Department of Ultrasonography, Third Xiangya Hospital, Central South University, Changsha 410013, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2021 Dec 28;46(12):1375-1379. doi: 10.11817/j.issn.1672-7347.2021.200974.
Inflammation in carotid atherosclerotic plaques is closely related to the occurrence of cerebrovascular events. Studies have shown that the use of contrast-enhanced ultrasound technology can assess the level of inflammation in the plaques, but there is no pathological-relevant research. In this study, contrast-enhanced ultrasound was used to assess the level of inflammation in the plaques of patients undergoing carotid endarterectomy (CEA) and to discuss the correlation among ultrasound parameters and clinical symptoms and histopathology.
Fifty-four patients were selected to receive CEA due to carotid artery stenosis in Department of Neurosurgery, Third Xiangya Hospital, among which 3 patients received CEA surgery for bilateral carotid artery. The patients were divided into a symptomatic group (33 cases) and an asymptomatic group (21 cases) according to the diagnosis and treatment guideline of carotid stenosis of Chinese Medical Association. All patients received late-phase contrast-enhanced ultrasound (LP-CEUS) examination, and quantitative analysis was applied to observe the intensity of late-phase plaque enhancement and the relative intensity ratio of late-phase plaque enhancement. CD68 histopathological examination was performed on carotid artery plaque after surgery, the number of macrophage infiltration was calculated, and the correlation between ultrasound parameters and histopathology was analyzed by Pearson correlation.
The intensity of late-phase plaque enhancement and the relative intensity ratio of late-phase plaque enhancement in the symptomatic group were significantly higher than those in the asymptomatic group, with statistically significant differences (<0.05). The number of macrophages in the plaque in the symptom group was significantly higher than that in the asymptomatic group, and the difference was statistically significant (<0.05). The intensity of late-phase enhancement and the relative intensity of late-phase plaque enhancement were positively correlated with the number of macrophages (=0.69, =0.65, respectively, both <0.05).
The parameters of LP-CEUS are helpful in assessing inflammation in carotid plaque. The degree of macrophage infiltration in plaque of patients with symptoms was higher than that of asymptomatic patients.
颈动脉粥样硬化斑块中的炎症与脑血管事件的发生密切相关。研究表明，使用对比增强超声技术可以评估斑块的炎症水平，但没有相关的病理学研究。本研究采用对比增强超声评估颈动脉内膜切除术（CEA）患者斑块的炎症水平，并探讨超声参数与临床症状和组织病理学之间的相关性。
选择我院神经外科因颈动脉狭窄行 CEA 的 54 例患者，其中 3 例患者行双侧颈动脉 CEA 手术。根据中华医学会颈动脉狭窄诊治指南的诊断和治疗标准，将患者分为症状组（33 例）和无症状组（21 例）。所有患者均行晚期增强超声（LP-CEUS）检查，采用定量分析观察晚期斑块增强强度和晚期斑块增强相对强度比。术后对颈动脉斑块进行 CD68 组织病理学检查，计算巨噬细胞浸润数量，并采用 Pearson 相关分析超声参数与组织病理学的相关性。
症状组晚期斑块增强强度和晚期斑块增强相对强度比值明显高于无症状组，差异有统计学意义（<0.05）。症状组斑块内巨噬细胞数量明显高于无症状组，差异有统计学意义（<0.05）。晚期增强强度和晚期斑块增强相对强度与巨噬细胞数量呈正相关（=0.69，=0.65，均<0.05）。
LP-CEUS 参数有助于评估颈动脉斑块的炎症程度。症状患者斑块内巨噬细胞浸润程度高于无症状患者。
