Department of Ultrasound, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China.
Division of Cardiothoracic Surgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, 02903, USA.
J Ultrasound Med. 2021 Dec;40(12):2629-2638. doi: 10.1002/jum.15652. Epub 2021 Feb 15.
Although superb microvascular imaging (SMI) (Toshiba/Canon, Tokyo, Japan) has enabled routine characterization of intraplaque neovascularization (IPN) features in patients with carotid stenosis, no reports have been published on the multicenter and large sample size research in this aspect. The efficacy of SMI in detecting carotid IPN has not been concluded. This study aimed to assess the efficacy of SMI comparing with contrast-enhanced carotid ultrasonography (CEUS) in the detection of carotid IPN or pathologic evaluations of IPN correlated with a history of stroke or transient ischemic attack (TIA).
Web of Science, Cochrane Library, PubMed, Embase, and Scopus were searched up to August 2020 to identify peer-reviewed human studies on the diagnostic accuracy of SMI in detecting IPN. For the selected study, the correlation coefficient R and Kappa index between SMI and CEUS in detecting IPN were calculated. The correlation coefficient R between SMI in identifying IPN and pathologic evaluations of IPN and the odds ratio of IPN detected by SMI and history of stroke or TIA were also extracted. The subgroup analysis was performed to indicate the source of heterogeneity.
Our search identified 11 reports enrolling a total of 605 carotid stenosis patients. Carotid IPN detected by SMI was significantly correlated with which detected by CEUS (R, 0.89; 95% CI, 0.80-0.94; P = .00, and Kappa index, 0.73; 95% CI, 0.67-0.80; P = .00). Notably, a significant correlation was observed in SMI in detecting IPN and pathologic evaluations of IPN (R, 0.52; 95% CI, 0.40-0.62; P = .00). The odds ratio of IPN detected by SMI and history of stroke or TIA was pooled summary with statistical significance (OR, 3.33; 95% CI, 1.78-6.23; P = .00). In subgroup analysis, lower heterogeneity was associated with the degree of carotid stenosis, patients from which country, and types of equipment.
SMI and CEUS display an excellent agreement in detecting carotid IPN. IPN detected by SMI shows high consistency with pathologic evaluations of IPN. Individuals with carotid IPN are more likely to develop stroke or TIA than those without carotid IPN.
尽管超微血管成像（SMI）（东芝/佳能，东京，日本）能够常规地对颈动脉狭窄患者斑块内新生血管（IPN）特征进行特征描述，但在这方面尚无多中心、大样本量的研究报告。SMI 检测颈动脉 IPN 的效果尚未得出结论。本研究旨在评估 SMI 与对比增强颈动脉超声（CEUS）在检测颈动脉 IPN 或与中风或短暂性脑缺血发作（TIA）病史相关的 IPN 病理评估方面的效果。
截至 2020 年 8 月，通过 Web of Science、Cochrane 图书馆、PubMed、Embase 和 Scopus 搜索，以确定关于 SMI 检测 IPN 的诊断准确性的同行评审人类研究。对于所选研究，计算 SMI 和 CEUS 在检测 IPN 方面的相关系数 R 和 Kappa 指数。还提取了 SMI 在识别 IPN 与 IPN 病理评估之间的相关系数 R，以及 SMI 检测到的 IPN 和中风或 TIA 病史的比值比。进行了亚组分析以指示异质性的来源。
我们的搜索确定了 11 项共纳入 605 例颈动脉狭窄患者的报告。SMI 检测到的颈动脉 IPN 与 CEUS 检测到的 IPN 显著相关（R，0.89；95%CI，0.80-0.94；P=0.00，和 Kappa 指数，0.73；95%CI，0.67-0.80；P=0.00）。值得注意的是，SMI 检测到的 IPN 与 IPN 的病理评估之间存在显著相关性（R，0.52；95%CI，0.40-0.62；P=0.00）。SMI 检测到的 IPN 和中风或 TIA 病史的比值比汇总具有统计学意义（OR，3.33；95%CI，1.78-6.23；P=0.00）。在亚组分析中，与颈动脉狭窄程度、患者所在国家和设备类型相关的异质性较低。
SMI 和 CEUS 在检测颈动脉 IPN 方面具有极好的一致性。SMI 检测到的 IPN 与 IPN 的病理评估高度一致。与无颈动脉 IPN 者相比，有颈动脉 IPN 者更有可能发生中风或 TIA。
