Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
Clin Imaging. 2022 Oct;90:90-96. doi: 10.1016/j.clinimag.2022.08.001. Epub 2022 Aug 4.
A comprehensive understanding of atherosclerotic middle cerebral artery (MCA) plaques aids physicians in diagnosis and treatment of ischemic stroke. High-resolution magnetic resonance imaging (MRI) has been used to identify imaging biomarkers of symptomatic MCA plaque. We performed this systematic review and meta-analysis to evaluate which characteristics of MCA plaque are markers of culprit lesions.
The PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched for publications up to March 2022. Two independent reviewers extracted data on study design, high-resolution MRI parameters, and imaging end points. Odds ratios (ORs) for the prevalence of stroke with atherosclerotic MCA plaque features were pooled in the meta-analysis by using a random-effects model. Subgroup analysis, sensitivity analysis, and evaluation of publication bias were also conducted.
Seventeen articles were included in this review. Symptomatic MCA plaques were significantly associated with contrast enhancement (OR, 9.4; 95 % CI, 4.3-20.4) and T1 hyperintensity (OR, 6.2; 95 % CI, 2.7-14.3). However, there was no association between symptomatic plaques and T2 hyperintensity (OR, 1.4; 95 % CI, 0.8-2.3). Plaque enhancement was significantly associated with downstream ischemic events in subgroup analyses based on different study designs and MR sequence types.
Based on current evidence, contrast enhancement and T1 hyperintensity on high-resolution MRI have high potential as imaging biomarkers of patients with MCA plaques at risk of ischemic events. Future prospective, longitudinal studies of intracranial-plaque high-resolution MRI are required to improve decision-making for the management of intracranial atherosclerotic plaques.
全面了解动脉粥样硬化性大脑中动脉（MCA）斑块有助于医生对缺血性脑卒中进行诊断和治疗。高分辨率磁共振成像（MRI）已用于识别有症状 MCA 斑块的影像学生物标志物。我们进行了这项系统评价和荟萃分析，以评估 MCA 斑块的哪些特征是致病病变的标志物。
检索了截至 2022 年 3 月的 PubMed、EMBASE、Web of Science 和 Cochrane Library 数据库中的出版物。两名独立的审查员提取了关于研究设计、高分辨率 MRI 参数和影像学终点的数据。使用随机效应模型对具有动脉粥样硬化性 MCA 斑块特征的卒中患病率的比值比（OR）进行荟萃分析。还进行了亚组分析、敏感性分析和发表偏倚评估。
本综述共纳入了 17 篇文章。症状性 MCA 斑块与对比增强（OR，9.4；95%CI，4.3-20.4）和 T1 高信号（OR，6.2；95%CI，2.7-14.3）显著相关。然而，症状性斑块与 T2 高信号（OR，1.4；95%CI，0.8-2.3）之间无相关性。在基于不同研究设计和 MR 序列类型的亚组分析中，斑块增强与下游缺血性事件显著相关。
基于目前的证据，高分辨率 MRI 上的对比增强和 T1 高信号具有作为 MCA 斑块患者发生缺血事件风险的影像学生物标志物的高潜力。需要对颅内斑块高分辨率 MRI 进行前瞻性、纵向研究，以改善颅内动脉粥样硬化斑块管理的决策。
