Department of Radiology, Mayo Clinic, Rochester, MN, USA -
Department of Medicine, The University of Texas Medical Branch at Galveston, Galveston, TX, USA -
J Neurosurg Sci. 2020 Oct;64(5):480-486. doi: 10.23736/S0390-5616.20.04959-0.
Magnetic resonance imaging (MRI) can characterize carotid plaque features, including intraplaque hemorrhage (IPH), lipid-rich necrotic core (LRNC), and thin/ruptured fibrous cap (TRFC), that have increased tendency to cause future cerebrovascular ischemic events. We performed a systematic review and meta-analysis of studies evaluating association of MRI-identified high-risk plaque features, including IPH, LRNC, and TRFC, with risks of subsequent ischemic events of stroke, transient ischemic attack (TIA), or amaurosis fugax (AF) over follow-up duration of ≥3 months.
Multiple databases were searched for relevant publications between January 2000 and March 2020. Studies reporting outcomes of future ischemic events of stroke, TIA, or AF for individual MRI-identified high-risk carotid plaque features over follow-up duration of ≥3 months were included. Random effects meta-analysis was performed to estimate odds ratios (OR) and 95% confidence intervals (CI) comparing outcomes between MRI-positive and MRI-negative groups.
Fifteen studies including 2350 patients were included. The annual rate of future ischemic events was 11.9% for MRI-positive IPH, 5.4% for LRNC, and 5.7% for TRFC. IPH, LRNC, and TRFC were associated with increased risk of future ischemic events (OR 6.37; 95% CI, 3.96 to 10.24), (OR 4.34; 95% CI, 1.65 to 11.42), and (OR 10.60, 95% CI 3.56 to 31.58), respectively.
The current study findings strengthen the assertion that MRI-positive "high-risk" or "vulnerable" plaque features, including IPH, LRNC, and/or TRFC can predict risks of future ischemic events of stroke, TIA, or AF.
磁共振成像（MRI）可以对颈动脉斑块特征进行分析，包括斑块内出血（IPH）、富含脂质的坏死核心（LRNC）和薄/破裂的纤维帽（TRFC），这些特征增加了未来发生脑血管缺血性事件的风险。我们对评估 MRI 识别的高危斑块特征（包括 IPH、LRNC 和 TRFC）与中风、短暂性脑缺血发作（TIA）或一过性黑矇（AF）的后续缺血事件风险的研究进行了系统评价和荟萃分析，随访时间≥3 个月。
在 2000 年 1 月至 2020 年 3 月期间，我们对多个数据库进行了检索，以寻找与未来缺血事件（中风、TIA 或 AF）相关的研究。纳入了随访时间≥3 个月，对 MRI 识别的高危颈动脉斑块特征与未来缺血事件风险的研究。采用随机效应荟萃分析来估计比较 MRI 阳性组和 MRI 阴性组的优势比（OR）和 95%置信区间（CI）。
纳入了 15 项研究，共 2350 例患者。MRI 阳性 IPH 的未来缺血事件年发生率为 11.9%，LRNC 为 5.4%，TRFC 为 5.7%。IPH、LRNC 和 TRFC 与未来缺血事件的风险增加相关（OR 6.37；95%CI，3.96 至 10.24）、（OR 4.34；95%CI，1.65 至 11.42）和（OR 10.60，95%CI，3.56 至 31.58）。
本研究结果进一步证实，MRI 阳性的“高危”或“易损”斑块特征，包括 IPH、LRNC 和/或 TRFC 可预测中风、TIA 或 AF 的未来缺血事件风险。
