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目的探讨采用超声造影技术对老年脑梗死患者颈动脉斑块的稳定性进行评估的临床价值。方法回顾性分析2014年7月至2015年1月就诊并采用超声造影和核磁共振(MRI)行颈动脉斑块检测的178例老年脑梗死患者的影像学资料,评价超声造影在老年脑梗死患者颈动脉斑块稳定性评价中的作用。检测结果采用SPSS 17.0软件进行处理,因多数数据呈偏态分布,故行自然对数转换为近似正态后,采用方差分析和两两比较的LSD-t检验进行分析。结果 178例患者检出颈动脉斑块178块,包括软斑64块,硬斑39块,混合斑51块,钙化斑24块;部位在颈总动脉35块,颈动脉窦部125块,颈内动脉18块。超声造影结果显示,软斑+混合斑的最大增强密度明显高于硬斑+钙化斑(P<0.05);MRI结果显示,软斑的脂质坏死核体积显著高于其他类型斑块(P均<0.05),软斑和混合斑的斑块内出血体积高于硬斑(P均<0.05)。结论采用超声造影对老年脑梗死患者颈动脉斑块进行观察,可以明确区分出斑块属于软斑和混合斑、硬斑和钙化斑,但是对软斑和混合斑的区分难度较大,需要结合临床和MRI进一步判断,以避免不稳定斑块漏诊情况的发生。
Objective To investigate the clinical value of using ultrasound contrast to evaluate the stability of carotid plaque in elderly patients with cerebral infarction. Methods A retrospective analysis was performed on the imaging data of 178 elderly patients with cerebral infarction who were diagnosed with carotid plaques by ultrasound contrast and magnetic resonance imaging (MRI) from July 2014 to January 2015. The diagnostic value of contrast-enhanced ultrasound in patients with senile cerebral infarction The role of carotid plaque stability assessment. The test results were processed by SPSS 17.0 software. Because most of the data were skewed distribution, the natural logarithm was converted to approximately normal, and then analyzed by analysis of variance and pairwise comparison LSD-t test. Results A total of 178 carotid plaques were detected in 178 patients, including 64 soft plaque, 39 hard plaque, 51 mixed plaque and 24 calcified plaque. The carotid artery plaque was found in 35 carotid arteries, 125 carotid sinus, 18 internal arteries. The results of CEUS showed that the maximum enhancement density of soft plaque + mixed plaque was significantly higher than that of sclerotic plaque + calcified plaque (P <0.05). The MRI findings showed that the necrotic nucleus of soft plaque was significantly higher than other types of plaque <0.05). The plaque hemorrhage volume in soft plaque and mixed plaque was higher than that in hard plaque (all P <0.05). Conclusions The use of contrast-enhanced ultrasound in the observation of carotid plaques in elderly patients with cerebral infarction clearly differentiates the plaques from soft plaque, mixed plaque, hard plaque and calcified plaque. However, it is difficult to differentiate the soft plaque from the mixed plaque. Clinical and MRI further judgments to avoid the occurrence of unstable plaque misdiagnosis.