Zhao Ya-Chao, He Yi-Ming, Wang Fei, Xu Ming-Jun, Zhang Da, Wang Dong-Hai, Zhang Mei
National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences; Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China.
Neurosurgery Department, Qilu Hospital of Shandong University, Jinan, China.
Ultrasound Med Biol. 2025 Oct;51(10):1682-1690. doi: 10.1016/j.ultrasmedbio.2025.05.034. Epub 2025 Jul 14.
The high-frame-rate vector flow imaging (V Flow) technique is a simple, practical and feasible quantitative imaging method for detecting hemodynamic parameters of peripheral arteries in healthy people and patients with low carotid stenosis. However, whether V Flow can be used to assess hemodynamic parameters in patients with severe carotid stenosis remains to be illustrated. We sought to investigate the relationship between V Flow-evaluated hemodynamic parameters of advanced carotid stenosis and plaque composition and its value in assessing plaque vulnerability.
Patients undergoing carotid endarterectomy and ultrasound examination were collected, and plaque characteristics were graded on simple semiquantitative scales. Correlations between the turbulence index (Tur) and wall shear stress (WSS) in different parts of plaque and plaque components were analyzed. Receiver operating characteristic curves were used to analyze values of ultrasonic parameters in investigating plaque vulnerability.
Tur was more severe in vulnerable plaque than in stable plaque (35.99 ± 26.17 vs 7.82 ± 8.41; p < 0.001). Plaques with severe Tur showed more intraplaque hemorrhage, thrombus, and thinner fibrous cap thickness (p < 0.05 for all). At the upstream sides of carotid stenosis, plaque with a lower mean WSS (meanWSS) was associated with decreased fibrous tissue (p = 0.022). At the peak of carotid stenosis, meanWSS (meanWSS) was higher in the plaques with intraplaque hemorrhage (p = 0.028) and intraplaque neovascularization (p = 0.037). Plaques with a higher oscillatory shear index of WSS had fewer lipid core (p = 0.029) thinner fibrous cap thicknesses (p = 0.004) and more intraplaque neovascularization (p = 0.032). The areas under the curves of carotid intima-media thickness, total plaque area (TPA), Tur, MeanWSS, MaxWSS, MeanWSS model 1, model 5 and model 6 for predicting plaque vulnerability were 0.804 (95% confidence interval [CI], 0.650-0.911), 0.886 (95% CI, 0.748-0.964), 0.843 (95% CI, 0.695-0.937), 0.733 (95% CI, 0.571-0.858), 0.677 (95% CI, 0.514-0.815), 0.672 (95% CI, 0.508-0.811), 0.895 (95% CI, 0.759-0.969), 0.973 (95% CI, 0.867-0.999) and 0.930 (95% CI, 0.805-0.986).
V Flow-detected hemodynamic parameters were related to plaque components and plaque vulnerability. V Flow has the potential to be an effective tool for investigating patients with severe carotid plaque.
高帧率矢量血流成像（V Flow）技术是一种用于检测健康人和轻度颈动脉狭窄患者外周动脉血流动力学参数的简单、实用且可行的定量成像方法。然而，V Flow是否可用于评估重度颈动脉狭窄患者的血流动力学参数仍有待阐明。我们旨在研究V Flow评估的重度颈动脉狭窄血流动力学参数与斑块成分之间的关系及其在评估斑块易损性方面的价值。
收集接受颈动脉内膜切除术和超声检查的患者，并根据简单的半定量量表对斑块特征进行分级。分析斑块不同部位的湍流指数（Tur）和壁面切应力（WSS）与斑块成分之间的相关性。使用受试者工作特征曲线分析超声参数在研究斑块易损性方面的价值。
易损斑块中的Tur比稳定斑块更严重（35.99±26.17对7.82±8.41；p<0.001）。Tur严重的斑块显示出更多的斑块内出血、血栓形成以及更薄的纤维帽厚度（所有p<0.05）。在颈动脉狭窄的上游侧，平均WSS（meanWSS）较低的斑块与纤维组织减少相关（p=0.022）。在颈动脉狭窄的峰值处，斑块内出血（p=0.028）和斑块内新生血管形成（p=0.037）的斑块中meanWSS较高。WSS振荡剪切指数较高的斑块脂质核心较少（p=0.029）、纤维帽厚度较薄（p=0.004）且斑块内新生血管形成较多（p=0.032）。颈动脉内膜中层厚度、总斑块面积（TPA）、Tur、MeanWSS、MaxWSS、MeanWSS模型1、模型5和模型6预测斑块易损性的曲线下面积分别为0.804（95%置信区间[CI]：0.650-0.911）、0.886（95%CI：0.748-0.964）、0.843（95%CI：0.695-0.937）、0.733（95%CI：0.571-0.858）、0.677（95%CI：0.514-0.815）、0.672（95%CI：0.508-0.811）、0.895（95%CI：0.759-0.969）、0.973（95%CI：0.867-0.999）和0.930（95%CI：0.805-0.986）。
V Flow检测的血流动力学参数与斑块成分和斑块易损性相关。V Flow有潜力成为研究重度颈动脉斑块患者的有效工具。
