Correlation between carotid hypoechoic plaques and recurrent cerebral infarction based on quantitative analysis of contrast-enhanced ultrasound
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摘要:
目的 探讨超声造影定量分析评估颈动脉低回声斑块对预测脑梗死复发的价值。 方法 选取2019年8月—2021年8月于金华市中心医院(浙江大学医学院附属金华医院)神经内科住院治疗的116例首次确诊脑梗死患者作为研究对象，所有患者均行超声造影定量分析。随访1年，根据脑梗死是否复发分为复发组(17例)和未复发组(99例)，比较2组患者的一般临床资料及超声造影时间-强度曲线相关参数，并采用ROC曲线分析超声造影时间-强度曲线相关参数对脑梗死复发的诊断效能。 结果 (1) 2组患者性别、美国国立卫生研究院卒中量表(NIHSS)评分及小卒中发生率比较差异均无统计学意义(P＞0.05)，复发组年龄明显高于未复发组，差异有统计学意义(P＜0.05)；(2)复发组各项脑血管疾病风险因素与未复发组相比，差异均无统计学意义(P＞0.05)；(3)复发组EI值、斜率及Ratio值均明显高于未复发组，差异均有统计学意义(P＜0.05)；(4)多因素logistic回归分析发现EI值及Ratio值是脑梗死复发的独立影响因素；(5)EI值及Ratio值预测脑梗死复发的AUC分别为0.679和0.706(Z=1.051，P=0.318)，且Ratio值联合EI值具有更大的AUC。 结论 超声造影定量分析能客观准确地评价颈动脉斑块内新生血管及密度，对预测脑梗死复发具有一定的参考价值。 Abstract:Objective To evaluate the value of quantitative contrast-enhanced ultrasound analysis in predicting recurrence cerebral infarction by assessing carotid hypoechoic plaques. Methods A total of 116 patients diagnosed with cerebral infarction for the first time at Jinhua Municipal Central Hospital Affiliated to Zhejiang University School of Medicine from August 2019 to August 2021 were included in the study. All patients underwent quantitative contrast-enhanced ultrasound analysis and were followed up for 1 year. Based on recurrence, they were divided into a recurrence group (n=17) and a non-recurrence group (n=99). The general clinical data and relevant parameters of contrast-enhanced ultrasound time-intensity curve were compared between the two groups. The diagnostic performance of contrast-enhanced ultrasound time-intensity curve parameters in predicting cerebral infarction recurrence was analyzed by ROC curves. Results (1) There were no significant differences in gender, the National Institutes of Health stroke scale (NIHSS) score, and stroke between the two groups (P > 0.05). However, the average age of the recurrence group was higher than that of the non-recurrence group (P < 0.05). (2) There were no significant differences in the risk factors of cerebrovascular disease between the two groups (P > 0.05). (3) The enhanced intensity (EI) value, slope, and ratio value of the recurrence group were significantly higher than in the non-recurrence group (P < 0.05). (4) Multifactorial logistic regression analysis revealed that EI value and ratio value were independent risk factors for recurrence of cerebral infarction. (5) The AUC values of EI value and ratio in predicting the recurrence of cerebral infarction were 0.679 and 0.706, respectively (Z=1.051, P=0.318), with a higher AUC observed when both values were combined. Conclusion Quantitative contrast-enhanced ultrasound analysis can effectively detect the neovascularization and density, and provide valuable reference value for predicting the recurrence of cerebral infarction. -
Key words:
- Cerebral infarction /
- Contrast-enhanced ultrasound /
- Carotid plaque
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图 1 颈动脉斑块超声造影定量分析
注：图中可见少许短线状增强。
Figure 1. Quantitative analysis of carotid artery plaque by contrast-enhanced ultrasound
图 2 EI值及Ratio值预测脑梗死复发的ROC曲线
Figure 2. ROC curve of EI and Ratio values for predicting cerebral infarction recurrence
表 1 2组脑梗死患者一般资料比较
Table 1. Comparison of general information between two groups of cerebral infarction patients
组别 例数 年龄(x±s，岁) 性别(男/女，例) NIHSS评分(x±s，分) 小卒中(例) 复发组 17 70.82±6.32 11/6 8.76±3.07 6 未复发组 99 65.07±5.30 61/38 8.69±3.08 34 统计量 4.012a 0.059b 0.096a 0.006b P值 ＜0.001 0.808 0.924 0.939 注：a为t值，b为χ2值。 
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表 2 2组脑梗死患者脑血管疾病风险因素比较[例(%)]
Table 2. Comparison of risk factors for cerebrovascular disease between two groups of cerebral infarction patients [cases (%)]
组别 例数 高血压史 高血脂史 糖尿病史 冠心病史 吸烟史 饮酒史 复发组 17 15(88.24) 8(47.06) 7(41.18) 6(35.29) 5(29.41) 3(17.65) 未复发组 99 70(70.71) 45(45.45) 40(40.40) 26(26.26) 27(27.27) 18(18.18) χ2值 1.469 0.015 0.004 0.592 ＜0.001 ＜0.001 P值 0.225 0.902 0.952 0.441 0.999 0.999
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表 3 2组脑梗死患者颈动脉斑块超声造影相关参数比较(x±s)
Table 3. Comparison of contrast-enhanced ultrasound parameters of carotid artery plaque between two groups of cerebral infarction patients (x±s)
组别 例数 始增时间(s) 峰值时间(s) 基线强度(LeV) 强度峰值(LeV) EI值(LeV) 斜率(LeV/s) Ratio值 复发组 17 18.95±3.33 29.89±4.86 3.71±0.81 30.86±4.52 27.05±4.98 3.06±0.72 0.18±0.03 未复发组 99 17.64±3.42 28.40±5.57 3.62±0.72 29.72±4.48 23.86±3.42 2.43±0.61 0.15±0.04 t值 1.466 1.036 0.464 0.968 2.828 3.302 3.836 P值 0.146 0.302 0.643 0.335 0.006 0.001 ＜0.001
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表 4 脑梗死复发影响因素的多因素logistic回归分析
Table 4. Multivariate logistic regression analysis of factors influencing cerebral infarction recurrence
变量 B SE Waldχ2 P值 OR值 95% CI 年龄 0.334 0.091 13.407 ＜0.001 1.397 1.168~1.672 EI值 2.664 0.832 10.261 0.001 14.356 2.813~73.280 Ratio值 1.802 0.791 5.182 0.023 6.059 1.285~28.581 斜率 1.572 0.776 4.104 0.043 4.818 1.052~22.056
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表 5 EI值、Ratio值预测脑梗死复发的诊断效能
Table 5. Diagnostic efficacy of EI and Ratio value in predicting cerebral infarction recurrence
项目 截断值 AUC 95% CI 灵敏度(%) 特异度(%) P值 EI值 26.73 0.679 0.528~0.830 52.90 82.80 0.019 Ratio值 0.16 0.706 0.575~0.836 76.50 64.50 0.007 Ratio值+EI值 0.778 0.675~0.881 94.10 58.60 ＜0.001
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