| Objective:In order to provide sufficient supports for the early prevention and timely treatment of ischemic stroke,carotid atherosclerosis plaque was assessed by ultrasound elastography from three aspects: morphological features,plaque stability and plaque echo characteristics.Method:1 Out-patients attending cervical vascular examination in the Affiliated Hospital of people's armed police Logistics university from January to December in 2016 were recruited in the control group,while the in-patients with acute cerebral infarction in the brain center of the hospital over the same period were enrolled to the acute cerebral infarction group.The baseline data of the two groups was collected as well,such as BMI,history,blood pressure and biochemical tests and so on.2 GE-LOGIQ E9 ultrasonic diagnostic instrument(9L linear array probe,5.0~9.0MHz)was used to observe the carotid intima media thickness(IMT)and plaque echo features through the conventional 2D ultrasound methods.According to echo features,the plaques were divided into four ranks: low echo plaques,echo plaques,mixed echo plaques and strong echo plaques.The associated elastic parameters(e.g.elastic score,elastic area ratio)were acquired from the plaque's elastic dynamic image information through real-time elastography.3 Then these elastic parameters between the two groups were compared,and the elastic area ratios among different plaque echo ranks were analyzed as well.Based on these data,the Logistic multivariate regression analysis was used to establish an early prediction model of acute cerebral infarction.Results:1 The baseline data of the two groups60 in-patients with acute cerebral infarction were enrolled,43 men and17 women,aged from 32 to 78 years(61.88±8.77y).55 outpatients were recruited,40 men and 15 women,aged from 30 to 78 years(60.42±11.54y).There are no significant differences between the two groups in the following aspects: age,sex,BMI(P>0.05).However,the number of people with the hyperlipidemia history,or drinking history,or smocking history,or with high levels of glucose,triglyceride,total cholesterol,or low density lipoprotein cholesterol in blood is higher than that in the control group significantly(P<0.05).While the high density lipoprotein cholesterol concentration in the acute cerebral infarction group is higher than in the control group(P<0.05).2 Results of conventional two-dimensional ultrasound in carotid atherosclerotic plaque2.1 Carotid intima-media thickness(IMT)results IMT in the acute cerebral infarction group(1.71 ± 0.20)is higher than in the control group(1.34 ±0.27)significantly(P<0.05).2.2 The two-dimensional gray scale echo results of carotid atherosclerotic plaque61 plaques are detected in the 60 acute cerebral infarction group patients,including 18 low echo plaque,10 echo plaques,22 mixed echo plaques,and11 strong echo plaques.While 53 plaques are found in the control group people with 10 low echo plaques,15 echo plaques,13 mixed echo plaques and15 strong echo plaques.There is no significant different in the plaque frequency distribution in different echo ranks between the two groups(P>0.05).3 Results of elastic imaging technology3.1 Comparisons of the plaque ultrasonic elastography scoreIn the acute cerebral infarction group,the Low echo plaque elastic score is 1.22 ± 0.43,echo plaque elastic score is 2.10 ± 0.57,the mixed echo plaque elastic score is 2.95 ± 0.51,the strong echo plaque elastic score is 4.27 ± 0.47.In the control group,the elastic score for the four plaque ranks is 1.73 ± 0.78,2.33 ± 0.49,3.38 ± 0.59,and 4.60 ± 0.51,respectively.The low echo plaque elastic score and mixed echo plaque elastic score are both lower than those parameters in the control group significantly(P=0.033,0.036,respectively),however,there are no significant differences between the two groups in the echo plaque elastic score and strong echo plaque elastic score(P=0.261,0.106,respectively).3.2 Comparisons of the ultrasound plaque elastic area ratioIn the acute cerebral infarction group,the Low echo plaque elastic area ratio is 1.15±0.09,echo plaque elastic area ratio is 1.35±0.12,the mixed echo plaque elastic area ratio is 1.44±0.12,the strong echo plaque elastic area ratio is 1.91±0.14.In the control group,the plaque elastic area ratio for the four plaque ranks is 1.23±0.10,1.41±0.11,1.55±0.09,1.93±0.061,respectively.The low echo plaque elastic area ratio and mixed echo plaque elastic area ratio are both lower than those parameters in the control group significantly(P=0.029;P =0.010,respectively),however,there are no significant differences between the two groups in the echo plaque elastic area ratio and strong echo plaque elastic area ratio(P=0.252;P=0.488,respectively).3.3 Comparisons of the plaque elastic area ratio between different echo ranksFor both acute cerebral infarction group and control group,the plaque elastic ratio is increasing with the rank,and there are significant differences among the different ranks(F=214.931,P=0.000),which can easily distinguish the hardness of the plaques in different ranks.4 The early prediction model of acute cerebral infarction by the multivariate logistic regression analysisThese parameters with significant differences between the two groups were used to establish an acute cerebral infarction early prediction model by the logistic regression analysis,Wald=12.173 P=0.000,suggesting the model has prediction value.Among these parameters used to build the prediction model,a history of alcohol can increase the risk of acute cerebral infarction up to 25.538 times(95% CI 6.591~98.961)and a Hyperlipidemia history can raise the risk 6.681 times(95% confidence interval 1.651~27.032).With one unit up of the diastolic blood pressure,the risk of acute cerebral infarction increase 1.068 times(confidence interval of 95% 1.015~1.123).When the blood triglyceride or glucose increases one unite,the risk of acute cerebral infarction increased 3.765 times(95% CI 1.324~10.701),or 2.310 times(95%CI 1.344~3.969)respectively.However,for people with same number of plaques,the more they have strong echo plaques,the less likely they will have acute cerebral infarction(OR 0.200,95% CI 0.042~0.957).Conclusions:1 As IMT of the acute cerebral infarction group is thicker than the control group,IMT can be used to predict the risk of cerebral infarction.For the two groups,the elastic score based on ultrasonic elastography can easily distinguish the organizational characteristics between low echo plaques and mixed echo plaques,which can be used to evaluate the plaque stability more efficiently than the 2D gray scale echo technology.2 For the two groups,the elastic area ratio based on ultrasonic elastography can also easily distinguish the organizational characteristics between low echo plaques and mixed echo plaques,which can be used to evaluate the plaque stability more efficiently than the 2D gray scale echo technology.What's more,the elastic area ratio can be used to distinguish the plaque hardness effectively.3 By observing the tissue acoustic characteristics and monitoring thecarotid atherosclerotic plaque in real time,ultrasound elastography can provide some semi-quantitative indices to better reflect the hardness of the internal structure of biological tissues(such as carotid atherosclerotic plaque),so the technology will make detecting plaque instability more easily compared with the traditional 2D gray scale echo technology,especially for the low echo plaques and mixed echo plaques,which will be valuable for the early prevention and timely treatment of the clinical ischemic cerebrovascular events.4 With the multivariate logistic regression analysis,an acute cerebral infarction early prediction model is established using the following parameters:the diastolic blood pressure,the hyperlipidemia history,drinking history,blood glucose,triglyceride and strong echo plaque. |
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