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Gadolinium Enhancement in Intracranial Atherosclerotic Plaque and Ischemic Stroke: A Systematic Review and Meta ‐ Analysis

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ABSTRACT

Background: Gadolinium enhancement on high‐resolution magnetic resonance imaging (MRI) has been proposed as a marker of inflammation and instability in intracranial atherosclerotic plaque. We performed a systematic review and meta‐analysis to summarize the association between intracranial atherosclerotic plaque enhancement and acute ischemic stroke.

Methods and results: We searched the medical literature to identify studies of patients undergoing intracranial vessel wall MRI for evaluation of intracranial atherosclerotic plaque. We recorded study data and assessed study quality, with disagreements in data extraction resolved by a third reader. A random‐effects odds ratio was used to assess whether, in any given patient, cerebral infarction was more likely in the vascular territory supplied by an artery with MRI‐detected plaque enhancement as compared to territory supplied by an artery without enhancement. We calculated between‐study heterogeneity using the Cochrane Q test and publication bias using the Begg‐Mazumdar test. Eight articles published between 2011 and 2015 met inclusion criteria. These studies provided information about plaque enhancement characteristics from 295 arteries in 330 patients. We found a significant positive relationship between MRI enhancement and cerebral infarction in the same vascular territory, with a random effects odds ratio of 10.8 (95% CI 4.1–28.1, P<0.001). No significant heterogeneity (Q=11.08, P=0.14) or publication bias (P=0.80) was present.

Conclusions: Intracranial plaque enhancement on high‐resolution vessel wall MRI is strongly associated with ischemic stroke. Evaluation for plaque enhancement on MRI may be a useful test to improve diagnostic yield in patients with ischemic strokes of undetermined etiology.

No MeSH data available.


Related in: MedlinePlus

Magnetic resonance images showing an enhancing atherosclerotic plaque in the right middle cerebral artery in a symptomatic patient who had suffered a recent right cerebral hemispheric acute ischemic stroke. A mixture of acute and chronic infarction involving the right periventricular and frontal subcortical regions is seen in the diffusion‐weighted image (DWI); the plaque is shown by an arrow in the time‐of‐flight (TOF) image, and a cross section at the most stenotic site is shown in T2, T1, and contrast‐enhanced (CE) T1 images (red asterisks: lumen).
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jah31698-fig-0001: Magnetic resonance images showing an enhancing atherosclerotic plaque in the right middle cerebral artery in a symptomatic patient who had suffered a recent right cerebral hemispheric acute ischemic stroke. A mixture of acute and chronic infarction involving the right periventricular and frontal subcortical regions is seen in the diffusion‐weighted image (DWI); the plaque is shown by an arrow in the time‐of‐flight (TOF) image, and a cross section at the most stenotic site is shown in T2, T1, and contrast‐enhanced (CE) T1 images (red asterisks: lumen).

Mentions: Recent investigations have begun to address this problem by leveraging high‐resolution, multiplanar MRI to detect high‐risk abnormalities of the intracranial vessel walls. Previous studies in both the coronary and extracranial carotid arteries have shown that abnormal plaque enhancement after the administration of gadolinium contrast agent is a marker of inflammation, neovascularity, and plaque instability.8, 9 For this reason, plaque enhancement has been recently studied as a potential high‐risk plaque feature in the intracranial circulation (Figure 1). Plaque enhancement is a particularly attractive MRI biomarker because it can be rapidly detected, qualitatively assessed, and does not require significant image postprocessing to analyze. While research to date on the detection of nonstenosing intracranial atherosclerotic lesions based on enhancement characteristics has been promising, individual studies have been small, making it difficult to draw firm conclusions about this emerging technique. We therefore performed a systematic review and meta‐analysis to evaluate the association between abnormal plaque enhancement on high‐resolution MRI and acute ischemic stroke.


Gadolinium Enhancement in Intracranial Atherosclerotic Plaque and Ischemic Stroke: A Systematic Review and Meta ‐ Analysis
Magnetic resonance images showing an enhancing atherosclerotic plaque in the right middle cerebral artery in a symptomatic patient who had suffered a recent right cerebral hemispheric acute ischemic stroke. A mixture of acute and chronic infarction involving the right periventricular and frontal subcortical regions is seen in the diffusion‐weighted image (DWI); the plaque is shown by an arrow in the time‐of‐flight (TOF) image, and a cross section at the most stenotic site is shown in T2, T1, and contrast‐enhanced (CE) T1 images (red asterisks: lumen).
© Copyright Policy - creativeCommonsBy-nc
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5015301&req=5

jah31698-fig-0001: Magnetic resonance images showing an enhancing atherosclerotic plaque in the right middle cerebral artery in a symptomatic patient who had suffered a recent right cerebral hemispheric acute ischemic stroke. A mixture of acute and chronic infarction involving the right periventricular and frontal subcortical regions is seen in the diffusion‐weighted image (DWI); the plaque is shown by an arrow in the time‐of‐flight (TOF) image, and a cross section at the most stenotic site is shown in T2, T1, and contrast‐enhanced (CE) T1 images (red asterisks: lumen).
Mentions: Recent investigations have begun to address this problem by leveraging high‐resolution, multiplanar MRI to detect high‐risk abnormalities of the intracranial vessel walls. Previous studies in both the coronary and extracranial carotid arteries have shown that abnormal plaque enhancement after the administration of gadolinium contrast agent is a marker of inflammation, neovascularity, and plaque instability.8, 9 For this reason, plaque enhancement has been recently studied as a potential high‐risk plaque feature in the intracranial circulation (Figure 1). Plaque enhancement is a particularly attractive MRI biomarker because it can be rapidly detected, qualitatively assessed, and does not require significant image postprocessing to analyze. While research to date on the detection of nonstenosing intracranial atherosclerotic lesions based on enhancement characteristics has been promising, individual studies have been small, making it difficult to draw firm conclusions about this emerging technique. We therefore performed a systematic review and meta‐analysis to evaluate the association between abnormal plaque enhancement on high‐resolution MRI and acute ischemic stroke.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Gadolinium enhancement on high‐resolution magnetic resonance imaging (MRI) has been proposed as a marker of inflammation and instability in intracranial atherosclerotic plaque. We performed a systematic review and meta‐analysis to summarize the association between intracranial atherosclerotic plaque enhancement and acute ischemic stroke.

Methods and results: We searched the medical literature to identify studies of patients undergoing intracranial vessel wall MRI for evaluation of intracranial atherosclerotic plaque. We recorded study data and assessed study quality, with disagreements in data extraction resolved by a third reader. A random‐effects odds ratio was used to assess whether, in any given patient, cerebral infarction was more likely in the vascular territory supplied by an artery with MRI‐detected plaque enhancement as compared to territory supplied by an artery without enhancement. We calculated between‐study heterogeneity using the Cochrane Q test and publication bias using the Begg‐Mazumdar test. Eight articles published between 2011 and 2015 met inclusion criteria. These studies provided information about plaque enhancement characteristics from 295 arteries in 330 patients. We found a significant positive relationship between MRI enhancement and cerebral infarction in the same vascular territory, with a random effects odds ratio of 10.8 (95% CI 4.1–28.1, P<0.001). No significant heterogeneity (Q=11.08, P=0.14) or publication bias (P=0.80) was present.

Conclusions: Intracranial plaque enhancement on high‐resolution vessel wall MRI is strongly associated with ischemic stroke. Evaluation for plaque enhancement on MRI may be a useful test to improve diagnostic yield in patients with ischemic strokes of undetermined etiology.

No MeSH data available.


Related in: MedlinePlus