Qiu Yi-Jie, Cheng Juan, Zhang Qi, Yang Dao-Hui, Zuo Dan, Mao Feng, Liu Ling-Xiao, Dong Yi, Cao Si-Qi, Wang Wen-Ping
Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
Diagnostics (Basel). 2023 Jan 31;13(3):519. doi: 10.3390/diagnostics13030519.
This study seeks to evaluate the value of the high-frame-rate vector flow imaging technique in assessing the hemodynamic changes of carotid atherosclerotic stenosis in aging people (>60 years old).
Aging patients diagnosed with carotid atherosclerotic stenosis who underwent carotid high-frame-rate vector flow imaging examination were prospectively enrolled. A Mindray Resona7s ultrasound machine equipped with high-frame-rate vector flow function was used for ultrasound evaluation. First, B mode ultrasound and color Doppler flow imaging were used to evaluate carotid stenosis. Then, the vector arrows and flow streamline detected by V Flow were analyzed and the wall shear stress values (Pa) at the carotid stenosis site were measured. All patients were divided into symptomatic and asymptomatic groups according to whether they had acute/subacute stroke or other clinical symptoms within 2 weeks before ultrasound examination. The results of digital subtraction angiography or computed tomography angiography were used as the gold standard. The stenosis rate was calcified, according to North American Symptomatic Carotid Endarterectomy Trial criteria. The diagnostic values of wall shear stress, conventional ultrasound, and the combined diagnosis in carotid atherosclerotic stenosis were compared.
Finally, 88 patients with carotid atherosclerotic plaque were enrolled (71 males (80.7%), mean age 67.6 ± 5.4 years). The success rate of high-frame-rate vector flow imaging was 96.7% (88/91). The WSS value of symptomatic carotid stenosis (1.4 ± 0.15 Pa) was significantly higher than that of asymptomatic carotid stenosis (0.80 ± 0.08 Pa) ( < 0.05). Taking the wall shear stress value > 0.78 Pa as the diagnostic criteria for symptomatic carotid atherosclerotic plaque, the area under receiver operating characteristic curves was 0.79 with 87.1% sensitivity and 69.6% specificity. The area under receiver operating characteristic curves of the combined diagnosis (0.966) for differentiating severe carotid atherosclerotic stenosis was significantly higher than that of conventional ultrasound and WSS value, with 89.7% sensitivity and 93.2% specificity ( < 0.05).
As a non-invasive imaging method, the high-frame-rate vector flow imaging technique showed potential value in the preoperative assessment of the symptomatic carotid atherosclerotic stenosis and diagnosing carotid atherosclerotic stenosis in aging patients.
本研究旨在评估高帧率矢量血流成像技术在评估老年（>60岁）人群颈动脉粥样硬化狭窄血流动力学变化中的价值。
前瞻性纳入诊断为颈动脉粥样硬化狭窄且接受颈动脉高帧率矢量血流成像检查的老年患者。使用配备高帧率矢量血流功能的迈瑞Resona7s超声机进行超声评估。首先，采用B型超声和彩色多普勒血流成像评估颈动脉狭窄情况。然后，分析V Flow检测到的矢量箭头和血流流线，并测量颈动脉狭窄部位的壁面切应力值（Pa）。根据超声检查前2周内是否发生急性/亚急性卒中或其他临床症状，将所有患者分为有症状组和无症状组。以数字减影血管造影或计算机断层血管造影结果作为金标准。根据北美症状性颈动脉内膜切除术试验标准对狭窄率进行钙化评估。比较壁面切应力、传统超声及联合诊断对颈动脉粥样硬化狭窄的诊断价值。
最终纳入88例患有颈动脉粥样硬化斑块的患者（男性71例（80.7%），平均年龄67.6±5.4岁）。高帧率矢量血流成像成功率为96.7%（88/91）。有症状颈动脉狭窄的壁面切应力值（1.4±0.15 Pa）显著高于无症状颈动脉狭窄（0.80±0.08 Pa）（<0.05）。以壁面切应力值>0.78 Pa作为有症状颈动脉粥样硬化斑块的诊断标准，受试者操作特征曲线下面积为0.79，灵敏度为87.1%，特异度为69.6%。联合诊断鉴别重度颈动脉粥样硬化狭窄的受试者操作特征曲线下面积（0.966）显著高于传统超声和壁面切应力值，灵敏度为89.7%，特异度为93.2%（<0.05）。
作为一种非侵入性成像方法，高帧率矢量血流成像技术在有症状颈动脉粥样硬化狭窄的术前评估及老年患者颈动脉粥样硬化狭窄的诊断中显示出潜在价值。
