目的 探讨实时超声弹性成像技术联合常规超声检查在评估脑卒中患者颈动脉粥样硬化斑块稳定性中的临床应用价值。方法 收集我院收治的临床确诊脑卒中患者(卒中组)34例作为研究对象,另抽取同期存在颈动脉斑块但未发生过脑卒中的人群(对照组)56例作为对照研究对象,进行超声弹性成像检测,并对检查结果进行统计分析。结果 34例脑卒中患者发现颈动脉粥样硬化斑块57个,其中低回声斑块29个,混合回声斑块21个,强回声斑块7个;56例对照组患者发现颈动脉粥样硬化斑块75个,其中低回声斑块22个,混合回声斑块25个,强回声斑块28个;两组间比较斑块数量之间、斑块大小之间差异有统计学意义(P<0.05)。颈动脉粥样硬化低回声、混合回声及强回声斑块弹性评分依次升高,其斑块硬度值依次升高;两组间斑块的评分数量分布差异有统计学意义(P<0.05);对于同一类型斑块的硬度值两组间差异无统计学意义(P>0.05);脑卒中组不同类型斑块间的硬度值差异有统计学意义(P<0.05)。结论 超声弹性成像技术可对脑卒中患者颈动脉粥样硬化斑块的稳定性进行半定量评估,不同类型斑块因所含组织成分的不同其弹性应变率表现也不同,能有效补充常规超声检查的信息的不足,进而评估斑块的稳定性。

Objective To explore the clinical value of real-time ultrasound elastography combined with conventional ultrasound in assessing the stability of carotid atherosclerotic plaques in stroke patients. Methods Thirty-four patients with clinically confirmed stroke (stroke group) in our hospital were collected as the research object. Another 56 patients with carotid plaque but without stroke (control group) in the same period were selected as the control object for ultrasonic elastography detection, and the results were analyzed statistically. Results Thirty-four stroke patients were found 57 carotid atherosclerotic plaques, including 29 hypoechoic plaques, 21 mixed echoic plaques and 7 hyperechoic plaques; 56 control patients were found 75 carotid atherosclerotic plaques, including 22 hypoechoic plaques, 25 mixed echoic plaques and 28 hyperechoic plaques. There were significant differences between the number of plaques and the size of plaques (P<0.05). Carotid atherosclerosis low echo, mixed echo and strong echo plaque elasticity score increased in turn, the plaque hardness value increased in turn; the number of plaque scores between the two groups had statistical significance (P<0.05); for the same type of plaque hardness value between the two groups had no significant difference (P>0.05); There were significant differences in hardness values between the same types of plaques (P<0.05). Conclusion Ultrasound elastography may semi-quantitatively evaluate the stability of carotid atherosclerotic plaques in stroke patients. Different types of plaques have different elastic strain rates because of different tissue components. It may effectively complement the information deficiency of conventional ultrasound examination, and then evaluate the stability of plaques.

目的 探讨超声不同方法联合应用对提高卵圆孔未闭检出率的应用价值。方法 收集我院收治的临床疑似卵圆孔未闭的患者88例作为研究对象,进行超声影像组合检查(常规经胸超声心动图检查,经食道超声检查,右心声学造影检查),并对多组超声影像检查结果记录行回顾性统计分析。结果 88例研究对象中常规经胸超声心动图初步筛查发现PFO(+)12例(13.6%),其中合并房间隔膨出瘤2例。经食道超声检查22例,发现PFO(+)20例(90.9%),其中发现来源于肺动静脉瘘2例。全部研究对象均行右心声学造影发现PFO(+)39例(44.3%),分别于静息状态下发现PFO(+)24例,Valsalva动作后发现PFO(+)39例;其中发现合并房间隔膨出瘤形成者4例;合并肺动静脉瘘者3例(其中1例来源于肺静脉)。经食道超声联合右心声学造影检查的14例患者中发现PFO(+)10例(71.4%)。右心声学造影依据微气泡的数量进行半定量分级发现:I级有16例;II级有5例;III级有18例;不同状态下对于RLS的半定量分级差异有统计学意义(χ²=12.729,P=0.02)。结论 超声影像组合可对卵圆孔未闭患者进行半定量评估,能有效补充单一常规超声检查的信息的不足,进而为临床诊治提供客观化依据。

Objective To explore the value of ultrasound combined with different methods in improving the detection rate of patent foramen ovale. Methods 88 cases of clinically suspected patent foramen ovale in our hospital were collected as the research objects to carry out the ultrasonic image group examination (routine transthoracic echocardiography TTE, transesophageal echocardiography TEE, right heart contrast echocardiography), and the results of multiple groups of ultrasonic image examination were recorded for retrospective statistical analysis. Results Among 88 subjects, 12 (13.6%) were found to have PFO (+)by conventional transthoracic echocardiography, 2 of them had atrial septal aneurysm. 20 cases (90.9%) of PFO were found by transesophageal ultrasonography, and two of them were from pulmonary arteriovenous fistula.In all the subjects, 39 cases (44.3%) of PFO were found by right heart sonography, 24 cases were found in resting state, 39 cases were found after Valsalva operation, 4 cases were found with aneurysm of atrial septum, 3 cases with pulmonary arteriovenous fistula (one of them was from pulmonary vein). Among the 14 patients examined by transesophageal ultrasound combined with right cardiac sonography, 10 (71.4%) were found to have PFO(+). According to the number of microbubbles, the right echocardiography showed that there were 16 cases in grade I, 5 cases in grade II, 18 cases in grade III, and there were statistical differences in the semi quantitative classification of RLS in different states (χ²=12.729, P=0.02). Conclusion Ultrasound image histology can be used for semi quantitative evaluation of patients with patent foramen ovale, which can effectively supplement the lack of single conventional ultrasound information, and provide objective basis for clinical diagnosis and treatment.

目的 通过超声造影成像技术( CEUS)观察颈动脉斑块内新生血管的情况,探讨颈动脉斑块的厚度与新生血管的关系。方法 选择颈动脉粥样硬化患者40例,经常规超声确诊存在斑块,共64个,应用CEUS成像技术检测斑块内新生血管情况。结果 不同厚度的颈动脉斑块的增强强度与斑块厚度成正相关(r=0.897 6,P=0.000 0)。结论 超声造影成像技术可以在常规超声的基础上通过检测斑块内的新生血管,进而判断斑块的性质,提供更多有用的信息进一步评估颈动脉斑块内新生血管增强强度与斑块厚度存在线性正相关性。

Objective To evaluate the neovascularization in carotid plaques by gray-scale harmonic contrast echocardiography (CEUS), and to investigate the relationship between the thickness of carotid artery plaque and the neovascularization.Methods 40 patients with carotid atherosclerosis were selected, and 64 plaques were diagnosed by regular ultrasound. The neovascularization in plaques was detected by CEUS imaging technique.Results The enhanced strength of carotid plaques with different thickness was positively correlated with plaque thickness (r=0.8976,P=0.0000).Conclusion Ultrasound contrast imaging can detect angiogenesis within the plaque based on conventional ultrasound, and then determine the nature of the plaque. More useful information is provided to further evaluate the linear positive correlation between the intensity of neovascularization and the thickness of plaque in carotid plaque.