey scale ultrasound. The carotid plaque characteristics were evaluated for grey-scale median (GSM) and detailed plaque texture analysis (DPTA) using specific computer software. In DPTA, five different intra-plaque components were colour-coded according to different grey scale ranges. A multivariate linear regression model was used to evaluate the correlation of risk factors and carotid plaque characteristics.
Post-RT NPC patients have significantly higher CIMT (748±15.1 µm, P=0.001), more patients had a plaque formation (80.4%, P<0.001) and more plaque locations (2.3±0.2, P<0.001) than CVRF subjects (680.4±10.0 µm, 38.2% and 0.5±0.1 respectively). Among the five intra-plaque components, radiation-induced carotid plaques had significantly larger area of calcification (4.8%±7.7%, P=0.012), but lesser area of lipid (42.1%±16.9%, P=0.034) when compared to non-radiation-induced carotid plaques (3.0%±5.7% and 46.3%±17.9% respectively). Age, radiation and number of CVRF were significantly associated with the carotid atherosclerosis burden (P<0.001). Besides, age was significantly associated with the amount of lipid and calcification within carotid plaques (P<0.001).
Radiation caused more severe carotid artery disease than CVRF with larger CIMT and more prevalent of carotid plaque. Radiation-induced carotid plaques tended to have more intra-plaque calcifications, whereas non-radiation-induced carotid plaques had more lipids. Ultrasound aided by computer-assisted image analysis has potential for more accurate assessment of carotid atherosclerosis.
本研究探讨了使用计算机辅助方法评估和区分放射性与非放射性颈动脉粥样硬化中颈动脉斑块特征的可行性。
本研究纳入了107例放疗后鼻咽癌患者和110例具有心血管危险因素的受试者。每位参与者均接受了颈动脉超声检查，并使用灰阶超声评估颈动脉斑块和颈动脉内膜中层厚度（CIMT）。使用特定计算机软件对颈动脉斑块特征进行灰阶中位数（GSM）和详细斑块纹理分析（DPTA）评估。在DPTA中，根据不同的灰阶范围对五种不同的斑块内成分进行颜色编码。使用多元线性回归模型评估危险因素与颈动脉斑块特征的相关性。
放疗后鼻咽癌患者的CIMT显著更高（748±15.1 µm，P=0.001），与具有心血管危险因素的受试者（分别为680.4±10.0 µm、38.2%和0.5±0.1）相比，有更多患者出现斑块形成（80.4%，P<0.001）和更多斑块部位（2.3±0.2，P<0.001）。在五种斑块内成分中，与非放射性颈动脉斑块（分别为3.0%±5.7%和46.3%±17.9%）相比，放射性颈动脉斑块的钙化面积显著更大（4.8%±7.7%，P=0.012），但脂质面积更小（42.1%±16.9%，P=0.034）。年龄、放疗和心血管危险因素数量与颈动脉粥样硬化负担显著相关（P<0.001）。此外，年龄与颈动脉斑块内脂质和钙化量显著相关（P<0.001）。
放疗导致的颈动脉疾病比心血管危险因素导致的更严重，CIMT更大且颈动脉斑块更普遍。放射性颈动脉斑块倾向于有更多的斑块内钙化，而非放射性颈动脉斑块有更多的脂质。计算机辅助图像分析辅助的超声检查在更准确评估颈动脉粥样硬化方面具有潜力。
