CN108742707A - 一种基于三维超声断层技术评估颈动脉斑块性质的方法 - Google Patents
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Abstract
本发明公开了一种基于三维超声断层技术评估颈动脉斑块性质的方法,采用Philips iU Elite超声诊断仪,获取血管最狭窄处的清晰的三维超声扫描图像,以DICOM格式输出,脱机进入QLab 10.5工作站,进行三维超声重建和定量分析,以纵断面定位、再以间隔3mm层厚对粥样斑块进行横断面观察,同时观察颈动脉粥样斑块每个层面的形态学及斑块回声等并记录,用截面积法定量评估颈内动脉狭窄的程度,取三次测量结果的平均值进行计算;然后以iSlice智能容积断层模式完成三维超声图像的分析。本发明提供了一种全面观察斑块特征、准确评估斑块性质并显示斑块立体结构的检查方法,为临床采取内科药物治疗提供依据。
Description
技术领域
本发明涉及医疗领域,具体涉及一种基于三维超声断层技术评估颈动脉斑块性质的方法。
背景技术
根据《全球疾病负担报告2013》最新研究表明,脑卒中已成为我国居民的首位死亡原因,动脉粥样硬化(atherosclerosis,AS)斑块形成是脑卒中发生发展伴随的重要病理及临床基础,颈动脉粥样斑块可致颈动脉狭窄,其中易损斑块形成以及随之形成的血栓是脑血管疾病致残、致死的重要原因。Magge等报道,约30%的缺血性卒中由颈动脉粥样斑块导致。
近年来临床研究,更关注颈动脉斑块性质对脑卒中高危患者进行危险分层,而不是仅采用测量颈动脉狭窄程度进行评估。Brinjikji等和Pikija等指出,颈动脉易损斑块(即不稳定斑块或罪犯斑块)更易引起脑缺血事件的发生。那么,如何及早、实时动态、准确评估斑块性质、斑块累及范围及其血管狭窄程度,成为临床关注的焦点。
现有的二维超声可以对血管的横断面及纵断面扫查,通过二维超声显像、彩色多普勒成像及血流频谱多普勒成像技术观察颈动脉斑块性质,如纤维帽不完整、斑块缺损,斑块内低回声或斑块内见血流信号等,但尚缺乏对颈动脉粥样斑块全方位整体评估,且依赖于操作者的临床经验等,二维超声不能对颈动脉粥样斑块内部的新生血管进行评估,这一局限性使得二维超声在粥样斑块内新生血管的早期检测及斑块稳定性评价方面受到了限制;有研究,超声造影技术能够分析颈动脉粥样斑块内新生血管,但一次造影只能观察一个部位斑块,如果患者多个部位斑块则需要多次造影,且超声造影剂的成本昂贵,对患者而言具有较重的经济负担,少数患者可以出现不同程度的过敏反应,因而限制了它在临床工作的应用推广。
发明内容
为解决上述问题,本发明提供了一种基于三维超声断层技术评估颈动脉斑块性质的方法,运用三维超声断层扫描技术,无创、实时动态、薄层(3mm)扫查颈动脉,对颈动脉斑块进行横断面、纵断面及矢状面检查,模拟颈动脉内膜剥脱术(CEA)获取的粥样斑块进行薄层分析,为颈动脉斑块或颈动脉狭窄患者尤其是无需手术的颈动脉斑块致颈动脉狭窄患者,提供“精准评估”、采取“个体化”治疗的依据。
为实现上述目的,本发明采取的技术方案为:
一种基于三维超声断层技术评估颈动脉斑块性质的方法,包括如下步骤:
S1、采用Philips iU Elite超声诊断仪,获取血管最狭窄处的清晰的三维超声扫描图像;
S2、将所述三维超声扫描图像以DICOM格式输出,脱机进入QLab 10.5工作站,进行三维超声重建和定量分析,以纵断面定位、再以间隔3mm层厚对粥样斑块进行横断面观察,同时观察颈动脉粥样斑块每个层面的形态学及斑块回声等并记录,用截面积法定量评估颈内动脉狭窄的程度,取三次测量结果的平均值进行计算;
S3、进入三维超声图像分析程序:选择待分析病例的“DICOMDIR”索引文件,所述“DICOMDIR”索引文件指导出的原始图所对应病人的目录信息;进入“分析方式”-“GI3DQ”-“iSlice智能容积断层模式”,可同时显示任一个MPR平面的多层平行图像,也可选择所需要的层厚对粥样斑块进行多层面分析。
本发明采用三维超声断层扫查技术,能够从血管横断面、纵断面及矢状面断层扫查,对粥样斑块全方位整体观察,克服现有二维超声检测技术的不足,以每层间隔3mm的距离对责任斑块进行横断面观察,模拟颈动脉内膜剥脱术后获取斑块进行研究,提供了一种全面观察斑块特征、准确评估斑块性质并显示斑块立体结构的检查方法,为临床采取内科药物治疗提供依据。
具体实施方式
为了使本发明的目的及优点更加清楚明白,以下结合实施例对本发明进行进一步详细说明。应当理解,此处所描述的具体实施例仅仅用以解释本发明,并不用于限定本发明。
实施例
1.采用Philips iU Elite超声诊断仪,先选取L9-3探头,按照中国脑卒中血管超声检查指导规范进行检查,对颈内动脉狭窄符合实施颈动脉内膜剥脱术(CEA)患者进行横断面及纵断面扫查,确定血管最狭窄处;
2.再选取VL 13-5三维容积探头,将探头放在感兴趣区中间(血管最狭窄处)并保持稳定,嘱咐患者勿做吞咽动作,保持探头界面稳定,启动“3D”功能键,进行自动扫描成像(扫描时间约4~5s)、回放图像清晰后储存,并以DICOM格式输出,脱机进入QLab 10.5工作站,进行三维超声重建和定量分析,以纵断面定位、再以间隔3mm层厚对粥样斑块进行横断面观察。
3.同时观察颈动脉粥样斑块每个层面的形态学及斑块回声等并记录,用截面积法定量评估颈内动脉狭窄的程度,取三次测量结果的平均值进行计算。以上由两名有经验医师独立完成。
4.进入三维超声图像分析程序:选择待分析病例的“DICOMDIR”索引文件,进入“分析方式”-“GI3DQ”-“iSlice智能容积断层模式”,可同时显示任一个MPR平面的多层平行图像,也可选择所需要的层厚对粥样斑块进行多层面分析。
5.血管超声检查24小时内患者均接受颈动脉内膜剥脱术(CEA)并获取斑块进行病理研究,进一步以验证血管三维断层技术评估颈动脉斑块易损性的准确性。
6.使用SPSS17.0统计学软件,三维超声(3D-US)评估斑块易损性的一致性分析采用Kappa值计算,Kappa值≤0.04表示一致性差,0.75>Kappa值>0.40表示一致性佳,Kappa值≥0.75表示一致性极佳。以P<0.05为差异有统计学意义。
敏感性=3D-US检查真阳性数/真阳性数×100%;特异性=3D-US检查真阴性数/真阴性数×100%;阳性预测值=3D-US检查真阳性数/3D-US检查阳性数×100%;阴性预测值=3D-US检查真阴性数/3D-US检查阴性数×100%。
三维超声断层扫描评估易损斑块的敏感性、特异性、阳性预测值、阴性预测值见表1。结果显示:三维超声断层扫描技术评估斑块性质与病理结果具有较高的一致性。
表1三维超声评估斑块性质的诊断效能
注:3D-US为三维超声;Se(%)为敏感性;Sp(%)为特异性;PPV(%)为阳性预测值;NPV(%)为阴性预测值。
以上所述仅是本发明的优选实施方式,应当指出,对于本技术领域的普通技术人员来说,在不脱离本发明原理的前提下,还可以作出若干改进和润饰,这些改进和润饰也应视为本发明的保护范围。
Claims (1)
1.一种基于三维超声断层技术评估颈动脉斑块性质的方法,其特征在于,包括如下步骤:
S1、采用Philips iU Elite超声诊断仪,获取血管最狭窄处的清晰的三维超声扫描图像;
S2、将所述三维超声扫描图像以DICOM格式输出,脱机进入QLab 10.5工作站,进行三维超声重建和定量分析,以纵断面定位、再以间隔3mm层厚对粥样斑块进行横断面观察,同时观察颈动脉粥样斑块每个层面的形态学及斑块回声等并记录,用截面积法定量评估颈内动脉狭窄的程度,取三次测量结果的平均值进行计算;
S3、进入三维超声图像分析程序:选择待分析病例的“DICOMDIR”索引文件,进入“分析方式”-“GI3DQ”-“iSlice智能容积断层模式”,可同时显示任一个MPR平面的多层平行图像,也可选择所需要的层厚对粥样斑块进行多层面分析。
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Cited By (4)
Publication number | Priority date | Publication date | Assignee | Title |
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CN111265252A (zh) * | 2020-02-25 | 2020-06-12 | 上海市同仁医院 | 一种评估动脉粥样硬化斑块稳定性的方法 |
CN112215836A (zh) * | 2020-10-22 | 2021-01-12 | 深圳市第二人民医院(深圳市转化医学研究院) | 基于医学超声图像的颈动脉斑块检测方法及装置 |
CN113456106A (zh) * | 2021-08-03 | 2021-10-01 | 无锡祥生医疗科技股份有限公司 | 颈动脉扫查方法、装置和计算机可读存储介质 |
CN113499099A (zh) * | 2021-07-21 | 2021-10-15 | 上海市同仁医院 | 一种颈动脉超声自动扫查及斑块识别***及方法 |
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- 2018-06-22 CN CN201810653267.9A patent/CN108742707A/zh active Pending
Cited By (5)
Publication number | Priority date | Publication date | Assignee | Title |
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CN111265252A (zh) * | 2020-02-25 | 2020-06-12 | 上海市同仁医院 | 一种评估动脉粥样硬化斑块稳定性的方法 |
CN112215836A (zh) * | 2020-10-22 | 2021-01-12 | 深圳市第二人民医院(深圳市转化医学研究院) | 基于医学超声图像的颈动脉斑块检测方法及装置 |
CN113499099A (zh) * | 2021-07-21 | 2021-10-15 | 上海市同仁医院 | 一种颈动脉超声自动扫查及斑块识别***及方法 |
CN113456106A (zh) * | 2021-08-03 | 2021-10-01 | 无锡祥生医疗科技股份有限公司 | 颈动脉扫查方法、装置和计算机可读存储介质 |
CN113456106B (zh) * | 2021-08-03 | 2023-11-21 | 无锡祥生医疗科技股份有限公司 | 颈动脉扫查方法、装置和计算机可读存储介质 |
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