1、Correlation of Carotid Plaque Neovascularization Detected by Contrast-Enhanced Ultrasound Imaging With Clinical Symptoms You-Bin Deng,MD,邓又斌邓又斌Tongji Hospital,Huazhong University of Science and Technology,Wuhan,China 武汉同济医院武汉同济医院Mechanisms of vessel wall neovascularization in atherosclerosisDoyle B
2、et al.JACC 2007;49:2073Possible roles for microvessels in disease progression include the supply of cellular and soluble lesion components,enhancement of intraplaque gas exchange,anddelivery of metabolic substrates to the plaque core.Doyle B et al.JACC 2007;49:2073Neovascularization in Stable and Un
3、stable Coronary PlaquesKolodgie FD et al.JACC 2007;49:2093Plaque neovascularization and clinical symptomsFleiner M et al.Circulation 2004;110:2843Number of microvessels identified from plaques of symptomatic and asymptomatic patients.McCarthy MJ et al.J Vasc Surg 1999;30:261Vessel Density at Histolo
4、gy According to Plaque Contrast-Agent EnhancementColi S et al.JACC 2008;52:223Vulnerable patients have vulnerable plaques Plaque neovascularization is the remarkably consistent feature of vulnerable plaque in cerebrovascular patients Contrast-enhanced carotid ultrasound imaging is promising and may
5、serve to detect the neovascularization within the atherosclerotic plaque in vivo.Carotid plaque contrast-agent enhancement with sonographic agent correlates with histological density of neovessels within the carotid plaque The association between the carotid plaque enhancement with contrast agent mi
6、crobubbles and clinical symptoms is not fully understood.Study Population研究方法 GE Log9超声诊断仪9L探头：频率为6MHz机械指数：0.13104例患者快速静脉注射SonoVue 1.5 ml实时观察颈动脉腔及斑块内造影剂显影情况Grade 1:no enhancement within the plaque or enhancement confined to plaque adventitial side and/or shoulderGrade 2:enhancement reaching plaque c
7、ore/or extensive contrast agent enhancement throughout the plaque.Grading of Contrast-Agent Enhancement by Visual InterpretationGrading of Contrast-Agent Enhancement by Quantitative AnalysisEnhanced intensity in the plaqueRatio of the enhanced intensity in the plaque to that in the carotid artery lu
8、men Receiver Operating Characteristic Curve AnalysisThe sensitivity and specificity for enhanced intensity in the plaque(cutoff value:10.0 dB)were 74%and 62%,respectively and those for ratio of enhanced intensity in the plaque to that in the carotid artery lumen(cutoff value:0.46)were 74%and 75%,res
9、pectively.No 2984,M,71 yrsStandard and contrast-enhanced carotid ultrasound images in a 78-year-old man who experienced serial transient ischemic attack 2 days before examination.No 2274,F,74 yrs双侧颈总动脉可见多处斑块，患者最近有双侧颈总动脉可见多处斑块，患者最近有TIATIA病史，注射病史，注射Sonovue Sonovue 2ml2ml造影剂后，左侧一斑块显影，回声增强。造影剂后，左侧一斑块显影，
10、回声增强。No 2290,M,51 yrs双侧颈总动脉可见多处斑块，患者三天前发生脑梗死，有高血压病史，注射双侧颈总动脉可见多处斑块，患者三天前发生脑梗死，有高血压病史，注射Sonovue 2ml造影剂后，右侧一斑块显影，回声增强，斑块后方可见丰富的造影剂后，右侧一斑块显影，回声增强，斑块后方可见丰富的滋养血管。滋养血管。No 2295,M,64 yrs冠心病患者，有高血压病史，双侧颈总动脉可见多处斑块，注射冠心病患者，有高血压病史，双侧颈总动脉可见多处斑块，注射Sonovue 2ml造影造影剂后，左侧一斑块显影，回声增强。剂后，左侧一斑块显影，回声增强。No 2330,M,53 yrs双侧颈
11、动脉窦可见斑块，患者发作性右侧肢体无力双侧颈动脉窦可见斑块，患者发作性右侧肢体无力20天，注射天，注射Sonovue 1.5ml造影剂后，左侧颈动脉窦处的后方一斑块全部显影，前方的斑块周边造影剂后，左侧颈动脉窦处的后方一斑块全部显影，前方的斑块周边显影。显影。In conclusion,contrast-enhanced carotid ultrasound imaging provided us a way for the direct visualization of neovascularization within the plaque.Patients with recent transient ischemic attack and/or cerebrovascular ischemic stroke had more intense contrast-agent enhancement in the plaque than those without symptoms,suggesting that contrast-enhanced carotid ultrasound imaging may be used as a routine method for plaque risk stratification.
