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.


Related in: MedlinePlus

Funnel plot to evaluate for publication bias. Individual study effect sizes expressed as odds ratios are shown on the x‐axis and each study's standard error is shown on the y‐axis. Larger and more precise studies are plotted at the top, near the combined (pooled) odds ratio, whereas smaller and less precise studies will show a wider distribution below. If there is no publication bias, the studies would be expected to be symmetrically distributed on both sides of the pooled odds ratio line. In the case of publication bias, the funnel plot may be asymmetrical, since the absence of studies would distort the distribution on the scatter plot.
© Copyright Policy - creativeCommonsBy-nc
Related In: Results  -  Collection

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

jah31698-fig-0004: Funnel plot to evaluate for publication bias. Individual study effect sizes expressed as odds ratios are shown on the x‐axis and each study's standard error is shown on the y‐axis. Larger and more precise studies are plotted at the top, near the combined (pooled) odds ratio, whereas smaller and less precise studies will show a wider distribution below. If there is no publication bias, the studies would be expected to be symmetrically distributed on both sides of the pooled odds ratio line. In the case of publication bias, the funnel plot may be asymmetrical, since the absence of studies would distort the distribution on the scatter plot.

Mentions: We were able to obtain sufficient raw data to calculate a pooled OR expressing the strength of association between MRI enhancement and cerebral infarction in all of our included 8 studies (Table 3). In this analysis, information about plaque enhancement characteristics was available from 295 atherosclerotic lesions, 143 of which supplied a vascular territory containing an acute infarction and 152 of which supplied an infarct‐free vascular territory. We found a significant association between MRI enhancement of an artery and stroke within the vascular territory of that same artery, with a random effects OR of 10.8 (95% CI 4.1–28.1, P<0.001, Figure 3). These results were robust to a sensitivity analysis excluding the 2 retrospective studies (OR 8.4, 95% CI 3.1–22.8, P<0.001). There was neither statistically significant heterogeneity (Q=11.08, P=0.14) nor significant publication bias (Begg‐Mazumdar test for publication bias P=0.80, Figure 4) present in this analysis.


Gadolinium Enhancement in Intracranial Atherosclerotic Plaque and Ischemic Stroke: A Systematic Review and Meta ‐ Analysis
Funnel plot to evaluate for publication bias. Individual study effect sizes expressed as odds ratios are shown on the x‐axis and each study's standard error is shown on the y‐axis. Larger and more precise studies are plotted at the top, near the combined (pooled) odds ratio, whereas smaller and less precise studies will show a wider distribution below. If there is no publication bias, the studies would be expected to be symmetrically distributed on both sides of the pooled odds ratio line. In the case of publication bias, the funnel plot may be asymmetrical, since the absence of studies would distort the distribution on the scatter plot.
© Copyright Policy - creativeCommonsBy-nc
Related In: Results  -  Collection

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

jah31698-fig-0004: Funnel plot to evaluate for publication bias. Individual study effect sizes expressed as odds ratios are shown on the x‐axis and each study's standard error is shown on the y‐axis. Larger and more precise studies are plotted at the top, near the combined (pooled) odds ratio, whereas smaller and less precise studies will show a wider distribution below. If there is no publication bias, the studies would be expected to be symmetrically distributed on both sides of the pooled odds ratio line. In the case of publication bias, the funnel plot may be asymmetrical, since the absence of studies would distort the distribution on the scatter plot.
Mentions: We were able to obtain sufficient raw data to calculate a pooled OR expressing the strength of association between MRI enhancement and cerebral infarction in all of our included 8 studies (Table 3). In this analysis, information about plaque enhancement characteristics was available from 295 atherosclerotic lesions, 143 of which supplied a vascular territory containing an acute infarction and 152 of which supplied an infarct‐free vascular territory. We found a significant association between MRI enhancement of an artery and stroke within the vascular territory of that same artery, with a random effects OR of 10.8 (95% CI 4.1–28.1, P<0.001, Figure 3). These results were robust to a sensitivity analysis excluding the 2 retrospective studies (OR 8.4, 95% CI 3.1–22.8, P<0.001). There was neither statistically significant heterogeneity (Q=11.08, P=0.14) nor significant publication bias (Begg‐Mazumdar test for publication bias P=0.80, Figure 4) present in this analysis.

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.


Related in: MedlinePlus