IgG4-positive Hashimoto’s thyroiditis (IgG4-HT) is an aggressive HT subtype that may be misdiagnosed as primary thyroid lymphoma (PTL) due to overlapping clinical and imaging features. This study aimed to evaluate the utility of ultrasound for non-invasive differentiation between IgG4-HT and PTL. Data from 13 IgG4-HT and 19 PTL patients (all pathology-proven) were retrospectively collected. Clinical characteristics, laboratory findings, and sonographic features were compared between the two groups. IgG4-HT patients were younger than PTL patients (40.31 ± 11.38 vs. 69.00 ± 10.25 years, P < 0.001). No significant differences in sex distribution, compressive symptoms, or thyroid function were found. On ultrasound, PTL showed larger anterior-posterior thyroid diameters (left lobe: 3.00 ± 1.29 cm vs. 1.65 ± 0.32 cm, P < 0.001; right lobe: 3.19 ± 1.24 cm vs. 1.62 ± 0.44 cm, P < 0.001), more frequent linear hyperechoic areas (89.5

OBJECTIVES:To investigate the value of intraoperative conventional and contrast-enhanced ultrasound in the surgical resection of brain metastases (BMs). METHODS:A total of 46 patients with solitary tumors were enrolled. Intraoperative conventional ultrasound was performed to locate the tumors and observe the size, echo characteristics, position, depth, and degree of peritumoral edema of BMs and compare them with the findings from preoperative magnetic resonance imaging (MRI). Contrast-enhanced ultrasound was performed on 7 BMs with unclear borders to observe the borders and perfusion pattern. Completeness of tumor resection was assessed by ultrasound and compared with the assessment from postoperative MRI. RESULTS:All BMs were detected by intraoperative conventional ultrasound. Although BMs had various ultrasonic manifestations, most of them had clear boundaries (32/46, 69.6%), severe peritumoral edema (33/46, 71.7%), and a rich blood supply (35/46, 76.1%). There was no significant difference in assessing tumor size and peritumoral edema between intraoperative conventional ultrasound and preoperative MRI (P = .121 and 1.000, respectively). BMs exhibited a rapidly inhomogeneous high enhancement and a delayed wash-out in enhancement compared with surrounding tissues on contrast-enhanced ultrasound. All the BMs had complete resection as assessed by intraoperative conventional ultrasound, which was confirmed by the postoperative MRI. CONCLUSIONS:BMs have some certain characteristics on both conventional and contrast-enhanced ultrasound. Intraoperative conventional ultrasound plays a useful role in real-time navigation and assessing the completeness of tumor resection for neurosurgeons. In addition, contrast-enhanced ultrasound is helpful in recognizing the tumor borders when the distinction between BMs and surrounding tissues is unclear.

OBJECTIVE:This retrospective study involving a large dataset of unilateral multifocal papillary thyroid carcinoma (UM-PTC) sought to identify factors that predict central lymph node metastases (CLNM) in patients. METHODS:We identified a cohort of 158 patients who underwent cervical ultrasonography followed by UM-PTC diagnosis based on postoperative pathology. The relationship between CLNM and UM-PTC clinical ultrasound features was evaluated using univariate and multivariate analyses. Receiver operating characteristic (ROC) curve analysis was used to determine the ability of total tumor diameter (TTD) to predict CLNM. RESULTS:Among the 158 UM-PTC patients, the incidence of CLNM was 29.7% (47/158). Univariate and multivariate analyses revealed that a number of similarity of sonographic features (NSSF) ≥4 (odds ratio [OR] = 11.335, 95% confidence interval [CI]: 3.95-32.50, p = 0.000), microcalcifications (OR = 3.54, 95% CI: 1.30-9.70, p = 0.014), a TTD of ≥2 cm (OR = 4.48, 95% CI: 1.62-12.34, p = 0.004), number of nodules ≥3 (OR = 13.17, 95% CI: 3.24-53.52, p = 0.000), and Lateral cervical lymph node metastasis (LLNM) (OR = 5.57, 95% CI: 1.59-19.48, p = 0.007) were independently associated with CLNM in UM-PTC. ROC curve analysis revealed that the TTD cut-off of 1.795 cm had a sensitivity of 0.723 and a specificity of 0.676 for predicting CLNM. CONCLUSIONS:Patients with UM-PTC are at high risk of CLNM. NSSF ≥4, microcalcifications, TTD of ≥2 cm, LLNM, and a number of nodules ≥3 were independently associated with CLNM. Our data show that ultrasound may guide surgical decisions in the treatment of UM-PTC.

AbstractBackgroundCarotid vulnerable plaque is an important risk factor for stroke occurrence and recurrence. However, the relationship between risk parameters related to carotid vulnerable plaque (plaque size, echogenicity, intraplaque neovascularization, and plaque stiffness) and neurological outcome after ischemic stroke or TIA is unclear. This study investigates the value of multimodal ultrasound-based carotid plaque risk biomarkers to predict poor short-term functional outcome after ischemic stroke or TIA.MethodsThis study was a single-center, prospective, continuous, cohort study to observe the occurrence of adverse functional outcomes (mRS 2–6/3–6) 90 days after ischemic stroke or TIA in patients, where the exposure factors in this study were carotid plaque ultrasound risk biomarkers and the risk factors were sex, age, disease history, and medication history. Patients with ischemic stroke or TIA (mRS ≤3) whose ipsilateral internal carotid artery stenosis was ≥50% within 30 days were included. All patients underwent multimodal ultrasound at baseline, including conventional ultrasound, superb microvascular imaging (SMI), and shear wave elastography (SWE). Continuous variables were divided into four groups at interquartile spacing for inclusion in univariate and multifactorial analyses. After completion of a baseline ultrasound, all patients were followed up at 90 days after ultrasound, and patient modified neurological function scores (mRSs) were recorded. Multivariate Cox regression and ROC curves were used to assess the risk factors and predictive power for predicting poor neurological function.ResultsSMI revealed that 20 (30.8%) patients showed extensive neovascularization in the carotid plaque, and 45 (69.2%) patients showed limited neovascularization in the carotid plaque. SWE imaging showed that the mean carotid plaque stiffness was 51.49 ± 18.34 kPa (23.19–111.39 kPa). After a mean follow-up of 90 ± 14 days, a total of 21 (32.3%) patients had a mRS of 2–6, and a total of 10 (15.4%) patients had a mRS of 3–6. Cox regression analysis showed that the level of intraplaque neovascularization and plaque stiffness were independent risk factors for a mRS of 2–6, and the level of intraplaque neovascularization was an independent risk factor for a mRS of 3–6. After correcting for confounders, the HR of intraplaque neovascularization level and plaque stiffness predicting a mRS 2–6 was 3.06 (95% CI 1.05–12.59,P = 0.041) and 0.51 (95% CI 0.31–0.83,P = 0.007), respectively; the HR of intraplaque neovascularization level predicting a mRS 3–6 was 6.11 (95% CI 1.19–31.45,P = 0.031). For ROC curve analysis, the mRSs for intraplaque neovascularization level, plaque stiffness, and combined application to predict 90-day neurological outcome ranged from 2 to 6, with AUCs of 0.73 (95% CI 0.59–0.87), 0.76 (95% CI 0.64–0.89) and 0.85 (95% CI 0.76–0.95), respectively. The mRSs for the intraplaque neovascularization level to predict 90-day neurological outcome ranged from 3 to 6, with AUCs of 0.79 (95% CI 0.63–0.95).ConclusionIntraplaque neovascularization level and plaque stiffness may be associated with an increased risk of poor short-term functional outcome after stroke in patients with recent anterior circulation ischemic stroke due to carotid atherosclerosis. The combined application of multiple parameters has efficacy in predicting poor short-term functional outcome after stroke.

Abstract Background Moyamoya disease can lead to stroke with devastating consequences, it is necessary to find a non-invasive and effective approach to identify the occurrence of stroke. In this study, we aim to analyze the association between ultrasound parameters and ipsilateral cerebral hemisphere stroke in patients with moyamoya disease by logistic regression analysis. Methods In this retrospective case–control study, 88 patients with MMD (153 cerebral hemispheres) hospitalized in Beijing Tiantan Hospital, Capital Medical University from November 2020 to October 2021 were analyzed. According to the occurrence of stroke, the 153 cerebral hemispheres were divided into a stroke group and a non-stroke group. Clinical data and ultrasound parameters of the ipsilateral internal carotid artery, superficial temporal artery, maxillary artery, and posterior cerebral artery were recorded. The ultrasound parameters were divided into four groups according to interquartile range, and then they were compared between the stroke group and the non-stroke group. Those with significant differences were scored by multivariate logistic regression analysis. Results There were 75 cerebral hemispheres (49.0%) in the stroke group and 78 cerebral hemispheres (51.0%) in the non-stroke group. Logistic regression analysis showed that the internal diameter of the internal carotid artery, peak systolic velocity of the internal carotid artery and peak systolic velocity of the posterior cerebral artery were independently correlated factors for stroke in patients with MMD. The fourth quartile group of the above three ultrasound parameters was taken as the reference group, and the odds ratio of the first quartile group were 11.679 (95% CI 2.918–46.749, P = 0.001), 19.594 (95% CI 4.973–77.193, P < 0.001), and 11.657 (95% CI 3.221–42.186, P < 0.001), respectively. Conclusion Ultrasound parameters are independently correlated with ipsilateral cerebral stroke in patients with MMD. Ultrasound provides a new way to identify stroke in MMD patients. Future prospective cohort studies are needed to verify the clinical value of ultrasound in identifying patients with MMD at high risk of stroke.

Background Coronary slow flow phenomenon (CSFP) is not uncommon in conventional coronary angiography. A disorder of serum homocysteine (tHcy) metabolism may play a role in the pathogenesis of slow coronary flow. Moreover, elevated tHcy concentration is closely associated with atherosclerosis. We aimed to evaluate the relationship between carotid artery stiffness and serum tHcy levels in patients with CSFP. Methods This was a case-control study. The study population comprised 146 patients with newly diagnosed stable angina, including 73 patients with CSFP and 73 patients with normal coronary flow. All participants underwent conventional coronary angiography, carotid ultrasonography, and biochemical examination. Results The carotid artery stiffness parameters of β index (β), pressure-strain elastic modulus (Ep), and local pulse wave velocity (PWV) in the CSFP group were significantly higher than those in the control group (β: 10.75±2.16 vs. 9.02±2.11, P=0.007; Ep: 147.41±41.22 vs. 116.21±39.21, P=0.004; PWV: 7.45±1.23 vs. 6.16±1.20, P=0.003), However, arterial compliance (AC) was lower in the CSFP group than the control group (0.52±0.11 vs. 0.69±0.24, P=0.008). The mean thrombolysis in myocardial infarction (TIMI) frame count and the tHcy concentration in the CSFP group were significantly higher than those in the control group (48.60±1.30 vs. 24.50±3.80, P=0.001; 19.95±4.00 vs. 9.12±2.72, P=0.009). The tHcy concentration was positively correlated with β (R value =0.494, P<0.0001), Ep (R value =0.469, P<0.0001), and PWV (R value =0.436, P<0.0001), but negatively correlated with AC (R value =-0.230, P=0.022). The predictors of CSFP were tHcy concentration, left PWV, right PWV, left β index, and right β index. Among them, the left β index and right β index were the best indictors for predicting CSFP. The cutoff values of left β index, right β index, left PWV, and right PWV were 9.3, 9.3, 6.7, and 6.6, respectively. Conclusions Our data showed that serum tHcy levels were elevated in patients with CSFP compared with the control group. Carotid artery stiffness parameters were correlated with tHcy. The best predictors of CSFP were left β index and right β index. These findings may contribute to a better understanding of systemic vascular disorders in patients with coronary slow flow, rather than simply attributing such disorders to a single and isolated lesion of the epicardial coronary artery.

患者女,29岁,两年前间断出现呃逆症状,食欲差,体质量减轻1年,3个月前无明显诱因出现头痛,伴恶心、呕吐,偶有走路左侧偏斜1个月.头颅MRI检查:后颅窝多发占位,考虑多发血管母细胞瘤(图1).行后颅窝肿瘤切除术,先行枕下后正中切口,见肿瘤位于延髓背侧,与小脑蚓部、小脑扁桃体粘连紧密,术中肿瘤切除完成并彻底止血后,患者突发颅内压增高、急性脑膨出.随即使用术中超声进行实时探查,超声所见:幕上区域左侧额颞叶骨板下方见一梭形高回声区,距后颅窝骨窗深约6.0 cm,范围约1.8 cm×5.5 cm,边界清,形态规则;CDFI未探及明显血流信号(图2A).15 min后再次行超声检查:梭形高回声区面积增大,范围约4.1 cm×7.2 cm,性质同前(图2B);提示病变为位于左侧额颞叶的硬膜外血肿.于超声监测下清除部分血肿,左侧额颞叶血肿较前缩小,范围约1.8 cm×6.5 cm(图2C).因残余血肿位置较深,行额颞开路进一步清除血肿,铣额颞骨瓣行硬膜外血肿清除并骨瓣复位.术后患者CT检查示左侧颞顶叶血肿部位未见明显异常(图2D),生命体征正常.

OBJECTIVES:To identify the ultrasonographic characteristics of primary squamous cell carcinoma of the thyroid (PSCCT), and to assess the value of the 2015 American Thyroid Association (ATA) guideline and 2017 American College of Radiology (ACR) Thyroid Imaging, Reporting and Data System (TI-RADS) in the evaluation of this disease.METHODS:Eight patients with 9 PSCCTs over a 20-year study period were enrolled. Ultrasonic characteristics including nodule echogenicity, composition, shape, margin, calcification, size, vascularity, and cervical lymphadenopathy were reviewed. All nodules were then evaluated by 2017 ACR TI-RADS and 2015 ATA guidelines.RESULTS:The average size of PSCCTs was 3.87 ± 1.41 cm. All PSCCTs were hypoechoic or very hypoechoic, solid nodules with intranodular vascularity. The average resistive index (RI) was 0.84 ± 0.18. Near half of PSCCTs (44.4%) demonstrated extrathyroidal extension. Taller-than-wide signs and cervical lymphadenopathy were observed in 33.3% of PSCCTs, and microcalcification was observed in 11.1% of them. All PSCCTs were classified as high suspicion patterns by 2015 ATA and recommended for fine-needle aspiration (FNA). Six PSCCTs (66.7%) were classified as grade 5 by 2017 ACR TI-RADS, while the remaining were grade 4. 88.9% of PSCCTs were recommended for FNA based on 2017 ACR TI-RADS.CONCLUSION:PSCCT has certain ultrasonic features, including relatively large, hypoechoic, or very hypoechoic solid nodules with intranodular vascularity and extrathyroidal extension. Both 2015 ATA and 2017 ACR TI-RADS could identify PSCCT as suspicious for malignancy.

BACKGROUND:To develop an ultrasound-derived stroke risk (USR) score combining plaque stiffness, surface morphology and lumen narrowing to evaluate the risk of stroke in patients with asymptotic carotid stenosis. METHODS:We developed the USR score in a prospective study of symptomatic and asymptomatic patients with ipsilateral carotid lumen narrowing. Multivariable analysis was performed to identify parameters associated with ischemic events, and a USR score was constructed based on the observed β coefficient. The discrimination performance of the USR score was assessed using receiver operating characteristic (ROC) curves. Twenty iterations of 5-fold cross-validation were used for internal validation. RESULTS:We derived the USR score (range, 0-7) by incorporating plaque stiffness (≥80 kPa, 0 points; 60-79 kPa, 1 point; 40-59 kPa, 2 points; <40 kPa, 3 points), plaque surface (smooth, 0 points; irregular, 1 point; ulcer, 2 points) and carotid stenosis (<50%, 0 points; 50-69%, 1 point; ≥70%, 2 points). After adjusting for age and sex, the odds ratio (OR) for every 1-point increase in the USR score increase was 3.3 (P<0.001). The risk of ischemic events increased with increasing USR score (P for trend <0.001). The C statistic of the USR score was 0.84 in the derivation sample and 0.82 in the validation sample. CONCLUSIONS:The USR score to assess the risk of ischemic events in patients with carotid stenosis showed preferable discrimination ability and robustness. While external validation is warranted to prove the predictive value, this risk score could help accelerate triage decisions in similar patient populations.

Background Risk stratification of asymptomatic carotid plaque remains an issue in stroke prevention in clinical practice. Purpose To investigate whether a multimodal ultrasound (MMU) model would help plaque risk stratification in patients with asymptomatic carotid stenosis. Material and Methods A prospective study was conducted of symptomatic and asymptomatic patients with > 50% proximal internal carotid artery (ICA) stenosis. All patients underwent MMU examination. Multivariable regression analyses were performed to identify parameters associated with ischemic vascular events (IVE). These parameters were used to develop a scoring nomogram to assess the probability of IVE. We elaborated the diagnostic performance of the MMU nomogram using receiver operating characteristic (ROC) curves. Results From December 2018 to December 2019, 98 patients (75 men, mean age 67 ± 8 years) were included; 50 were symptomatic and 48 were asymptomatic. Multivariable regression analyses revealed that plaque surface morphology (PSM) (odds ratio [OR] 2.99, 95% confidence interval [CI] 1.26–7.12, P = 0.013), intraplaque neovascularization (IPN) grades (OR 3.23, 95% CI 1.77–5.89, P<0.001), and carotid stenosis degree (CSD) (OR 4.12, 95% CI 1.47–11.55, P = 0.007) were independently associated with IVE. For the nomogram, the area under the ROC curve was 0.85 (95% CI 0.77–0.92) and the Hosmer-Lemeshow test P value was 0.822. Conclusions In patients with proximal ICA > 50%, PSM, IPN grades, and CSD were independent variables associated with IVE. The MMU nomogram provided favorable value to risk stratification of IVE. Future large-scale studies with long-term follow-up are needed to validate these findings.

Background Advanced carotid ultrasound techniques may be useful in characterizing plaque vulnerability, but comprehensive studies are still lacking. The aim of this study was to identify factors associated with vulnerable plaques using advanced ultrasound techniques. Methods This is a prospective observational study of patients with >50% internal carotid stenosis (ICA). All patients underwent conventional ultrasound, superb microvascular imaging (SMI) and shear wave elastography (SWE) examinations. Plaque size, echogenicity, stiffness and intraplaque neovascularization (IPN) were assessed and compared between symptomatic and asymptomatic groups. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of SWE and SMI of the vulnerable plaques. Results The final analysis included 123 patients (78.9% male; mean age, 66±8 years), 65 were enrolled in the symptomatic group, and 58 were enrolled in the asymptomatic group. The mean elasticity was 78.1±25.4 kPa for asymptomatic and 51.5±18.3 kPa for symptomatic plaques. Symptomatic plaques showed higher visual IPN grades on SMI than asymptomatic plaques (P<0.001). Multivariate regression analysis showed that plaque stiffness (PS) (OR 0.95, 95% CI, 0.919-0.974) and IPN level (OR 4.17, 95% CI, 2.008-8.664) were independently associated with symptomatic plaques. The combination of the two factors had a preferable accuracy to discriminate symptomatic plaques (AUC 0.89, 95% CI, 0.827-0.944). Conclusions Advanced carotid ultrasound techniques can identify plaque characteristics that are associated with ischemic events and may be potentially indicative of plaque vulnerability. These factors may ultimately be used in the clinical management of carotid stenosis.

Background To evaluate the value of intraoperative B-mode ultrasound and shear wave elastography (SWE) in differentiating low-grade and high-grade gliomas. Methods A total of 172 patients with glioma were examined by B-mode ultrasound to obtain a tumor sonogram. Intraoperative SWE was performed on 52 patients to obtain Young's modulus values of peritumor tissue and tumor tissue, and the differences in conventional B-mode signs and Young's modulus values of gliomas of different grades were then compared. The diagnostic performance of SWE in glioma grading was assessed by receiver operating characteristic (ROC) curve analysis, and the intra- and interobserver reliability of SWE was analyzed by the intraclass correlation coefficient (ICC). Results For B-mode ultrasound, patient age, cystic degeneration, and peritumor edema were independent risk factors for high-grade glioma (P<0.05, OR >1). For SWE, Young's modulus values of peritumor tissue, low-grade glioma, and high-grade glioma tissues were 8.20 (7.50, 9.70) kPa, 19.65 (15.30, 24.75) kPa, and 9.55 (8.50, 13.80) kPa, respectively. The area under the ROC curve for the diagnosis of high-grade glioma by SWE was 0.859 (95% CI: 0.758-0.961, P<0.05), and the optimal cutoff value was 12.1 kPa, with 89.3% sensitivity and 75.0% specificity. The intra- and interobserver reliability of SWE in grading gliomas was excellent, with ICCs ranging from 0.921 to 0.965. Conclusions High-grade glioma is associated with significantly more severe necrotic cystic degeneration and peritumoral edema on B-mode ultrasound and lower stiffness on SWE. Further, SWE exhibits excellent intra- and interobserver reliability. Intraoperative B-mode ultrasound combined with SWE helps differentiate different grades of gliomas.

目的:探讨实时剪切波弹性成像技术评价脑胶质瘤的可行性.方法:选取2018年12月—2019年3月在我院进行脑胶质瘤颅脑手术患者15例,对其行常规超声及实时剪切波弹性成像检查,测量正常脑组织及胶质瘤的杨氏模量值,观察其剪切波弹性成像特点.结果:在硬脑膜剪开前,胶质瘤的杨氏模量值高于周边正常脑组织,胶质瘤的杨氏模量最大值及平均值分别为(39.56±16.02)kPa、(19.88±7.73)kPa,正常脑组织的杨氏模量最大值及平均值分别为(17.43±3.58)kPa、(10.51±2.09)kPa,两者间差异有统计学意义.剪开硬脑膜后,进行剪切波弹性成像检查显示脑胶质瘤及周边正常脑组织的杨氏模量值均减小,胶质瘤的杨氏模量最大值及平均值分别为(28.01±8.66)kPa、(14.98±5.46)kPa,正常脑组织的杨氏模量最大值及平均值分别为(14.51±3.05)kPa、(8.66±1.23)kPa,两者间差异有统计学意义.低级别胶质瘤杨氏模量平均值较高级别胶质瘤杨氏模量平均值高(硬脑膜剪开前(25.03±8.45)kPa vs(15.38±2.93)kPa;硬脑膜剪开后(19.24±5.13)kPa vs(11.27±1.76)kPa),差异有统计学意义.结论:实时剪切波弹性成像可以对脑胶质瘤的弹性情况进行评价,硬脑膜剪开后测量效果更好.

一、临床资料 患儿男性,5 岁,5 d 前被枪击伤左侧头部,铅质子弹留滞颅内,伴有右侧上肢麻木,无四肢运动障碍,无意识丧失,CT检查提示:左侧顶叶异物(图1),蛛网膜下腔出血,左侧颅骨骨折.予以破伤风疫苗及抗生素预防感染.查体神志清,双眼视力、视野未见明显异常,眼球活动正常,双瞳等大等圆,四肢肌力Ⅴ级,肌张力未见明显异常,双侧肢体无感觉异常,生理反射存在,病理反射未引出;左顶部头皮挫裂伤,直径0.5～1.0 cm,无异常渗出物.

INTRODUCTION:Transcranial color-coded duplex sonography (TCCS) with and without ultrasound contrast agent has been used to diagnose cerebral venous thrombosis, however, no experience in the diagnosis of patients with cerebral venous thrombosis and with dural arteriovenous fistula (dAVF) by contrast-enhanced TCCS has been reported yet.CASE REPORT:The authors reported a 49-year-old male patient with straight sinus (StS) thrombosis and dAVF. Plain TCCS and contrast-enhanced TCCS demonstrated the direct presentation of the selected feeder and drainage veins of the dAVFs, arterialized venous flow waveform, and an enlarged optic nerve sheath diameter, indicating an increased intracranial pressure, and a filling defect in the StS even after administration of an ultrasound contrast agent. After intravascular thrombolysis and blockage of 2 feeders of the dAVF, TCCS still showed retrograde flow direction in the left basal vein and significantly elevated flow velocity in the StS, reflecting a high venous pressure caused by a high volume of arteriovenous shunt and severe stenosis in the StS. The patient's clinical manifestation did not substantially improve until 3 stents were implanted in the StS, and TCCS unveiled that the stents were well filled with flow signal, and the flow velocity in the StS dramatically decreased.CONCLUSIONS:TCCS could provide reliable data about the feeder and drainage veins of dAVF in our case. The extent of an increase in venous flow velocity may be closely associated with clinical manifestations, which may influence therapy. Moreover, TCCS possesses a unique advantage in terms of evaluating the patency of the stents compared with other neuroimaging techniques.

Objective:To analyze the ultrasound examination and computed tomography angiography (CTA) features of carotid web(CAW), and compare with the pathology after carotid endarterectomy, and then compare diagnostic efficacies of the two methods.Methods:From June 2018 to July 2019, 159 patients underwent carotid endarterectomy(CEA) in Beijing Tian Tan Hospital were collected, ultrasound examination and CTA were performed preoperatively. The presence or absence of CAW and whether there were thrombosis or atherosclerotic plaques associated with it were identified. The location length, thickness, direction in the lumen, echo characteristics of CAW, and complicated with or without thrombosis or atherosclerotic plaques were recorded. The postoperative specimens were observed, and the pathological analysis was performed.Results:Among the 159 cases of CEA, 22 cases were confirmed to have CAW structure by pathology, and HE staining showed extensive intimal fibrohyperplasia and mucoid degeneration, among which 18 cases had plaque formation at the bottom of the carotid web, and 4 cases associated with thrombosis. There were 17 cases of CAW structure diagnosed by ultrasound, 5 cases were misdiagnosed or missed, the sensitivity and specificity of ultrasound in the diagnosis of CAW were 77% (17/22) and 98% (135/137), and the accuracy was 75%. Eleven cases of CAW were diagnosed by preoperative CTA, and 11 cases were misdiagnosed and missed diagnosis, the sensitivity and specificity of CTA in the diagnosis of CAW were 50%(11/22) and 97%(134/137), and the accuracy was 47%.Conclusions:The sensitivity of ultrasound in the diagnosis of CAW is higher than that of CTA, which can better display the structure of CAW and whether it is associated with plaque or thrombosis.

This study aimed to determine the detection rate of transcranial color-coded sonography (TCCS) of cerebral veins and sinuses and to explore the diagnostic accuracy of TCCS for straight sinus (SS) and transverse sinus (TS) thromboses. The detection rates of cerebral veins and sinuses using TCCS and contrast-enhanced TCCS (CE-TCCS) were analyzed. The diagnostic accuracy of CE-TCCS was evaluated. Median time from symptoms to CE-TCCS was 10 (range, 1–150) d. The detection rate of bilateral basal veins of Rosenthal was 100% by CE-TCCS, followed by right TS (91.89%), SS (88.12%), left TS (74.59%) and vein of Galen (70.27%). Compared with magnetic resonance imaging/magnetic resonance venography, CE-TCCS showed 100% sensitivity and 96.3% specificity for SS thrombosis, 100% and 100% for right TS thrombosis and 100% and 94.4% for left TS thrombosis. In conclusion, CE-TCCS shows high identification rates of cerebral veins and sinuses and a high diagnostic accuracy for SS and TS thrombosis.

目的 探讨经颅彩色编码超声(TCCS)及经颅超声造影(CE-TCCS)诊断颅内静脉窦血栓(CVST)及大脑大静脉、基底静脉的血流动力学变化的价值.方法 选取经DSA和/或MR静脉血管成像(MRV)确诊为颅内横窦和/或直窦血栓的22例患者为CVST组,行TCCS及CE-TCCS;以同期因其他疾病就诊的68例患者为对照组,行TCCS;对比观察2组大脑大静脉、基底静脉及静脉窦的显示率和血流动力学变化.结果 CVST组中,TCCS诊断直窦血栓13例,左侧横窦血栓20例,右侧横窦血栓1 7例,与DSA和/或MRV结果比较差异有统计学意义(P均＜0.05);经CE-TCCS判定直窦血栓5例,左侧横窦血栓14例,右侧横窦血栓9例,与DSA和/或MRV结果比较差异均无统计学意义(P均＞0.05).CVST组较对照组大脑大静脉、双侧基底静脉显示率及峰值血流速度均增高(P均＜0.05).结论 CE TCCS诊断CVST与DSA和/或MRV相似.TCCS可显示静脉窦血栓形成后的大脑大静脉、基底静脉;静脉流速升高可提示CVST形成可能.