Biasi G M, Mingazzini P M, Baronio L, Piglionica M R, Ferrari S A, Elatrozy T S, Nicolaides A N
Division of Vascular Surgery, Bassini Teaching Hospital, University of Milan, Italy.
J Endovasc Surg. 1998 Aug;5(3):240-6. doi: 10.1583/1074-6218(1998)005<0240:CPCUDI>2.0.CO;2.
To corroborate the validity of a computerized methodology for evaluating carotid lesions at risk for stroke based on plaque echogenicity.
The records of 96 carotid endarterectomy patients (59 men; median age 69.5 years, range 52 to 83) with stenoses > 50% were studied retrospectively. Forty-one patients (43%) had been symptomatic preoperatively. All patients had undergone computed tomography (CT) to detect infarction in the carotid territory and a duplex scan to measure carotid stenosis. Plaque echogenicity was analyzed by computer, expressing the echodensity in terms of the gray scale median (GSM). The incidence of CT-documented cerebral infarction was analyzed in relation to symptomatology, percent stenosis, and echodensity.
Symptoms correlated well with CT evidence of brain infarction: 32% of symptomatic patients had a positive CT scan versus 16% for asymptomatic plaques (p = 0.076). The mean GSM value was 56 +/- 14 for plaques associated with negative CT scans and 38 +/- 13 for plaques from patients with positive scans (p < 0.0001). However, there was no difference in the GSM value between plaques with > or < 70% stenosis. Furthermore, the incidence of CT infarction was 40% in the cerebral territory of carotid plaques with a GSM value < 50 and only 9% in those with a GSM > 50 (p < 0.001).
Computerized analysis of plaque echogenicity appears to provide clinically useful data that correlates with the incidence of cerebral infarction and symptoms. This method of analyzing plaque echolucency could be used as a screening tool for carotid stent studies to identify high-risk lesions better suited to conventional surgical treatment.
证实基于斑块回声特性评估有中风风险的颈动脉病变的计算机化方法的有效性。
回顾性研究96例颈动脉内膜切除术患者（59例男性；中位年龄69.5岁，范围52至83岁），其狭窄程度> 50%。41例患者（43%）术前有症状。所有患者均接受计算机断层扫描（CT）以检测颈动脉区域的梗死情况，并进行双功扫描以测量颈动脉狭窄程度。通过计算机分析斑块回声特性，以灰度中位数（GSM）表示回声密度。分析CT记录的脑梗死发生率与症状、狭窄百分比和回声密度的关系。
症状与脑梗死的CT证据密切相关：32%有症状的患者CT扫描呈阳性，无症状斑块患者为16%（p = 0.076）。CT扫描阴性的斑块平均GSM值为56±14，阳性患者的斑块为38±13（p < 0.0001）。然而，狭窄程度>或< 70%的斑块之间GSM值无差异。此外，GSM值< 50的颈动脉斑块所在脑区CT梗死发生率为40%，GSM> 50的脑区仅为9%（p < 0.001）。
斑块回声特性的计算机化分析似乎能提供与脑梗死发生率和症状相关的临床有用数据。这种分析斑块回声的方法可作为颈动脉支架研究的筛选工具，以更好地识别更适合传统手术治疗的高危病变。
