【摘要】 目的 分析颈部血管彩色超声联合超声造影（CEUS）对脑梗死颈动脉斑块性质的评估价值。方法 回顾性分析2022年7月至2024年8月于南阳医学高等专科学校第一附属医院就诊的90例脑梗死患者的病历资料，所有患者均接受颈部血管彩色超声、 CEUS以及数字减影血管造影（DSA）检查。以DSA检查结果作为诊断脑梗死颈动脉斑块性质的“金标准”，统计颈部血管彩色超声、 CEUS及二者联合检查的结果，对比不同检查方法对脑梗死颈动脉斑块性质的评估价值，分析其与DSA检查结果的一致性；并比较不同性质的颈动脉斑块CEUS检查的相关参数。结果 90例脑梗死患者经DSA检查确诊颈动脉斑块95个，包括稳定斑块59个，不稳定斑块36个；颈部血管彩色超声检出稳定斑块58个，不稳定斑块37个；CEUS检出稳定斑块61个，不稳定斑块34个；联合检查检出稳定斑块60个，不稳定斑块35个。颈部血管彩色超声、 CEUS联合检查评估脑梗死颈动脉斑块不稳定性的灵敏度、特异度、准确度、阳性预测值与阴性预测值均高于颈部血管彩色超声、 CEUS单独检查（P<0.05）。经一致性检验显示，颈部血管彩色超声、 CEUS单独检查结果与DSA检查结果一致性尚可（Kappa值=0.488、 0.593, P=0.000、 0.000），联合检查结果与DSA检查结果一致性良好（Kappa值=0.978, P=0.000）。不稳定斑块CEUS检查中的造影剂到达时间、斑块达峰时间、渡越时间均短于稳定斑块，最大增强强度大于稳定斑块（P<0.05）。结论 颈部血管彩色超声联合CEUS检查评估脑梗死颈动脉斑块性质价值较高，且联合检查结果与DSA检查结果一致性良好，有助于明确评估颈动脉斑块性质，能为后续临床医生准确评估患者病情及制定个性化治疗方案提供重要参考依据。更多还原

【Abstract】 Objective To analyze the value of color Doppler ultrasound combined with contrast-enhanced ultrasound(CEUS) of cervical vessels in evaluating the nature of carotid artery plaques in cerebral infarction. Methods The medical records of 90 cerebral infarction patients admitted to the First Affiliated Hospital of Nanyang Medical College from July 2022 to August 2024 were retrospectively analyzed. All patients underwent cervical vessels color Doppler ultrasound, CEUS and digital subtraction angiography(DSA) examinations.Using DSA test results as the "gold standard" for diagnosing the nature of carotid artery plaques in cerebral infarction, the results of color Doppler ultrasound, CEUS, and their combined examination were statistically analyzed, the evaluation value of different examination methods for the nature of carotid plaque in cerebral infarction was compared, and the consistency with DSA examination results was analyzed, the relevant parameters of CEUS for carotid artery plaques of different natures were also compared. Results Among 90 patients with cerebral infarction, 95 carotid artery plaques were diagnosed by DSA examination, including 59 stable plaques and 36 unstable plaques.Color ultrasound of cervical vessels detected 58 stable plaques and 37 unstable plaques, CEUS detected 61 stable plaques and 34 unstable plaques, their combined examination detected 60 stable plaques and 35 unstable plaques. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the combined examination(color Doppler ultrasound + CEUS) for evaluating unstable carotid artery plaques in cerebral infarction were higher than those of color Doppler ultrasound or CEUS alone(P <0.05). Consistency testing showed that the result of color Doppler ultrasound and CEUS had fair agreement with DSA result(Kappa values = 0.488, 0.593, P= 0.000, 0.000), while their combined examination result showed good agreement with DSA result(Kappa value = 0.978, P = 0.000). The arrival time of the contrast agent, the peak time of the plaque, and the transit time in the CEUS examination of unstable plaques were all shorter than those of stable plaques, and the maximum enhancement intensity was greater than that of stable plaques(P <0.05). Conclusions Color Doppler ultrasound combined with CEUS of cervical vessels has high value in evaluating the nature of carotid artery plaques in cerebral infarction. Their combined examination result show good agreement with DSA results, which helps in clearly evaluating the nature of carotid plaques and provides an important reference for clinicians to accurately assess the patients’ condition and formulate personalized treatment plans.更多还原