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目的探讨对比增强磁共振血管成像(CE-MRA)和多普勒超声(Doppler-US)检查技术对判断颈动脉血管斑块不稳定性的临床应用价值。方法对同济大学附属东方医院2006年5月至2007年7月收治的86例不同程度颈动脉病变患者(包括53例明确为颈内动脉系统缺血性脑血管病急性期患者和33例头晕头痛患者)的颈动脉同时进行CE-MRA和Doppler-US检查,分析颈动脉血管壁斑块的灌注增强表现、管腔狭窄程度以及斑块形态、密度、信号,并比较两种方法对评估不稳定性颈动脉斑块的敏感度。结果Doppler-US发现不稳定斑块者32例,不稳定斑块检出率为37.2%,CE-MRA发现不稳定斑块者42例,不稳定斑块检出率为48.9%。与Doppler-US组比较,CE-MRA检出率较高,两组比较差异有统计学意义(P<0.05)。不稳定斑块处血管壁强化明显高于稳定性斑块。结论Doppler-US和CE-MRA在评价颈动脉粥样硬化斑块的结构、性质和血流动力学改变方面各有优势,CE-MRA对不稳定性颈动脉斑块的敏感度较Doppler-US高,两者结合,能够为临床缺血性脑卒中的病因学研究和风险预测提供重要和准确的信息。
Objective To investigate the clinical value of contrast-enhanced magnetic resonance angiography (CE-MRA) and Doppler-ultrasound (Doppler-US) in detecting carotid artery plaque instability. Methods Totally 86 patients with carotid artery disease (including 53 patients with acute carotid artery ischemic cerebrovascular disease and 33 patients with dizziness and headache) admitted to Dongfang Hospital affiliated to Tongji University from May 2006 to July 2007 were enrolled in this study. Patients) were examined by CE-MRA and Doppler-US simultaneously. The perfusion enhancement, luminal stenosis and plaque morphology, density and signal of carotid artery plaque were analyzed. The two methods were compared to evaluate the instability Carotid plaque sensitivity. Results 32 cases of unstable plaques were found in Doppler-US, the detection rate of unstable plaques was 37.2%. In 42 cases of unstable plaques detected by CE-MRA, the detection rate of unstable plaques was 48.9%. Compared with Doppler-US group, the detection rate of CE-MRA was higher, the difference between the two groups was statistically significant (P <0.05). Vascular wall instability plaque was significantly higher than the stability of the plaque. Conclusion Doppler-US and CE-MRA have their own advantages in the evaluation of the structure, properties and hemodynamic changes of carotid atherosclerotic plaques. CE-MRA is more sensitive to unstable carotid plaques than Doppler-US High, combined with both, can provide important and accurate information on the etiology and risk prediction of clinical ischemic stroke.