Comparative Analysis Of Clinical Imaging Evaluation On The Carotid Atherosclerosis Plaque

Objective:At present,cardio-cerebrovascular diseases are the leading cause of death in China and the world.Although the clinical manifestations may be stroke,myocardial infarction and other target organ damage,b ut the root cause is the rupture of vulnerable plaques of atherosclerosi s.Because of the tortuous and bifurcation of carotid artery,it is the p redisposing sites of plaque,the rupture and exfoliation of vulnerable p laque can lead to further narrowing of lumen and change of hemodyn amics,which are important signs of ischemic stroke.the occurrence an d development of ischemic stroke depends not only on thedegree of s tenosis of carotid artery diameter,the main reason is the characteristi cs of plaque complicated from simple lesion,forming vulnerable plaq ue,Therefore,the identification of plaque,especially vulnerable plaque,by imaging methods has become an urgent problem to be solved.Bec ause the carotid artery is close to the surface of human body,it is e asy to imagine,so there are many imaging techniques,At present.the main imaging diagnostic methods for the characteristics of carotid ath erosclerotic plaque include carotid ultrasound,computed tomography a ngiography(CTA),magnetic resonance imaging(MRI),which have different imaging principle so the diagnostic values for vulnerable pla que and features is different.In this study,the pathological results of plaque were regarded as the gold standard.The clinical diagnostic valu e of three imaging techniques in the diagnosis of carotid atherosclerot ic vulnerable plaques and the ability to evaluate the structural features of the plaques were compared and analyzed.Methods:The plaque tissues of 55 patients with carotid atherosclerotic plaque treated by carotid endarterectomy were collected.The HE sectionsand im munnohistochemical staining and MASSON staining were performed in55 atherosclerotic plaques,and the CD31,CD34 and FVIII antibodies were labeled.The components of plaques were analyzed and the stability of plaques was judged,and the pathological manifestations of plaques were classified.At the same time,the diagnostic results of carotid arter y ultrasound,CTA and MRI in 55 patients before operation were collect ed,and the pathological diagnosis results were used as the gold standar d.The difference of three clinical imaging examinations in the identificati on of vulnerable plaques was analyzed by using quantitative data pairin g chi-square test(McNemar test)(diagnostic evaluation used four-grid ta ble),and the sensitivity?specificity?accuracy?positive predictive va lue and negative predictive value of carotid artery ultrasound,CTA and MRI in detecting the vulnerability of carotid atherosclerotic plaque were evaluated.And diagnostic value of MRI in plaque composition was an alysing,and the sensitivity?specificity?accuracy?positive predictive v alue and negative predictive value of MRI in detecting the plaque comp osition were evaluated(P<0.05 has statistical significance).Results:There was no significant difference in the detection rate of vulnera ble plaque between ultrasound and pathology(?~2?=1.5998,P=0.2059),Th ere was significant difference in the detection rate of vulnerable plaque between CTA and pathology(?~2?=4.6160.P?=0.0317),There was no s ignificant difference in the detection rate of vulnerable plaque between MRI and pathology(?~2?=0.0278.P?=0.8677)and according to the gol d standard of pathological results,sensitivity of MRI>carotid ultrasound>CTA?specificity of MRI=CTA>carotid ultrasound?accuracy of MRI>carotid ultrasound>CTA?positive predictive value of MRI>carotid u ltrasound>CTA.Because of the high sensitivity and accuracy of MRI in the diagnosis of plaque,The further evaluation of the findings of plaqu e nature on MRI is making,There was no significant difference in the detection rateof thin fibrous cap,lipid core,ulcer,calcification,hemorrha ge between MRI and pathological examination(P>0.05).Conclusions:Carotid ultrasound and MRI can be used in the diagnosis of vulner able plaque in patients with carotid atherosclerotic plaques,CTA can not clearly diagnose vulnerable plaque,and the sensitivity,specificity and ac curacy of MRI are higher.MRI has a better evaluation of thin fibrousca p,lipid core,ulcer,calcification and bleedingof plaque.and the sensitivit y of MRI to detecting calcification tissue is the highest.