O'Donnell T F, Erdoes L, Mackey W C, McCullough J, Shepard A, Heggerick P, Isner J, Callow A D
Arch Surg. 1985 Apr;120(4):443-9. doi: 10.1001/archsurg.1985.01390280037009.
Presently most noninvasive methods for assessing extracranial carotid disease have relied on hemodynamic change associated with significant stenosis. Recent evidence has suggested that both ulceration and/or plaque hemorrhage may frequently play an important role in the pathophysiology of carotid disease. To assess the ability of B-mode ultrasound to provide this anatomic information, in a prospective blinded manner we compared B-mode ultrasound and selective four-vessel arteriography to pathologic specimens obtained at the time of 89 carotid endarterectomies. The presence of ulceration, plaque characteristics (particularly hemorrhage), and luminal diameter were described for each modality. While arteriography detected only 16 of 27 ulcerations (sensitivity, 59%), B-mode ultrasound had a greater sensitivity (24/27, 89%). Both modalities had comparable specificities (arteriography, 73%; B-mode ultrasound, 87%). Moreover, B-mode ultrasound was highly sensitive for demonstrating plaque hemorrhage (27/29, 93%), as well as being quite specific (84%). Assessment of luminal reduction by B-mode ultrasound improved with technologist/interpreter experience and was significantly improved by adding real-time spectral analysis. Because of B-mode ultrasound's sensitivity for imaging ulceration and plaque hemorrhage, it offers significant advantages for the noninvasive detection of extracranial carotid disease.
目前，大多数评估颅外颈动脉疾病的非侵入性方法都依赖于与严重狭窄相关的血流动力学变化。最近的证据表明，溃疡和/或斑块出血可能经常在颈动脉疾病的病理生理学中发挥重要作用。为了评估B型超声提供这种解剖学信息的能力，我们以前瞻性盲法将B型超声和选择性四血管动脉造影与89例颈动脉内膜切除术时获取的病理标本进行了比较。描述了每种检查方式下溃疡的存在情况、斑块特征（尤其是出血情况）和管腔直径。动脉造影仅检测出27处溃疡中的16处（敏感性为59%），而B型超声的敏感性更高（24/27，89%）。两种检查方式的特异性相当（动脉造影为73%；B型超声为87%）。此外，B型超声对显示斑块出血高度敏感（27/29，93%），特异性也很高（84%）。随着技术人员/解读人员经验的增加，B型超声对管腔狭窄的评估有所改善，并且通过添加实时频谱分析有显著改善。由于B型超声对溃疡和斑块出血成像的敏感性，它在颅外颈动脉疾病的无创检测方面具有显著优势。
