本文選題：超聲造影 + 灰階中位數(shù)　； 參考：《福建醫(yī)科大學(xué)》2015年碩士論文

【摘要】：【目的】本課題是應(yīng)用超聲造影成像(contrast-enhanced ultrasound,CEUS)技術(shù)獲得不同回聲類型頸動脈粥樣硬化斑塊的超聲造影動態(tài)圖、造影增強(qiáng)強(qiáng)度視覺評分和造影參數(shù),分析不同回聲類型斑塊與腦血管事件發(fā)生率之間的相關(guān)性,為無創(chuàng)定量評估頸動脈粥樣硬化斑塊的穩(wěn)定性提供影像學(xué)依據(jù)。【方法】1、選擇2013年9月至2014年12月于我院行頸部血管超聲檢查的患者64個斑塊,來源于39例患者,男性31例,女性8例,平均年齡66.8±7.4歲。2、采用東芝Aplio500超聲診斷儀,9L線陣探頭,頻率6-8MHz。對頸動脈粥樣硬化斑塊行常規(guī)超聲及超聲造影檢查,獲得斑塊的二維灰階圖及超聲造影動態(tài)圖。3、根據(jù)斑塊的超聲造影動態(tài)圖獲得斑塊的造影增強(qiáng)強(qiáng)度視覺評分、造影參數(shù)。利用計(jì)算機(jī)輔助程序獲得各斑塊的灰階中位數(shù)值(gray-scale median,GSM)。4、根據(jù)Gray-weale等[1]提出的分類方法將頸動脈粥樣硬化斑塊分成四組。分析四組斑塊的造影增強(qiáng)強(qiáng)度視覺評分、造影參數(shù)及GSM值的差異。5、分析斑塊的超聲造影參數(shù)與斑塊的GSM值之間的相關(guān)性及不同灰階斑塊腦血管事件的發(fā)生率。【結(jié)果】1、四組斑塊的GSM值組間兩兩比較:四組斑塊的GSM值之間的差異具有統(tǒng)計(jì)學(xué)意義(F=29.365,P0.001),組間兩兩比較:不均質(zhì)低回聲斑塊組與均質(zhì)高回聲斑塊組差異沒有統(tǒng)計(jì)學(xué)意義(P=0.245),余組間差異有統(tǒng)計(jì)學(xué)意義(P0.05)。2、四組斑塊的造影動態(tài)圖表現(xiàn)及視覺評分結(jié)果:不同回聲類型的頸動脈粥樣硬化斑塊之間的超聲造影視覺評分增強(qiáng)分級中的增強(qiáng)強(qiáng)度值之間的差異具有統(tǒng)計(jì)學(xué)意義(c2=17.951,P0.001),頸動脈斑塊的回聲越低超聲造影視覺評分增強(qiáng)越明顯。均質(zhì)與不均質(zhì)低回聲斑塊組的增強(qiáng)顯影評分多為2分、3分,分別約占66.7%(14/21)、92.3%(12/13),但1個均質(zhì)低回聲斑塊表現(xiàn)為不增強(qiáng);而均質(zhì)與不均質(zhì)高回聲斑塊組的增強(qiáng)顯影評分多為1分,分別約占58.8%(10/17),46.2%(16/30)。3、四組斑塊的超聲造影參數(shù)組間兩兩比較:四組斑塊的超聲造影增強(qiáng)強(qiáng)度值(c2=29.025,P0.001)、增強(qiáng)密度值(c2=30.871,P0.001)之間的差異均具有統(tǒng)計(jì)學(xué)意義。組間兩兩比較:均質(zhì)低回聲斑塊組與均質(zhì)高回聲斑塊組及不均質(zhì)高回聲斑塊組之間的差異具有統(tǒng)計(jì)學(xué)意義(P0.05);不均質(zhì)低回聲斑塊與均質(zhì)高回聲斑塊組及不均質(zhì)高回聲斑塊組之間的差異具有統(tǒng)計(jì)學(xué)意義(P0.05);余組間無明顯統(tǒng)計(jì)學(xué)差異。4、超聲造影視覺評分增強(qiáng)分級的定量參數(shù)組間兩兩比較:不同分值的超聲造影增強(qiáng)強(qiáng)度值之間的差異具有統(tǒng)計(jì)學(xué)意義(c2=23.709,P0.001),組間兩兩比較:視覺評分為1分與視覺評分為2分、3分的超聲造影增強(qiáng)強(qiáng)度值之間的差異具有統(tǒng)計(jì)學(xué)意義(P0.05);余組間無明顯統(tǒng)計(jì)學(xué)差異。5、斑塊的增強(qiáng)強(qiáng)度與斑塊的GSM值呈負(fù)相關(guān)(r=-0.376,P=0.000),相關(guān)性顯著;斑塊的增強(qiáng)密度與斑塊的GSM值呈負(fù)相關(guān)(r=-0.252,P=0.000),相關(guān)性顯著。6、低回聲斑塊組腦血管事件發(fā)生率約92.9%(13/14),未發(fā)生腦血管事件約7.1%(1/14),高回聲斑塊組腦血管事件發(fā)生率約60%(9/15),未發(fā)生腦血管事件約40%(6/15)。【結(jié)論】1、不同灰階斑塊具有不同特征的造影動態(tài)圖。2、不同回聲類型的頸動脈粥樣硬化斑塊具有不同的GSM值。3、頸動脈粥樣硬化斑塊的超聲造影增強(qiáng)強(qiáng)度評分和造影參數(shù)值二者可間接反映不同灰階斑塊內(nèi)新生血管的增生情況。4、斑塊的超聲造影參數(shù)值與斑塊的GSM值呈負(fù)相關(guān),低回聲斑塊組腦血管事件發(fā)生率高。說明斑塊的回聲越低,GSM值越低,超聲造影增強(qiáng)強(qiáng)度值及增強(qiáng)密度值則越高,間接提示斑塊內(nèi)新生血管生成越多,斑塊穩(wěn)定性就越差,腦血管事件的發(fā)生率也就越高。5、超聲造影聯(lián)合GSM技術(shù)能更加客觀地定量評估不同回聲類型的頸動脈粥樣硬化斑塊內(nèi)新生血管的生成情況。由于研究組例數(shù)少,所得結(jié)論還需要擴(kuò)大樣本量做進(jìn)一步的研究。
[Abstract]:[Objective] this topic is the application of ultrasound contrast imaging (contrast-enhanced ultrasound, CEUS) technology to obtain different echo types of carotid atherosclerotic plaque dynamic ultrasound imaging, contrast enhancement intensity visual score and contrast parameters, analysis of the correlation between different echo type plaque and the incidence of cerebrovascular events, for noninvasive Quantitative evaluation of carotid atherosclerotic plaque stability provides imaging basis. [Methods] 1, 64 plaques were selected from September 2013 to December 2014 in our hospital with cervical vascular ultrasound examination, from 39 patients, 31 males and 8 women, with an average age of 66.8 + 7.4 years.2, using a Toshiba Aplio500 ultrasonic diagnostic instrument, 9L linear array probe, frequency Rate 6-8MHz. for carotid atherosclerotic plaques were examined by conventional ultrasound and ultrasound contrast. The two-dimensional gray scale of plaque and.3 were obtained. The visual score of the plaque enhancement intensity was obtained according to the dynamic map of the plaque, and the contrast parameters were obtained by the computer aided program (gray-s Cale median, GSM).4, divided the carotid atherosclerotic plaque into four groups according to the classification method proposed by Gray-weale and [1]. The contrast enhancement intensity visual score of the four groups of plaques, the difference of contrast parameters and the difference of GSM value were analyzed, and the correlation between the contrast parameters of the plaque and the GSM value of the plaque and the different gray scale plaque of the cerebral vascular events were analyzed. [results] [results] 1, 22 of the GSM values between the four groups were compared: the difference between the GSM values of the four groups was statistically significant (F=29.365, P0.001), and the difference between the groups was 22: the difference of the heterogeneous hypoechoic plaque group and the homogeneous hyperechoic plaque group was not statistically significant (P0.05) (P0.05).2, and the four groups were statistically significant (P=0.245). Dynamic images of plaque and the results of visual score: the difference between enhanced intensity values in the enhanced classification of carotid atherosclerotic plaques of different echo types was statistically significant (c2=17.951, P0.001), the lower the echo of carotid plaques, the greater the enhanced visual score of contrast-enhanced ultrasonography. The enhanced development score of the inhomogeneous hypoechoic plaque group was 2, 3, about 66.7% (14/21) and 92.3% (12/13), but the 1 homogeneous hypoechoic plaques were not enhanced, while the enhanced development score of the homogeneous and heterogeneous hyperechoic plaque group was 1, about 58.8% (10/17), 46.2% (16/30).3, and in the four group of atherosclerotic plaques 22 comparison: the contrast enhanced intensity value (c2=29.025, P0.001) and enhanced density (c2=30.871, P0.001) of the four groups were all statistically significant. The differences between the groups of the homogeneous hypoechoic plaque group and the homogeneous hyperechoic plaque group and the heterogeneous hyperechoic plaque group were statistically significant (P0.05). The difference between the homogeneous hypoechoic plaque and the homogeneous hyperechoic plaque group and the heterogeneous hyperechoic plaque group was statistically significant (P0.05), and there was no significant difference between the remaining groups.4. The comparison between the quantitative parameters of the enhanced classification of the visual score was 22: the difference between the contrast-enhanced intensities of contrast-enhanced ultrasound was statistically significant. Study meaning (c2=23.709, P0.001), 22 comparison between groups: visual score was 1 and visual score was 2, and the difference of enhanced intensity value between 3 points was statistically significant (P0.05); there was no significant difference between the remaining groups.5, the enhancement intensity of plaque was negatively correlated with the GSM value of plaque (r=-0.376, P=0.000), and the correlation was significant; plaque was significant; plaque The enhanced density was negatively correlated with the GSM value of the plaque (r=-0.252, P=0.000), the correlation was significant.6, the incidence of cerebrovascular events in the hypoechoic plaque group was about 92.9% (13/14), no cerebral vascular events were about 7.1% (1/14), the incidence of cerebrovascular events in the hyperechoic plaque group was about 60% (9/15), and the cerebral vascular events were not about 40% (6/15). [Conclusion] 1, different gray scale plaques. Different characteristics of contrast dynamic imaging.2, different echo types of carotid atherosclerotic plaques have different GSM values.3. The contrast enhancement intensity score of carotid atherosclerotic plaque and the value of contrast parameters can indirectly reflect the growth of the neovascularization in different gray scale plaques,.4, the parameters of the plaque and the plaque The GSM value of the block is negatively correlated and the incidence of cerebral vascular events in the hypoechoic plaque group is high. It shows that the lower the echo of the plaque, the lower the GSM value, the higher the contrast enhanced intensity value and the enhanced density value, the more the new angiogenesis in the plaque is, the worse the plaque stability is, the higher the incidence of cerebral vascular events is.5, contrast-enhanced ultrasound combined with G SM technology can more objectively evaluate the formation of neovascularization in carotid atherosclerotic plaques of different echo types. Because the number of cases in the study group is few, the results also need to expand the sample size to do further research.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R445.1;R743

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 ;各類腦血管疾病診斷要點(diǎn)[J];中華神經(jīng)科雜志;1996年06期

，

本文編號：1957845