CN111265252A - Method for evaluating stability of atherosclerotic plaque - Google Patents
Method for evaluating stability of atherosclerotic plaque Download PDFInfo
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- 208000037260 Atherosclerotic Plaque Diseases 0.000 title claims abstract description 37
- 238000000034 method Methods 0.000 title claims abstract description 24
- 230000017531 blood circulation Effects 0.000 claims abstract description 12
- 230000010412 perfusion Effects 0.000 claims abstract description 12
- 230000002308 calcification Effects 0.000 claims abstract description 11
- 210000004088 microvessel Anatomy 0.000 claims abstract description 4
- 238000002604 ultrasonography Methods 0.000 claims description 24
- 208000025865 Ulcer Diseases 0.000 claims description 9
- 231100000397 ulcer Toxicity 0.000 claims description 7
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- 230000036269 ulceration Effects 0.000 claims description 2
- 238000001514 detection method Methods 0.000 abstract description 9
- 238000007689 inspection Methods 0.000 abstract 1
- 238000011156 evaluation Methods 0.000 description 5
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- 210000001715 carotid artery Anatomy 0.000 description 4
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- 239000002961 echo contrast media Substances 0.000 description 3
- 238000013097 stability assessment Methods 0.000 description 3
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
- A61B8/08—Detecting organic movements or changes, e.g. tumours, cysts, swellings
- A61B8/0891—Detecting organic movements or changes, e.g. tumours, cysts, swellings for diagnosis of blood vessels
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
- A61B8/48—Diagnostic techniques
- A61B8/481—Diagnostic techniques involving the use of contrast agent, e.g. microbubbles introduced into the bloodstream
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
- A61B8/48—Diagnostic techniques
- A61B8/488—Diagnostic techniques involving Doppler signals
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
- A61B8/52—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves
- A61B8/5215—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves involving processing of medical diagnostic data
- A61B8/5238—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves involving processing of medical diagnostic data for combining image data of patient, e.g. merging several images from different acquisition modes into one image
- A61B8/5246—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves involving processing of medical diagnostic data for combining image data of patient, e.g. merging several images from different acquisition modes into one image combining images from the same or different imaging techniques, e.g. color Doppler and B-mode
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Abstract
The invention discloses a method for evaluating the stability of atherosclerotic plaques, which comprises the following steps: (1) determining the existence of plaque by adopting conventional ultrasonic examination, and then carrying out color Doppler examination and ultrasonic contrast examination on the plaque; (2) reading the inspection results: plaque morphology, plaque surface characteristics, plaque internal echo characteristics, plaque internal calcification conditions, plaque internal blood flow conditions, perfusion characteristics of plaque internal microvessels; (3) plaque stability was assessed from the readings. The method for evaluating the stability of the atherosclerotic plaque combines the conventional ultrasonic examination, color Doppler examination and ultrasonic contrast examination results to comprehensively evaluate the atherosclerotic plaque, can accurately detect the vulnerable plaque and greatly improve the detection rate of the vulnerable plaque.
Description
Technical Field
The invention relates to the field of medical detection, in particular to a method for evaluating the stability of atherosclerotic plaques by combining conventional ultrasonic imaging results and ultrasonic contrast detection results.
Background
Atherosclerotic plaques can be divided in nature into two types: the medicine belongs to a stable type, such as calcified plaque and fibrous plaque, and the medicine is not easy to break and fall off on the blood vessel wall; another category of unstable plaque, such as soft plaque, complex plaque, is structurally weak and prone to rupture, falling off the vessel and into the blood stream, causing sudden blockage of the vessel. The rupture and the desquamation of the plaque are not threatened, the rupture and the desquamation often happen accidentally, the rupture and the desquamation have strong abruptness in performance, and no clear cause can be found. At present, the medical community tries to find a method for identifying stable and unstable plaques so as to take measures to prevent the plaques from breaking and falling off as soon as possible and avoid the occurrence of vascular occlusion events. There are two current approaches to plaque management: one is surgical therapy, namely implanting a stent and bridging blood vessels, and the therapeutic effect of the stent can not only ensure the smooth lumen, but also support plaques and prevent rupture and falling off; the other is a pharmacotherapy, wherein western medicines are mainly statins, and traditional Chinese medicines are mainly blood-activating and stasis-removing medicines, so that plaques are reduced and disappear.
Carotid artery ultrasound is a conventional detection method clinically used for a carotid artery system, has the advantages of non-invasiveness, low cost, high diagnosis accuracy and the like, can accurately judge the degree and range of carotid artery stenosis, and provides a lot of reference information for clinical diagnosis and treatment scheme selection. However, several studies (e.g., Neuroimaging Clin N Am,2016,26(1):81-96), etc., have proven unreliable for assessing the stability of atherosclerotic plaques using conventional ultrasound alone.
Although Digital Subtraction Angiography (DSA) has been the "gold standard" for diagnosis of carotid atherosclerotic stenosis, its application is still very limited due to its inability to assess the conditions inside the vessel wall and plaque, invasive examination, high cost, and high radiation dose. Although MSCTA and high-resolution magnetic resonance imaging (HR-MRI) can accurately measure the stenosis of the lumen and judge the property of the plaque, because the CTA has insufficient evaluation advantages on the stability of the plaque, HR-MRI is limited by factors such as scanning time, coil and resolution, and the like, and the clinical application is difficult to popularize.
Plaque stability is difficult to assess purely by conventional ultrasound, with further examination. The invention aims to provide an assessment method for the stability of atherosclerotic plaques, overcomes the defect that no unified assessment method for atherosclerotic vulnerable plaques exists at present, reasonably identifies the stability of atherosclerotic plaques, and provides great guiding significance and theoretical value for the ultrasonic examination of atherosclerosis and carotid artery systems in scientific research, teaching and clinical practice.
Disclosure of Invention
Aiming at the defects of the prior art, the invention provides a method for evaluating the stability of atherosclerotic plaques, which combines the conventional ultrasonic imaging result and the ultrasonic contrast detection result for evaluation and can overcome the defect that the stability of plaques is difficult to evaluate by only using conventional ultrasound.
In order to achieve the purpose, the invention adopts the following technical scheme:
a method of assessing atherosclerotic plaque stability comprising the steps of:
the method comprises the following steps that firstly, conventional ultrasonic examination is adopted, the size, the position, the shape, the echo type and other characteristics of a plaque are determined, the blood flow characteristics of the plaque are observed by utilizing color Doppler in the conventional ultrasonic examination, and then ultrasonic contrast examination is carried out on the plaque;
reading the result of routine ultrasonic examination of atherosclerotic plaques, wherein the result comprises the following steps: plaque morphology, plaque surface features, plaque internal echo features, plaque internal calcification;
reading results of a color doppler examination of atherosclerotic plaques, the results comprising: intra-plaque blood flow conditions;
reading results of an ultrasound contrast examination of atherosclerotic plaques, the results comprising: perfusion characteristics of the microvessels within the plaque;
and step three, judging the specific indexes of the results read in the step two.
Further, the indexes in the second step include: 1. observing whether the plaque shape is regular; 2. observing whether the plaque surface is smooth, whether ulcer exists or not, whether the surface is angled or not and whether incisura exists or not; 3. observing whether the echoes inside the plaque are uniform or not, and whether a flaky extremely low echo area exists or not; 4. observing the calcification condition inside the plaque, namely the lump or the fine punctate calcification; 5. observing whether a blood flow signal exists inside the plaque; 6. observing the enhancement condition of the ultrasonic contrast in the plaque, namely enhancing the ultrasonic contrast at the plaque base or the body/shoulder and judging whether perfusion defects exist or not; 7. the intra-plaque ultrasound contrast perfusion pattern is observed, whether it is entering from the plaque base or the plaque surface.
Further, the assessment index for determining atherosclerotic plaque as unstable plaque is any of the following:
(1) the plaque has three or more characteristics of irregular shape, non-smooth/angular/incisional surface, uneven/flaky extremely low echo, fine-point calcification and blood flow;
(2) any one or more of contrast enhancement, plaque surface perfusion into the plaque, and ulceration within the plaque occurring at 3 or more sites of the body/shoulder.
By adopting the technical scheme, compared with the prior art, the invention has the following technical effects:
the method for evaluating the stability of the atherosclerotic plaque combines the conventional ultrasonic examination, color Doppler examination and ultrasonic contrast examination results to comprehensively evaluate the atherosclerotic plaque, can accurately detect the vulnerable plaque and greatly improve the detection rate of the vulnerable plaque.
Drawings
FIG. 1 is a schematic representation of an atherosclerotic plaque of the present invention;
FIG. 2 is a graph showing the results of conventional ultrasound detection of atherosclerotic plaques of the present invention, wherein the arrows indicate the sites of plaque;
FIG. 3 is a graph showing the results of detecting atherosclerotic plaques by ultrasound imaging in accordance with the present invention, wherein the large arrows indicate plaques and the small arrows indicate neovascularization within the plaques;
FIG. 4 is a schematic flow chart of a method of assessing atherosclerotic plaque stability of the present invention;
FIG. 5 is a graph showing the comparison of conventional ultrasound and color ultrasound to the same plaque in an embodiment of the present invention, wherein A is the result of conventional ultrasound; graph B is the color ultrasound results;
FIG. 6 is a comparison of the same plaque after ultrasound imaging of the same plaque in accordance with one embodiment of the present invention, wherein the circle depicted in FIG. A shows the plaque having a larger ulcer; panel B shows the neovasculature located alongside the ulcer within the plaque.
Detailed Description
The invention provides a method for evaluating the stability of atherosclerotic plaques.
Conventional ultrasound examination is currently the most common examination in assessing atherosclerotic plaque stability. But when the plaque tends to rupture, and even when it does, there can be cracks in the plaque surface, which can lead to microhemorrhage and thrombosis (as shown in figure 1) that cannot be detected by some ultrasound and other examinations. In the conventional ultrasonic display, the plaque is observed to be equal echo, the plaque is regular in shape, clear in boundary, smooth in surface, free of internal electrodeless low echo and fine point-shaped calcification, and seems to be a stable plaque (as shown in fig. 2); the plaque can be judged to be unstable plaque through the fact that the plaque base part, the plaque body part and the plaque shoulder part are all provided with new blood vessels through ultrasonic contrast examination, and the perfusion mode is that the plaque surface perfuses into the plaque (as shown in figure 3). In summary, the evaluation of the stability of atherosclerotic plaque using conventional ultrasound alone is unreliable, and conventional ultrasound does not provide much information for determining plaque stability.
In addition, the results of conventional ultrasound and color ultrasound examinations were compared (as shown in FIG. 5): due to plaque hypoechogenicity, conventional ultrasound (fig. 5A) does not well show the morphology of the plaque, making the lumen and plaque unclear; by means of color ultrasound (fig. 5B), the range of the lumen and the boundary of the plaque, as well as information of color blood flow inside a part of the plaque, can be roughly displayed.
Based on the above discussion, the invention provides a method for evaluating the stability of atherosclerotic plaques, which combines conventional ultrasound and ultrasound contrast examination for comprehensive evaluation, and the method can accurately detect vulnerable plaques and greatly improve the detection rate of vulnerable plaques.
The present invention will be described in detail and specifically with reference to the following examples to facilitate better understanding of the present invention, but the following examples do not limit the scope of the present invention.
Example one
Referring to FIG. 4, the present embodiment provides a method for assessing atherosclerotic plaque stability comprising the steps of:
step one, adopting a SIEMENS ACUSON OXANA2 color Doppler ultrasonic diagnostic apparatus, a 9L4 linear array probe, the probe frequency: 8MHz, and conventional ultrasound examination of the carotid artery to determine the presence of plaque. Reading results of ultrasonically examining atherosclerotic plaques, the results comprising: plaque morphology, plaque surface features, plaque internal echogenic features, plaque internal calcification.
And step two, performing color Doppler examination (CDFI) on the plaque, wrapping a color sampling frame in a range of 1.5cm around the plaque, and recording the blood flow conditions around the plaque and inside the plaque.
And step three, carrying out ultrasonic Contrast (CEUS) examination, wherein the ultrasonic contrast agent adopts sononovine (SonoVue) freeze-dried powder and contains sulfur hexafluoride microbubbles, 5ml of normal saline is injected into the ultrasonic contrast agent, the ultrasonic contrast agent is fully shaken until the freeze-dried powder is completely dispersed into white suspension, the average diameter of the microbubbles is about 2.5 mu m, and the microbubbles are discharged along with the respiration through the lung along with the blood circulation. Sonoweiwei (1.2ml) was bolus injected into the patient's peripheral vein using an 18G needle for 2-3 seconds, followed by 5ml saline at the same rate. After the contrast is finished, 2 doctors who work in ultrasonic contrast for more than 5 years observe the static images and the dynamic videos, and read the results of the ultrasonic contrast examination of atherosclerotic plaques, wherein the results comprise: perfusion characteristics of the microvessels within the plaque;
analyzing the characteristics of the two-dimensional image, the color image and the ultrasonic contrast image of the ultrasonic detection, and evaluating whether the atherosclerotic plaque is stable according to the stability evaluation factors shown in the table 1:
when the number of times of appearance of unstable features is more than or equal to 3 in the conventional ultrasonic features (1-5) in the table 1, unstable plaques can be prompted;
when the ultrasound contrast examination characteristics (6-8) in table 1 are shown, unstable plaque can be determined as long as 1 unstable characteristic appears.
TABLE 1 plaque stability assessment factors
As an example, as shown in FIG. 6, the circle depicted in FIG. 6A shows that a larger ulcer exists in the plaque; the circle in FIG. 6B shows the new blood vessels in the plaque located beside the ulcer, and the perfusion pattern is such that the ulcer perfuses towards the interior of the plaque, thus determining the plaque as an unstable plaque.
Verification experiment
Using SPSS 22.0 statistical software, stability assessments were performed on 35 plaques using the method provided in example 1, with the half-year-old occurrence of cerebrovascular accident in the patient as the end-point event, and the results are shown in table 2. The results show that: the method has higher consistency of evaluating plaque stability and cerebrovascular accident.
TABLE 2 verification experiment data of effectiveness of plaque stability assessment method
The embodiments of the present invention have been described in detail, but the embodiments are merely examples, and the present invention is not limited to the embodiments described above. Any equivalent modifications and substitutions to those skilled in the art are also within the scope of the present invention. Accordingly, equivalent changes and modifications made without departing from the spirit and scope of the present invention should be covered by the present invention.
Claims (3)
1. A method of assessing atherosclerotic plaque stability comprising the steps of:
the method comprises the steps of firstly, adopting conventional ultrasonic examination to determine the size, the position, the shape and the echo type characteristics of a plaque, observing the blood flow characteristics of the plaque by using color Doppler in the conventional ultrasonic examination, and then carrying out ultrasonic contrast examination on the plaque;
reading the result of the conventional ultrasonic examination of the atherosclerotic plaque, wherein the result comprises: plaque morphology, plaque surface features, plaque internal echo features, plaque internal calcification;
reading results of the color doppler examination of atherosclerotic plaques, the results comprising: intra-plaque blood flow conditions;
reading results of the sonography examining atherosclerotic plaques, the results comprising: perfusion characteristics of the microvessels within the plaque;
and step three, judging the specific indexes of the results read in the step two.
2. The method for evaluating the stability of atherosclerotic plaques according to claim 1, wherein said indicator in step two comprises: (1) observing whether the plaque shape is regular; (2) observing whether the plaque surface is smooth, whether ulcer exists or not, whether the surface is angled or not and whether incisura exists or not; (3) observing whether the echoes inside the plaque are uniform or not, and whether a flaky extremely low echo area exists or not; (4) observing the calcification condition inside the plaque, namely the lump or the fine punctate calcification; (5) observing whether a blood flow signal exists inside the plaque; (6) observing the enhancement condition of the ultrasonic contrast in the plaque, namely enhancing the ultrasonic contrast at the plaque base or the body/shoulder and judging whether perfusion defects exist or not; (7) the intra-plaque ultrasound contrast perfusion pattern is observed, whether it is entering from the plaque base or the plaque surface.
3. The method for assessing the stability of atherosclerotic plaques according to claim 1, wherein the assessment of said atherosclerotic plaques as unstable plaques is determined as any one of:
(1) the plaque has three or more characteristics of irregular shape, non-smooth/angular/incisional surface, uneven/flaky extremely low echo, fine-point calcification and blood flow;
(2) any one or more of contrast enhancement, plaque surface perfusion into the plaque, and ulceration within the plaque occurring at 3 or more sites of the body/shoulder.
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Cited By (6)
Publication number | Priority date | Publication date | Assignee | Title |
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CN111920450A (en) * | 2020-07-14 | 2020-11-13 | 上海市同仁医院 | Visual carotid plaque ultrasonic self-inspection instrument |
CN111950388A (en) * | 2020-07-22 | 2020-11-17 | 上海市同仁医院 | Vulnerable plaque tracking and identifying system and method |
CN113077432A (en) * | 2021-03-30 | 2021-07-06 | 中国人民解放军空军军医大学 | Patient risk grading system based on coronary artery CTA image atherosclerotic plaque comprehensive characteristics |
CN114366164A (en) * | 2022-01-18 | 2022-04-19 | 河南科技大学 | Ultrasonic quantitative evaluation and risk assessment method for atherosclerotic plaque |
US11436731B2 (en) | 2019-08-05 | 2022-09-06 | Lightlab Imaging, Inc. | Longitudinal display of coronary artery calcium burden |
CN116309248A (en) * | 2022-09-07 | 2023-06-23 | 拓微摹心数据科技(南京)有限公司 | Automatic evaluation method for calcification spatial distribution uniformity of aortic root |
Citations (1)
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CN108742707A (en) * | 2018-06-22 | 2018-11-06 | 苏州大学附属第医院 | A method of assessing carotid plaques property based on three-D ultrasonic tomographic techniques |
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Patent Citations (1)
Publication number | Priority date | Publication date | Assignee | Title |
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CN108742707A (en) * | 2018-06-22 | 2018-11-06 | 苏州大学附属第医院 | A method of assessing carotid plaques property based on three-D ultrasonic tomographic techniques |
Cited By (9)
Publication number | Priority date | Publication date | Assignee | Title |
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US11436731B2 (en) | 2019-08-05 | 2022-09-06 | Lightlab Imaging, Inc. | Longitudinal display of coronary artery calcium burden |
CN111920450A (en) * | 2020-07-14 | 2020-11-13 | 上海市同仁医院 | Visual carotid plaque ultrasonic self-inspection instrument |
CN111950388A (en) * | 2020-07-22 | 2020-11-17 | 上海市同仁医院 | Vulnerable plaque tracking and identifying system and method |
CN111950388B (en) * | 2020-07-22 | 2024-04-05 | 上海市同仁医院 | Vulnerable plaque tracking and identifying system and method |
CN113077432A (en) * | 2021-03-30 | 2021-07-06 | 中国人民解放军空军军医大学 | Patient risk grading system based on coronary artery CTA image atherosclerotic plaque comprehensive characteristics |
CN113077432B (en) * | 2021-03-30 | 2024-01-05 | 中国人民解放军空军军医大学 | Patient risk grading system based on coronary artery CTA image atherosclerosis plaque comprehensive characteristics |
CN114366164A (en) * | 2022-01-18 | 2022-04-19 | 河南科技大学 | Ultrasonic quantitative evaluation and risk assessment method for atherosclerotic plaque |
CN114366164B (en) * | 2022-01-18 | 2024-05-03 | 河南科技大学 | Ultrasonic quantitative evaluation and risk evaluation method for atherosclerosis plaque |
CN116309248A (en) * | 2022-09-07 | 2023-06-23 | 拓微摹心数据科技(南京)有限公司 | Automatic evaluation method for calcification spatial distribution uniformity of aortic root |
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