Department of Ultrasound, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
Department of Ultrasound, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
J Ultrasound Med. 2023 Sep;42(9):2135-2142. doi: 10.1002/jum.16238. Epub 2023 Apr 23.
Vulnerable plaques are closely related to ischemic stroke. To investigate the diagnostic value of multimodal plaque vulnerability ultrasound scoring system (PV-USS) using histopathology as the gold standard.
A total of 45 subjects who would be underwent carotid endarterectomy were recruited. The postoperative specimens were examined by histopathology. All responsible plaques were scanned dynamically in multiple sections by carotid ultrasound to measure maximum thickness and lumen stenotic degree, as well as, the echo, homogeneity, surface morphology, and echo type were observed. The above two-dimensional (2D) ultrasonic features were systematically scored, that is, PV-USS . Combined with contrast-enhanced ultrasonography (CEUS), neovascularization grade in plaque was scored, which is PV-USS .
According to the pathological results, 45 subjects were divided into vulnerable plaque group (27 cases, 60%) and non-vulnerable plaque group (18 cases, 40%). PV-USS and PV-USS in vulnerable plaque group were higher than those in non-vulnerable plaque group (PV-USS : 9.44 ± 2.10 vs 7.22 ± 1.73; PV-USS 12.37 ± 2.10 vs 8.28 ± 1.81, P < .001). ROC curve analysis showed that the AUC of PV-USS and PV-USS was 0.783 and 0.929, respectively (P < .001). The best cutoff values of PV-USS and PV-USS were, respectively, 9.5 (the maximum Youden index was 0.425, the sensitivity was 48.1%, the specificity was 94.4%) and 10.5 (the maximum Youden index was 0.667, the sensitivity was 77.8%, the specificity was 88.9%).
Ultrasound scoring system may be used as an effective method to evaluate the vulnerability of plaque. The diagnostic efficiency of PV-USS is more higher than PV-USS .
易损斑块与缺血性脑卒中密切相关。本研究旨在探讨以组织病理学为金标准的多模态斑块易损性超声评分系统（PV-USS）的诊断价值。
共纳入 45 例行颈动脉内膜切除术的患者。术后标本行组织病理学检查。采用颈动脉超声对所有责任斑块进行多节段动态扫描，测量最大厚度和管腔狭窄程度，观察回声、均匀性、表面形态和回声类型。对上述二维（2D）超声特征进行系统评分，即 PV-USS。结合对比增强超声（CEUS）对斑块内新生血管分级进行评分，即 PV-USS。
根据病理结果，45 例患者分为易损斑块组（27 例，60%）和非易损斑块组（18 例，40%）。易损斑块组的 PV-USS 和 PV-USS 均高于非易损斑块组（PV-USS：9.44±2.10 比 7.22±1.73；PV-USS：12.37±2.10 比 8.28±1.81，P<0.001）。ROC 曲线分析显示，PV-USS 和 PV-USS 的 AUC 分别为 0.783 和 0.929（P<0.001）。PV-USS 和 PV-USS 的最佳截断值分别为 9.5（最大 Youden 指数为 0.425，灵敏度为 48.1%，特异性为 94.4%）和 10.5（最大 Youden 指数为 0.667，灵敏度为 77.8%，特异性为 88.9%）。
超声评分系统可能是一种评估斑块易损性的有效方法。PV-USS 的诊断效率明显高于 PV-USS。
