David Pakizer, Jiří Kozel, Jolanda Elmers, Janusz Feber, Patrik Michel, David Školoudík, Gaia Sirimarco
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引用次数: 0
摘要
颈动脉斑块的构成是未来发生缺血性中风的主要风险因素之一。核磁共振成像具有良好的软组织对比度,可以区分斑块的特征。我们的目的是通过系统性回顾分析核磁共振成像与组织学相比在检测有症状和无症状颈动脉粥样硬化患者颈动脉斑块特征方面的诊断准确性。在PROSPERO(ID CRD42022329690)中进行前瞻性注册后,截至2022年5月27日,我们对Medline Ovid、Embase.com、Cochrane Library和Web of Science Core进行了无检索限制的检索,以确定符合条件的文章。在 8168 项研究中,有 53 项(37 × 1.5 T MRI,17 × 3 T MRI)在 169 项比较中评估了 MRI 检测 13 种特定颈动脉斑块特征的准确性。MRI 在检测钙化(3 T MRI:平均灵敏度 92%/平均特异度 90%;1.5 T MRI:平均灵敏度 81%/平均特异度 91%)、纤维帽(1.5 T:89%/87%)、不稳定斑块(1.5 T:89%/87%)、斑块内出血(1.5 T:86%/88%)和富脂质坏死核心(1.5 T:89%/79%)方面显示出很高的诊断准确性。事实证明,磁共振成像对所研究的颈动脉斑块特征具有较高的组织辨别能力,从而有可能更好地进行风险评估,并对可能受益于更积极治疗的患者进行随访。这些结果强调了磁共振成像作为全面评估颈动脉斑块形态(尤其是不稳定斑块)的一线成像模式的作用。证据级别:2 技术功效:2 级。
Diagnostics Accuracy of Magnetic Resonance Imaging in Detection of Atherosclerotic Plaque Characteristics in Carotid Arteries Compared to Histology: A Systematic Review.
Carotid plaque composition represents one of the main risk factors of future ischemic stroke. MRI provides excellent soft tissue contrast that can distinguish plaque characteristics. Our objective was to analyze the diagnostic accuracy of MRI imaging in the detection of carotid plaque characteristics compared to histology in patients with symptomatic and asymptomatic carotid atherosclerosis through a systematic review. After prospective registration in PROSPERO (ID CRD42022329690), Medline Ovid, Embase.com, Cochrane Library, and Web of Science Core were searched without any search limitation up to May 27, 2022 to identify eligible articles. Of the 8168 studies, 53 (37 × 1.5 T MRI, 17 × 3 T MRI) evaluated MRI accuracy in the detection of 13 specific carotid plaque characteristics in 169 comparisons. MRI demonstrated high diagnostic accuracy for detection of calcification (3 T MRI: mean sensitivity 92%/mean specificity 90%; 1.5 T MRI: mean sensitivity 81%/mean specificity 91%), fibrous cap (1.5 T: 89%/87%), unstable plaque (1.5 T: 89%/87%), intraplaque hemorrhage (1.5 T: 86%/88%), and lipid-rich necrotic core (1.5 T: 89%/79%). MRI also proved to have a high level of tissue discrimination for the carotid plaque characteristics investigated, allowing potentially for a better risk assessment and follow-up of patients who may benefit from more aggressive treatments. These results emphasize the role of MRI as the first-line imaging modality for comprehensive assessment of carotid plaque morphology, particularly for unstable plaque. EVIDENCE LEVEL: 2 TECHNICAL EFFICACY: Stage 2.
期刊介绍:
The Journal of Magnetic Resonance Imaging (JMRI) is an international journal devoted to the timely publication of basic and clinical research, educational and review articles, and other information related to the diagnostic applications of magnetic resonance.