Diagnostic accuracy of carotid plaque instability by noninvasive imaging: a systematic review and meta-analysis

被引:2
作者
Pakizer, David [1 ]
Kozel, Jiri [1 ]
Taffe, Patrick [2 ]
Elmers, Jolanda [3 ,4 ]
Feber, Janusz [1 ,5 ]
Michel, Patrik [6 ]
Skoloudik, David [1 ]
Sirimarco, Gaia [6 ,7 ]
机构
[1] Univ Ostrava, Fac Med, Ctr Hlth Res, Dept Clin Neurosci, Syllabova 19, Ostrava 70300, Czech Republic
[2] Univ Lausanne, Ctr Primary Care & Publ Hlth, Div Biostat, Route Corn 10, CH-1010 Lausanne, Switzerland
[3] Lausanne Univ Hosp, Med Lib, Rue Bugnon 46, CH-1011 Lausanne, Switzerland
[4] Univ Lausanne, Rue Bugnon 46, CH-1011 Lausanne, Switzerland
[5] Univ Ottawa, Childrens Hosp Eastern Ontario, Dept Pediat, Div Nephrol, 401 Smyth Rd, Ottawa, ON K1H 8L1, Canada
[6] Lausanne Univ Hosp, Dept Clin Neurosci, Serv Neurol, Stroke Ctr, Rue Bugnon 46, CH-1011 Lausanne, Switzerland
[7] Riviera Chablais Hosp, Dept Internal Med, Neurol Unit, Route Vieux Sequoia 20, CH-1847 Rennaz, Switzerland
关键词
computed tomography; magnetic resonance imaging; ultrasound; carotid atherosclerosis; plaque instability; ATHEROSCLEROTIC PLAQUE; INTRAPLAQUE HEMORRHAGE; COMPUTED-TOMOGRAPHY; ARTERY STENOSIS; RISK; ULTRASOUND; VULNERABILITY; IDENTIFY; RUPTURE; DISEASE;
D O I
10.1093/ehjci/jeae144
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims There is increasing evidence that plaque instability in the extracranial carotid artery may lead to an increased stroke risk independently of the degree of stenosis. We aimed to determine diagnostic accuracy of vulnerable and stable plaque using noninvasive imaging modalities when compared to histology in patients with symptomatic and asymptomatic carotid atherosclerosis. Methods and results Medline Ovid, Embase, Cochrane Library, and Web of Science were searched for diagnostic accuracy of noninvasive imaging modalities (CT, MRI, US) in the detection of 1) vulnerable/stable plaque, and 2) vulnerable/stable plaque characteristics, compared to histology. The quality of included studies was assessed by QUADAS-2 and univariate and bivariate random-effect meta-analyses were performed. We included 36 vulnerable and 5 stable plaque studies in the meta-analysis, and out of 211 plaque characteristics from remaining studies, we classified 169 as vulnerable and 42 as stable characteristics (28 CT, 120 MRI, 104 US characteristics). We found that MRI had high accuracy [90% (95% CI: 82-95%)] in the detection of vulnerable plaque, similar to CT [86% (95% CI: 76-92%); P > 0.05], whereas US showed less accuracy [80% (95% CI: 75-84%); P = 0.013]. CT showed high diagnostic accuracy in visualizing characteristics of vulnerable or stable plaques (89% and 90%) similar to MRI (86% and 89%; P > 0.05); however, US had lower accuracy (77%, P < 0.001 and 82%, P > 0.05). Conclusion CT and MRI have a similar, high performance in detecting vulnerable carotid plaques, whereas US showed significantly less diagnostic accuracy. Moreover, MRI visualized all vulnerable plaque characteristics allowing for a better stroke risk assessment.
引用
收藏
页码:1325 / 1335
页数:11
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