Study On The Correlation Between MVD And Intracarotid Neovascularization In Carotid Plaque Assessed By SMI And CEUS

Part I A Comparative Study on The Diagnosis of Carotid Artery Stenosis by Ultramicro Angiography and Contrast-enhanced UltrasoundBackgroundCerebrovascular disease is one of the most common vascular diseases in clinic,and one of the main causes of cerebrovascular disease is the stenosis of the lumen caused by carotid plaque.How to accurately judge the stenosis of the carotid artery is particularly important.Digital subtraction angiography(DSA)is the gold standard in the clinical diagnosis of carotid stenosis.Although the accuracy of this method is high,but the operation process is complex,there are certain risks,and it is limited in the clinical application.Super B microvascular imaging(SMI)is a new method of vascular imaging.It has more advantages than conventional ultrasound in blood flow imaging and can better judge the changes of hemodynamics in the carotid lumen.Contrast-enhanced ultrasound(CEUS)is a sulfur hexafluoride microbubble contrast agent,which has similar hemodynamic characteristics with red blood cells.It can accurately determine the degree of carotid stenosis and the perfusion of low-speed blood flow in the plaque.In this study,DSA was used as the gold standard to evaluate the accuracy of SMI and CEUS in the diagnosis of carotid stenosis,which is helpful for doctors to make a targeted treatment plan.ObjectivesTo explore the application value of ultramicro angiography and contrast-enhanced ultrasonography in the evaluation of carotid stenosis.MethodsFrom February 2018 to may 2019,60 patients who were hospitalized in our hospital due to carotid artery stenosis and occlusion were selected continuously.The DSA examination method was used as the gold standard to compare the consistency of super micro angiography(SMI)technology and CEUS and DSA on the degree of stenosis of extracranial carotid artery lumen.ResultsBoth of the two methods can clearly show the thin vascular structure,including the location of carotid stenosis,the diameter and characteristics of the vascular lumen.With DSA as the gold standard,there was no significant difference between SMI,CEUS and DSA in the classification of stenosis(?~2=7.500,4.667,P>0.05);the consistency between SMI and DSA was good(kappa=0.827).The degree of carotid stenosis was consistent with DSA by CEUS(kappa=0.873).ConclusionSMI and CEUS have good consistency in the evaluation of extracranial carotid stenosis compared with DSA.SMI and CEUS can accurately and sensitively evaluate the degree of carotid stenosis.Among them,SMI has the advantages of high reliability,economy,simplicity,rapidity and non-invasive,which is of great clinical value in the assessment of carotid stenosis,and can be used as an examination method for clinical primary screening of carotid stenosis.Part II The Evaluation Value of Ultramicro-vascular Imaging and Contrast-Enhanced Ultrasonography in The Neovascularization if Carotid Atherosclerotic PlaqueBackground The neovascularization in carotid plaque is an important risk factor for the rupture and fall off of the plaque,and the secondary thrombosis.It has been shown that the neovascularization in carotid plaque can be used as an independent standard to predict plaque stability.SMI and CEUS are highly recognized by clinicians and patients because of their simple operation,noninvasive,reusable and accurate effect.In this study,microvessel density(MVD)was used as the gold standard to explore the clinical value of SMI and CEUS in assessing whether there is neovascularization in carotid plaque.The purpose of this study is to screen the economic,noninvasive and rapid methods for screening high-risk patients with stroke,so as to facilitate clinical early intervention and prevent the occurrence of cerebrovascular events.Objectives To evaluate the value of microvascular imaging and contrast-enhanced ultrasonography in the evaluation of neovascularization in carotid plaque.Methods From February 2018 to may 2019,40 patients who were hospitalized in Luoyang Central Hospital for carotid plaque peeling(CEA)were selected as the study subjects.Before the operation,all patients underwent SMI and CEUS examination of carotid plaque and pathological examination of the removed plaque tissue.SMI and CEUS were compared with each other MVD was used to evaluate the detection rate of neovascularization in carotid plaque,and the correlation between MVD and the abundance of neovascularization in carotid plaque assessed by SMI and CEUS was analyzed.Results Among 40 patients,37 cases were detected by MVD,31 cases(83.8%)by SMI and 33 cases(89.2%)by CEUS.Compared with MVD,SMI and CEUS had no significant difference in the detection rate of neovascularization in carotid plaque(P>0.05).The MVD of patients with grade 0,1,2,and 3 in SMI was(5.00±3.84),(13.70±3.59),(21.82±4.02),(30.80±3.74)mm-2,respectively.The MVD of patients with grade 0,1,2,and 3 in CEUS was(5.71±5.65),(13.00±4.44),(18.82±4.58),(28.64±4.88)mm-2.The difference of MVD between SMI and CEUS was statistically significant(P<0.05),and there was a positive correlation(r=0.937,0.922,P<0.01).That is to say,with the increase of SMI and CEUS,MVD value gradually increased.Conclusion SMI and CEUS can accurately show the neovascularization of carotid plaque,better judge the nature of plaque,and clearly show the shape,location and size of plaque,which can provide valuable imaging information for clinical assessment of the vulnerability of carotid plaque.