超声声学造影评价颈动脉粥样硬化斑块新生血管形成及稳定性.ppt

Correlation of Carotid Plaque Neovascularization Detected by Contrast-Enhanced Ultrasound Imaging With Clinical Symptoms,You-Bin Deng, MD, 邓又斌 Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China 武汉同济医院,Mechanisms of vessel wall neovascularization in atherosclerosis Doyle B et al. JACC 2007; 49:2073,Possible roles for microvessels in disease progression include the supply of cellular and soluble lesion components, enhancement of intraplaque gas exchange, and delivery of metabolic substrates to the plaque core. Doyle B et al. JACC 2007; 49:2073,Neovascularization in Stable and Unstable Coronary Plaques,Kolodgie FD et al. JACC 2007;49:2093,Plaque neovascularization and clinical symptoms,Fleiner M et al. Circulation 2004;110:2843,Number of microvessels identified from plaques of symptomatic and asymptomatic patients.,McCarthy MJ et al. J Vasc Surg 1999;30:261,Vessel Density at Histology According to Plaque Contrast-Agent Enhancement,Coli S et al. JACC 2008;52:223,Vulnerable patients have vulnerable plaques Plaque neovascularization is the remarkably consistent feature of vulnerable plaque in cerebrovascular patients Contrast-enhanced carotid ultrasound imaging is promising and may serve to detect the neovascularization within the atherosclerotic plaque in vivo. Carotid plaque contrast-agent enhancement with sonographic agent correlates with histological density of neovessels within the carotid plaque The association between the carotid plaque enhancement with contrast agent microbubbles and clinical symptoms is not fully understood.,Study Population,研究方法,GE Log9超声诊断仪 9L探头：频率为6MHz 机械指数：0.13,104例患者,快速静脉注射SonoVue 1.5 ml,实时观察颈动脉腔及斑块内造影剂显影情况,Grade 1: no enhancement within the plaque or enhancement confined to plaque adventitial side and/or shoulder Grade 2: enhancement reaching plaque core/or extensive contrast agent enhancement throughout the plaque.,Grading of Contrast-Agent Enhancement by Visual Interpretation,Grading of Contrast-Agent Enhancement by Quantitative Analysis,Enhanced intensity in the plaque Ratio of the enhanced intensity in the plaque to that in the carotid artery lumen,Receiver Operating Characteristic Curve Analysis,The sensitivity and specificity for enhanced intensity in the plaque (cutoff value: 10.0 dB) were 74% and 62%, respectively and those for ratio of enhanced intensity in the plaque to that in the carotid artery lumen (cutoff value: 0.46) were 74% and 75%, respectively.,No 2984, M, 71 yrs,Standard and contrast-enhanced carotid ultrasound images in a 78-year-old man who experienced serial transient ischemic attack 2 days before examination.,No 2274, F, 74 yrs,双侧颈总动脉可见多处斑块，患者最近有TIA病史，注射Sonovue 2ml造影剂后，左侧一斑块显影，回声增强。,No 2290, M, 51 yrs,双侧颈总动脉可见多处斑块，患者三天前发生脑梗死，有高血压病史，注射Sonovue 2ml造影剂后，右侧一斑块显影，回声增强，斑块后方可见丰富的滋养血管。,No 2295, M, 64 yrs,冠心病患者，有高血压病史，双侧颈总动脉可见多处斑块，注射Sonovue 2ml造影剂后，左侧一斑块显影，回声增强。,No 2330, M, 53 yrs,双侧颈动脉窦可见斑块，患者发作性右侧肢体无力20天，注射Sonovue 1.5ml造影剂后，左侧颈动脉窦处的后方一斑块全部显影，前方的斑块周边显影。,In conclusion, contrast-enhanced carotid ultrasound imaging provided us a way for the direct visualization of neovascularization within the plaque. Patients with recent transient ischemic attack and/or cerebrovascular ischemic stroke had more intense contrast-agent enhanceme