Non-invasive imaging of individual histological carotid plaque characteristics: A diagnostic accuracy meta-analysis.

IF 4.9 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Atherosclerosis Pub Date : 2025-06-02 DOI:10.1016/j.atherosclerosis.2025.120391

David Pakizer, Patrick Taffé, Jiří Kozel, Jolanda Elmers, Janusz Feber, Vincent Dunet, Patrik Michel, David Školoudík, Gaia Sirimarco

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引用次数: 0

Abstract

Background and aims: Accurately detecting carotid plaque characteristics is crucial for identifying high-risk patients due to risk of cerebrovascular events and complications during revascularizations. Diagnostic accuracy of individual and overall carotid plaque characteristics using computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US) compared to histology in patients with symptomatic/asymptomatic carotid plaques was aimed.

Methods: After prospective registration on PROSPERO (CRD42022329690), Medline Ovid, Embase, Cochrane Library, and Web of Science were searched without any limitations. QUADAS-2 tool was used to study quality assessment, GRADE framework to assess evidence certainty, and univariate/bivariate random-effect meta-analyses for data analysis.

Results: Of 5960 studies screened, 107 were identified, resulting in 253 diagnostic accuracy comparisons of 16 plaque characteristics (28 CT, 120 MRI, and 105 US). CT detected intraplaque hemorrhage (IPH) and lipid-rich necrotic core (LRNC) with good accuracy (86 % [95 %CI 67-95] and 84 % [72-91], respectively) and exhibited very high accuracy for ulceration (92 % [87-95]; 76 % on MRI and 75 % on US) and calcification (90 % [58-98] vs. 89 % [87-91] on MRI). MRI identified LRNC and IPH with good accuracy (86 % [81-89] and 86 % [84-88], respectively), and differentiated between acute/subacute/old IPH (accuracy >87 %). US accurately detected ruptured fibrous cap (85 % [77-91]), comparable to MRI (85 % [79-90]), but demonstrated lower performance for other characteristics. Finally, CT detected overall carotid morphology with 89 % accuracy, followed by MRI (86 %; p = 0.374 to CT), and significantly lower by US (78 %; p < 0.001).

Conclusion: CT identified key plaque features, especially ulceration and calcification. MRI provided thorough plaque assessment by detecting all features and differentiating IPH age. For overall morphology, CT and MRI surpassed US accuracy.

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单个颈动脉斑块组织学特征的无创成像：诊断准确性荟萃分析。

背景和目的：准确检测颈动脉斑块特征对于识别高危患者是至关重要的，因为在血管重建过程中存在脑血管事件和并发症的风险。目的是利用计算机断层扫描（CT）、磁共振成像（MRI）和超声（US）对有症状/无症状颈动脉斑块患者的个体和整体颈动脉斑块特征进行诊断，并与组织学进行比较。方法：在PROSPERO （CRD42022329690）上前瞻性注册后，无任何限制地检索Medline Ovid、Embase、Cochrane Library和Web of Science。采用QUADAS-2工具进行质量评估，采用GRADE框架评估证据确定性，采用单因素/双因素随机效应荟萃分析进行数据分析。结果：在筛选的5960项研究中，确定了107项，对16项斑块特征进行了253项诊断准确性比较（28项CT， 120项MRI和105项US）。CT对斑块内出血（IPH）和富含脂质坏死核心（LRNC）的检测准确率较高（分别为86% [95% CI 67-95]和84%[72-91]），对溃疡的检测准确率也很高(92% [87-95]；MRI为76%，US为75%)和钙化（MRI为90%[58-98]，89%[87-91]）。MRI对LRNC和IPH的鉴别准确率较高（分别为86%[81-89]和86%[84-88]），并能区分急性/亚急性/老年性IPH（准确率> 87%）。US准确检测到纤维帽破裂（85%[77-91]），与MRI（85%[79-90]）相当，但在其他特征上表现较差。最后，CT检测颈动脉整体形态的准确率为89%，其次是MRI (86%；p = 0.374至CT)，且US显著降低(78%；结论：CT可识别斑块的主要特征，尤其是溃疡和钙化。MRI通过检测所有特征和区分IPH年龄提供了彻底的斑块评估。对于整体形态学，CT和MRI的准确性超过了US。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Atherosclerosis 医学-外周血管病

CiteScore

9.80

自引率

3.80%

发文量

1269

审稿时长

36 days

期刊介绍： Atherosclerosis has an open access mirror journal Atherosclerosis: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. Atherosclerosis brings together, from all sources, papers concerned with investigation on atherosclerosis, its risk factors and clinical manifestations. Atherosclerosis covers basic and translational, clinical and population research approaches to arterial and vascular biology and disease, as well as their risk factors including: disturbances of lipid and lipoprotein metabolism, diabetes and hypertension, thrombosis, and inflammation. The Editors are interested in original or review papers dealing with the pathogenesis, environmental, genetic and epigenetic basis, diagnosis or treatment of atherosclerosis and related diseases as well as their risk factors.