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

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.


Study selection flow diagram.
© Copyright Policy - creativeCommonsBy-nc
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC5015301&req=5

jah31698-fig-0002: Study selection flow diagram.

Mentions: We screened a total of 4437 titles and abstracts from which we identified 8 articles14, 15, 16, 17, 18, 19, 20, 21 that met all inclusion criteria for the systematic review. Study selection steps are summarized in Figure 2. In total, the 8 studies included a combined 330 individual subjects in whom data from 295 atherosclerotic plaques provided data eligible for meta‐analysis. Of the 8 articles meeting inclusion criteria (Table 1), 514, 18, 19, 20, 21 were prospective cross‐sectional studies and 315, 16, 17 were retrospective cross‐sectional studies. Three studies were conducted in China,19, 20, 21 2 in the United States,17, 18 and 1 each in Canada,16 the Netherlands,14 and South Korea.15 A preponderance of men were studied in 7 of the 8 included studies, with the range of percent of men in each study ranging from 46.9% to 88.9%. All studies had a mean age above 50 years (range 54.6–68.7 years). There were differences in the degree of intracranial luminal stenosis measurements required for patients to be included in the individual studies, with some studies17, 18, 20 requiring ≥50% or ≥70% stenosis while others focused on patients without significant stenosis (ie, <50%).19, 21 Though some studies included patients with transient ischemic attacks or nonacute ischemic strokes, all included studies provided adequate information to collect MRI enhancement data on the subset of relevant patients with acute ischemic stroke occurring within 30 days of imaging.


Gadolinium Enhancement in Intracranial Atherosclerotic Plaque and Ischemic Stroke: A Systematic Review and Meta ‐ Analysis
Study selection flow diagram.
© Copyright Policy - creativeCommonsBy-nc
Related In: Results  -  Collection

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

jah31698-fig-0002: Study selection flow diagram.
Mentions: We screened a total of 4437 titles and abstracts from which we identified 8 articles14, 15, 16, 17, 18, 19, 20, 21 that met all inclusion criteria for the systematic review. Study selection steps are summarized in Figure 2. In total, the 8 studies included a combined 330 individual subjects in whom data from 295 atherosclerotic plaques provided data eligible for meta‐analysis. Of the 8 articles meeting inclusion criteria (Table 1), 514, 18, 19, 20, 21 were prospective cross‐sectional studies and 315, 16, 17 were retrospective cross‐sectional studies. Three studies were conducted in China,19, 20, 21 2 in the United States,17, 18 and 1 each in Canada,16 the Netherlands,14 and South Korea.15 A preponderance of men were studied in 7 of the 8 included studies, with the range of percent of men in each study ranging from 46.9% to 88.9%. All studies had a mean age above 50 years (range 54.6–68.7 years). There were differences in the degree of intracranial luminal stenosis measurements required for patients to be included in the individual studies, with some studies17, 18, 20 requiring ≥50% or ≥70% stenosis while others focused on patients without significant stenosis (ie, <50%).19, 21 Though some studies included patients with transient ischemic attacks or nonacute ischemic strokes, all included studies provided adequate information to collect MRI enhancement data on the subset of relevant patients with acute ischemic stroke occurring within 30 days of imaging.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Gadolinium enhancement on high&#8208;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&#8208;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&#8208;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&#8208;detected plaque enhancement as compared to territory supplied by an artery without enhancement. We calculated between&#8208;study heterogeneity using the Cochrane Q test and publication bias using the Begg&#8208;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&ndash;28.1, P&lt;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&#8208;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.