Clinical Analysis Of Contrast-enhanced Ultrasound And High-resolution Magnetic Resonance Vessel Wall Imaging In Patients With Moderate To Severe Carotid Artery Stenosis

Objective: To study the clinical applications of contrast-enhanced ultrasound and high-resolution magnetic resonance vessel wall imaging in patients with moderate to severe carotid stenosis.Methods :From December 2021 to August 2022,69 patients with moderate to severe carotid stenosis who underwent carotid endarterectomy(CEA)in the Department of Neurosurgery of our hospital were enrolled.Contrast-enhanced ultrasound(CEUS)and high-resolution magnetic resonance vascular wall imaging(HR-VWI)were performed before surgery and the clinical data of the patients were collected.Pathological examination was performed to determine the nature of carotid plaque after CEA.The grade of neovascularization inside the plaque was evaluated according to the degree of CEUS enhancement,among which grade 0 and grade 1 were stable plaques,while grade2 and grade 3 were vulnerable plaques.In the HR-VWI image results,enhanced plaque,intraplaque hemorrhage,and positive remodeling were classified as vulnerable plaques,the rest were classified as stable plaques.According to the histopathological classification criteria of atherosclerotic plaques proposed by AHA,type IV,V and VI were regarded as vulnerable plaques,while type I-III,VII and VIII were regarded as stable plaques.All patients were divided into vulnerable plaque group and stable plaque group based on the results of each examination method.The relevant indicators of CEUS,HR-VWI and CEUS combined HR-VWI(hereinafter referred to as combined examination)in the diagnosis of plaque properties were compared,and the factors affecting the diagnosis of plaque properties by each examination method were studied.Results: The pathological examination of 69 postoperative plaques found 56 vulnerable plaques,and the detection rate of vulnerable plaques was 81.2 %.Among the 62 patients who underwent CEUS examination,46 were found to have vulnerable plaques,and the detection rate of vulnerable plaques was 74.2 %.Among the 62 patients who underwent HR-VWI examination,43 patients had vulnerable plaques,and the detection rate of vulnerable plaques was 69.4 %.58 vulnerable plaques were detected by combined examination,and the detection rate of vulnerable plaques was 84.1 %.There was no significant difference between the two groups of patients grouped by CEUS results except that smoking was an influencing factor of plaque vulnerability(P>0.05).The results of pathological examination were used as the "gold standard" to compare the relevant indexes of the three methods in the evaluation of plaque properties.The sensitivity and coincidence rate of the combined method were higher than the other two methods.The specificity of HR-VWI was higher than that of the other two methods.In terms of consistency test,the Kappa value of the combined test was higher than that of the other two methods.There was no significant difference in the detection of plaque properties between pathology,CEUS,HR-VWI and combined examination(P> 0.05).Conclusion : Both CEUS and HR-VWI can accurately identify vulnerable plaques.The detection rate of vulnerable plaques by CEUS was slightly higher than that by HR-VWI.Combined examination is expected to replace histopathological examination;smoking is the influencing factor of CEUS in judging the nature of plaque.CEUS,HR-VWI and combined examination have good consistency with pathological results in judging the nature.