■易损颈动脉斑块与缺血性卒中密切相关。超声造影(CEUS)和高分辨率磁共振成像(HR-MRI)是能够评估颈动脉斑块易损性的两种成像方式。这项系统评价旨在比较CEUS和HR-MRI在评估组织学定义的易损颈动脉斑块中的诊断性能。
■在PubMed上进行了具有预定义搜索词的系统文献检索,科克伦图书馆,Embase,和WebofScience从2001年1月到2023年12月。包括评估通过CEUS和/或HR-MRI组织学证实的易损颈动脉斑块的诊断准确性的研究。使用随机效应荟萃分析计算合并值以确定诊断能力。
■本分析共纳入20项研究的839名患者,包括1,357个HR-MRI斑块和504个CEUS斑块。参照组织学结果,所有9项CEUS研究都集中在检测斑块内新生血管(IPN),三项研究还检查了形态变化或溃疡斑块;同时,在HR-MRI研究中,7个主要集中于确定斑块内出血(IPH),3个主要检查富含脂质的坏死核心(LRNCs).汇集的敏感性,特异性,正似然比,负似然比,诊断赔率比,CEUS研究的曲线下面积(AUC)为0.85[95%置信区间(CI):0.81-0.89],0.76(95%CI:0.69-0.83),3.41(95%CI:1.68-6.94),0.14(95%CI:0.05-0.38),27.68(95%CI:5.78-132.62),和0.89[标准误差(SE)0.06],分别;对于HR-MRI,这些值为0.88(95%CI:0.85-0.90),0.89(95%CI:0.86-0.92),7.49(95%CI:3.28-17.09),0.17(95%CI:0.12-0.24),49.13(95%CI:23.87-101.11),和0.94(SE0.01),分别。两种模式之间的AUC差异无统计学意义(Z=0.82;P=0.68)。
■CEUS和HR-MRI是有价值的非侵入性诊断工具,可用于识别经组织学证实的易损颈动脉斑块,并具有相似的诊断性能。CEUS更能够检测IPN和形态变化,而HR-MRI更适合对IPH和LRNCs进行分类。
UNASSIGNED: Vulnerable carotid
plaque is closely associated with ischemic stroke. Contrast-enhanced ultrasound (CEUS) and high-resolution magnetic resonance imaging (HR-MRI) are two imaging modalities capable of assessing the vulnerability of carotid plaques. This systematic review aimed to compare the diagnostic performance of CEUS and HR-MRI in the evaluation of histologically defined vulnerable carotid plaques.
UNASSIGNED: A systematic literature search with predefined search terms was performed on PubMed, the Cochrane library, Embase, and Web of Science from January 2001 to December 2023. Studies that evaluated the diagnostic accuracy of vulnerable carotid plaques confirmed by histology with CEUS and/or HR-MRI were included. The pooled values were calculated using a random-effects meta-analysis to determine diagnostic power.
UNASSIGNED: This analysis included a total of 839 patients from 20 studies comprising 1,357 HR-MRI plaques and CEUS 504 plaques. With the reference to histological results, all nine CEUS studies focused on the detection of intraplaque neovascularization (IPN), and three studies also examined morphological changes or ulcerated plaques; meanwhile, among the HR-MRI studies, seven predominantly focused on identifying intraplaque hemorrhage (IPH) and three mainly examined lipid-rich necrotic cores (LRNCs). The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and the area under the curve (AUC) for CEUS studies were 0.85 [95% confidence interval (CI): 0.81-0.89], 0.76 (95% CI: 0.69-0.83), 3.41 (95% CI: 1.68-6.94), 0.14 (95% CI: 0.05-0.38), 27.68 (95% CI: 5.78-132.62), and 0.89 [standard error (SE) 0.06], respectively; for HR-MRI, these values were 0.88 (95% CI: 0.85-0.90), 0.89 (95% CI: 0.86-0.92), 7.49 (95% CI: 3.28-17.09), 0.17 (95% CI: 0.12-0.24), 49.13 (95% CI: 23.87-101.11), and 0.94 (SE 0.01), respectively. The difference in AUC between the two modalities was not statistically significant (Z=0.82; P=0.68).
UNASSIGNED: CEUS and HR-MRI are valuable noninvasive diagnostic tools for identifying histologically confirmed vulnerable carotid plaques and demonstrate similar diagnostic performance. CEUS is more capable of detecting IPN and morphological changes, while HR-MRI is more suited to classifying IPH and LRNCs.