摘要
Abstract
Objective To evaluate the value of high-resolution magnetic resonance vessel wall imaging(HR-VWI)combined with measurements of neuron-specific enolase(NSE)and homocysteine(Hcy)for determining the nature of carotid stenosis plaques and for diagnosis.Methods A total of 186 patients with carotid artery stenosis treated at Puyang Oilfield General Hospital from May 2022 to May 2024 were enrolled and categorized by plaque nature into a stable-plaque group(n=101)and an unstable-plaque group(n=85).All patients underwent preoperative HR-VWI before carotid endarterectomy.Histopathology served as the reference standard to assess the detection rate of HR-VWI for plaques and to evaluate plaque characterization.Serum NSE and Hcy levels were compared between the stable-and unstable-plaque groups.Receiver operating characteristic(ROC)analyses were used to assess the diagnostic performance of HR-VWI alone and in combination with NSE and Hcy.Results Histopathology identified 218 plaques in 186 patients.According to the Stary classification,type Ⅰ～Ⅳ plaques(n=130)were defined as stable and type Ⅵ plaques(n=88)as unstable.HR-VWI detected 209 plaques,yielding an overall detection rate of 95.87％(209/218)relative to pathology.Serum NSE and Hcy levels were lower in the stable-plaque group than in the unstable-plaque group(P＜0.05).ROC analysis showed that HR-VWI achieved an area under the curve(AUC)of 0.798(95％CI,0.741～0.854),with sensitivity 88.24％and specificity 70.24％.NSE yielded an AUC of 0.757(95％CI,0.685～0.829),sensitivity 63.53％,specificity 84.16％,and a cutoff of 15.57 μg/L.Hcy yielded an AUC of 0.632(95％CI,0.548～0.715),sensitivity 35.29％,specificity 95.05％,and a cutoff of 21.94 μmol/L.The combination of HR-VWI,NSE,and Hcy produced an AUC of 0.881(95％CI,0.834～0.927),with sensitivity 92.94％and specificity 71.24％.Conclusions:HR-VWI has important clinical value for characterizing the nature of carotid stenosis plaques.Combining HR-VWI with serum NSE and Hcy measurements improves the diagnostic performance for identifying vulnerable(unstable)plaques.关键词
影像学检查/颈动脉狭窄/高分辨磁共振血管壁成像/斑块性质/诊断价值/病理特征Key words
imaging examination/carotid artery stenosis/high-resolution magnetic resonance vessel wall imaging/plaque characteristics/diagnostic value/pathological features分类
医药卫生
