目的:探讨彩色多普勒超声(CDUS)与CT血管造影(CTA)对脑梗死患者颈动脉粥样硬化斑块的形态特点和生物学特性的评估价值.方法:选取2012年3月~2016年3月我院神经内科就诊的疑似脑梗死患者80例为研究对象,均行颈动脉CDUS、CTA检查,对两种诊断方法下颈总动脉(CCA)、颈内动脉(ICA)、颈外动脉(ECA)斑块检出数量、形态及回声特征进行对比,并比较CDUS、CTA诊断颈动脉中重度狭窄率.结果:CDUS显示脑梗死患者IMT增厚,内膜面局部粗糙,回声增强,逐渐形成斑块,CTA可见软斑块、硬斑块、混合斑块;CTA在ICA各类型斑块检出数量上与CDUS有显著差异,两种方法在CCA、ECA的斑块检出数量对比差异无统计学意义;在160支CCA中,CDUS检出的表面不规则型斑块、溃疡型斑块、软斑块比率25.97%、4.18%、22.99%高于CTA 0、0、22.39%;CTA诊断出颈动脉中重度狭窄率97.50%高于CDUS 88.75%.结论:脑梗死患者颈动脉粥样硬化斑块检出中,尤其是ICA上,CTA可作为首选检查方法,对颈动脉中重度狭窄诊断效果好,而CDUS能较好评估斑块表面光滑度及是否存在溃疡,明确不稳定斑块特征,两种检查方法各有优缺点,可根据实际情况作出准确评价.
Objective To explore the values of color Doppler ultrasonography (CDUS) and CT angiography (CTA) in as-sessing the morphological and biological characteristics of carotid atherosclerotic plaque in patients with cerebral infarction. Methods 80 cases of patients with suspected cerebral infarction treated in department of neurology of our hospital from March 2012 to March 2016 were selected for the study and treated with carotid CDUS and CTA examinations. The plaque detec-tion quantity, shape and echo characteristics of common carotid artery (CCA), internal carotid artery (ICA) and external carotid artery (ECA) were compared between the two diagnostic methods, and the effectiveness of carotid artery stenosis ≥ 70% by CDUS or CTA diagnosis was compared. Results The thickening IMT, the locally rough inner membrane surface, enhanced echo and gradually formed plaque were shown by CDUS in patients with cerebral infarction, and the soft plaque, hard plaque, mixed plaque and irregular surface or ulcerative plaque were visible in the CTA. The ICA all types plaques detection quantity by CTA was significantly different from that by CDUS, and there was no significant difference in the plaque detection quantity of CCA and ECA between the two methods. The percentages of irregular surface plaque, ulcerative plaque and soft plaque were 25.97%, 4.18% and 22.99% respectively in CDUS, which were higher than those of CTA with 0, 0 and 22.39%. The moderate and severe stenosis rate of carotid artery was 97.50% diagnosed by CTA, which was higher than that by CDUS with 88.75% . Conclusions CTA can be used as the first choice in the detection of carotid atherosclerotic plaque in patients with cerebral infarction, espe-cially in ICA. And CTA can have a good diagnosis in moderate to severe carotid artery stenosis while CDUS can better assess the plaque surface smoothness and ulcers presence with clearly unstable plaque characteristics. Therefore the two methods have their own advantages and disadvantages, an accurate evaluation should be made according to the actual situation.