【摘要】 目的 :应用能谱CT、MR高分辨率管壁成像(HR-VWI)分析颈动脉斑块成分,探讨两者联合检测对颈动脉斑块稳定性的诊断效能。方法:收集2018年1月—2020年6月于我院行颈动脉能谱CT增强及MR HR-VWI,并接受颈动脉内膜剥脱手术的患者42例。以斑块病理分析结果为金标准,与能谱CT、MR HR-VWI分析结果进行对照,判断能谱CT、MR HR-VWI在评价颈动脉斑块的特异度、敏感度、准确度,以及对颈动脉斑块稳定性的诊断价值。结果:能谱CT检查结果显示,纤维斑块、脂质斑块、内部出血斑块、钙化斑块的能谱曲线斜率及有效原子序数相比,差异均有统计学意义(P<0.05);MR HR-VWI检查结果显示,纤维斑块以T1WI等信号、3D TOF带状低信号为主,脂质斑块T1WI、PDWI、3D TOF等信号或稍高信号多见,内部出血斑块T1WI、PDWI、T2WI高信号多见,3D TOF混杂或高信号多见,钙化斑块T1WI、PDWI、T2WI、3D TOF均多见不规则低信号;以病理结果为金标准,能谱CT与MR HR-VWI检出率(92.45%比96.23%)、准确度(88.68%比94.34%)、特异度(85.71%比90.48%)和敏感度(78.13%比81.25%)相比,差异均无统计学意义(P<0.05)。能谱CT联合MR HR-VWI诊断颈动脉斑块稳定性的曲线下面积(0.914(95%CI 0.827～0.984))高于能谱CT(0.819(95%CI 0.698～0.941))和MR HR-VWI(0.859(95%CI 0.750～0.967))。结论:应用能谱CT、MR HR-VWI均能有效分析颈动脉斑块成分,能谱CT联合MR HR-VWI可提高对颈动脉斑块稳定性的诊断效能,为颈动脉粥样硬化患者的诊断和治疗提供临床参考依据。更多还原

【Abstract】 Objective: To explore the diagnostic efficacy of combined energy spectral CT and MR high resolution vessel wall imaging(HR-VWI) in analyzing the components of carotid artery plaque. Methods: 42 patients who underwent carotid artery energy spectrum CT enhancement, MR HR-VWI and carotid endarterectomy were collected in our hospital from January2018 to June 2020. Taking pathological analysis results as the gold standard, the diagnostic value of energy spectrum CT and MR HR-VWI in assessing carotid plaque stability was evaluated including the specificity, sensitivity, accuracy. Results: The results of energy spectrum CT examination showed that there were statistically significant differences in the energy spectrum curve slope and effective atomic number of fibrous plaques, lipid plaques, internal hemorrhage plaques, and calcified plaques(P<0.05). The results of MR HR-VWI showed that fibrous plaques were dominated by T1 WI equal signals and 3 D TOF bandlike low signals. Lipid plaques were more common with T1 WI, PDWI, 3 D TOF equal signals or slightly higher signals. Internal bleeding plaques were T1 WI, PDWI, T2 WI high signal and 3 D TOF mixed or high signal. Calcified plaques T1 WI, PDWI,T2 WI, 3 D TOF are more common with irregular low signal. Taking pathological results as the gold standard, the detection rate of energy spectrum CT and MR HR-VWI(92.45% vs 96.23%), accuracy(88.68% vs 94.34%), specificity(85.71% vs 90.48%)and sensitivity(78.13% vs 81.25%), the differences were not statistically significant(P<0.05). The area under the curve of energy spectrum CT combined with MR HR-VWI in the diagnosis of carotid plaque stability(0.914(95%CI 0.827～0.984)) was higher than that of energy spectrum CT(0.819(95%CI 0.698～0.941)) and MR HR-VWI(0.859(95%CI 0.750～0.967)). Conclusion: Both energy spectrum CT and MR HR-VWI can effectively analyze the components of carotid artery plaque. The combination of energy spectrum CT and MR HR-VWI can improve the diagnostic efficiency of carotid plaque stability, and objective to provide clinical reference for the diagnosis and treatment of carotid atherosclerosis.更多还原