Department of Radiologic Sciences, College of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.
Department of Public Health, College of Health Sciences, Saudi Electronic University, Riyadh, Saudi Arabia.
Echocardiography. 2022 Aug;39(8):1032-1043. doi: 10.1111/echo.15407. Epub 2022 Jun 29.
Contrast-enhanced ultrasound (CEUS) is a promising imaging modality for the assessment of plaque vulnerability. We aimed to systematically review and meta-analyze the ability of CEUS parameters to differentiate between symptomatic and asymptomatic carotid plaques and to assess its reproducibility.
PubMed, EMBASE, and Cochrane Library databases were searched for studies that potentially evaluated carotid plaques using CEUS. From the initial 2870 searches, 11 relevant publications comprising a total of 821 carotid plaques were reviewed. Data on CEUS parameters including quantitative and semi-quantitative parameters were extracted and analyzed.
The overall analysis showed significantly higher CEUS parameters in symptomatic carotid plaques compared to asymptomatic carotid plaques (standardised mean difference (SMD) .95, 95% confidence interval (CI) .56-1.27, p < .01). Intra and inter-observer reproducibility of quantitative CEUS parameters were excellent (intra-observer, r = .95, 95% CI .87-1; inter-observer, r = .93, 95% CI .80-.1). Semi-quantitative CEUS parameters showed good intra-observer reliability and moderate inter-observer reliability (intra-observer, r = .77, 95% CI .64-.89; inter-observer, r = .75, 95% CI .61-.89). Heterogeneity among studies compared CEUS parameters in symptomatic and asymptomatic plaques and studies assessed inter-observer reproducibility, and significant biases in studies assessing CEUS reproducibility were present.
CEUS is a useful vascular imaging method to differentiate between symptomatic and asymptomatic carotid plaques with moderate to excellent reproducibility. Quantitative CEUS analysis appeared to be more sensitive and reliable in assessing carotid plaques than semi-quantitative parameters. Further longitudinal prospective trials evaluating carotid plaque in asymptomatic population using CEUS to determine plaque characteristics that can become symptomatic are required.
对比增强超声（CEUS）是评估斑块易损性的一种很有前途的成像方式。我们旨在系统地回顾和荟萃分析 CEUS 参数区分症状性和无症状性颈动脉斑块的能力，并评估其可重复性。
检索了可能使用 CEUS 评估颈动脉斑块的研究的 PubMed、EMBASE 和 Cochrane Library 数据库。从最初的 2870 次搜索中，共审查了 11 篇相关文献，共涉及 821 个颈动脉斑块。提取并分析了关于 CEUS 参数的数据，包括定量和半定量参数。
总体分析显示，症状性颈动脉斑块的 CEUS 参数明显高于无症状性颈动脉斑块（标准化均数差（SMD）.95，95%置信区间（CI）.56-1.27，p<0.01）。定量 CEUS 参数的观察者内和观察者间可重复性均极佳（观察者内，r=0.95，95%CI 0.87-1；观察者间，r=0.93，95%CI 0.80-0.1）。半定量 CEUS 参数显示出良好的观察者内可靠性和中等的观察者间可靠性（观察者内，r=0.77，95%CI 0.64-0.89；观察者间，r=0.75，95%CI 0.61-0.89）。比较症状性和无症状性斑块的 CEUS 参数的研究存在异质性，评估观察者间可重复性的研究以及评估 CEUS 可重复性的研究存在显著偏倚。
CEUS 是一种有用的血管成像方法，可区分症状性和无症状性颈动脉斑块，具有中等到极好的可重复性。与半定量参数相比，定量 CEUS 分析似乎更能敏感和可靠地评估颈动脉斑块。需要进一步进行前瞻性纵向试验，使用 CEUS 评估无症状人群中的颈动脉斑块，以确定可能出现症状的斑块特征。
