Carotid Plaque MRI and Stroke Risk A Systematic Review and Meta-analysis
Carotid Plaque MRI and Stroke Risk A Systematic Review and Meta-analysis
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DOI：
10.1161/strokeaha.113.002551
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发表时间：
2013-11-01
期刊：
影响因子：
8.3
通讯作者：
Sanelli, Pina C.
中科院分区：
文献类型：
--
作者：
Gupta, Ajay;Baradaran, Hediyeh;Sanelli, Pina C.
背景和目的颈动脉斑块的MRI特征作为预测颈动脉粥样硬化引起的卒中的潜在工具，近年来得到了广泛的研究。我们进行了系统的回顾和荟萃分析，总结了MRI确定的斑块内出血，脂质丰富的坏死核心，变薄/破裂的纤维帽与随后的缺血events.Methods的关联，我们进行了全面的文献检索评估的相关性颈动脉斑块组成的MRI与缺血性结局。我们纳入队列研究，检查斑块内出血、富脂坏死核心或纤维帽变薄/破裂，平均随访1个月，并测量同侧卒中或短暂性脑缺血发作的结局。采用随机效应模型进行Meta分析，评估研究异质性和发表偏倚。结果在筛选的3436篇文献中，9篇研究共779例受试者符合系统评价的条件。斑块内出血、富脂坏死核心和纤维帽变薄/破裂作为随后卒中/短暂性脑缺血发作的预测因子的风险比分别为4.59（95%置信区间，2.91-7.24）、3.00（95%置信区间，1.51-5.95）和5.93（95%置信区间，2.65-13.20）。在3个主要的荟萃analysed.Conclusions存在斑块内出血，脂质丰富的坏死核心，和薄/破裂的纤维帽的MRI颈动脉斑块的异质性或出版偏见是没有统计学意义上的未来中风或短暂性脑缺血发作的危险性增加与颈动脉粥样硬化性疾病患者。斑块成分的专用MRI提供了超出颈动脉粥样硬化疾病管腔狭窄测量的卒中风险信息。
Background and Purpose MRI characterization of carotid plaque has been studied recently as a potential tool to predict stroke caused by carotid atherosclerosis. We performed a systematic review and meta-analysis to summarize the association of MRI-determined intraplaque hemorrhage, lipid-rich necrotic core, and thinning/rupture of the fibrous cap with subsequent ischemic events.Methods We performed a comprehensive literature search evaluating the association of carotid plaque composition on MRI with ischemic outcomes. We included cohort studies examining intraplaque hemorrhage, lipid-rich necrotic core, or thinning/rupture of the fibrous cap with mean follow-up of 1 month and an outcome measure of ipsilateral stroke or transient ischemic attack. A meta-analysis using a random-effects model with assessment of study heterogeneity and publication bias was performed.Results Of the 3436 articles screened, 9 studies with a total of 779 subjects met eligibility for systematic review. The hazard ratios for intraplaque hemorrhage, lipid-rich necrotic core, and thinning/rupture of the fibrous cap as predictors of subsequent stroke/transient ischemic attack were 4.59 (95% confidence interval, 2.91-7.24), 3.00 (95% confidence interval, 1.51-5.95), and 5.93 (95% confidence interval, 2.65-13.20), respectively. No statistically significant heterogeneity or publication bias was present in the 3 main meta-analyses performed.Conclusions The presence of intraplaque hemorrhage, lipid-rich necrotic core, and thinning/rupture of the fibrous cap on MRI of carotid plaque is associated with increased risk of future stroke or transient ischemic attack in patients with carotid atherosclerotic disease. Dedicated MRI of plaque composition offers stroke risk information beyond measurement of luminal stenosis in carotid atherosclerotic disease.