MRI and CT had similar high diagnostic accuracy for detecting vulnerable carotid plaques (90% and 86%; P>0.05), whereas ultrasound showed significantly lower accuracy (80%; P=0.013).
Meta-Analysis
Do noninvasive imaging modalities (CT, MRI, US) accurately detect vulnerable and stable carotid plaques compared to histology in patients with carotid atherosclerosis?
CT and MRI demonstrate high and comparable diagnostic accuracy for detecting vulnerable carotid plaques compared to histology, outperforming ultrasound.
Tasa de eventos absoluta: 90% vs 86%
valor p: p=> 0.05
AIMS: There is increasing evidence that plaque instability in the extracranial carotid artery may lead to an increased stroke risk independently of the degree of stenosis. We aimed to determine diagnostic accuracy of vulnerable and stable plaque using noninvasive imaging modalities when compared to histology in patients with symptomatic and asymptomatic carotid atherosclerosis. METHODS AND RESULTS: Medline Ovid, Embase, Cochrane Library, and Web of Science were searched for diagnostic accuracy of noninvasive imaging modalities (CT, MRI, US) in the detection of 1) vulnerable/stable plaque, and 2) vulnerable/stable plaque characteristics, compared to histology. The quality of included studies was assessed by QUADAS-2 and univariate and bivariate random-effect meta-analyses were performed. We included 36 vulnerable and 5 stable plaque studies in the meta-analysis, and out of 211 plaque characteristics from remaining studies, we classified 169 as vulnerable and 42 as stable characteristics (28 CT, 120 MRI, 104 US characteristics). We found that MRI had high accuracy 90% (95% CI: 82-95%) in the detection of vulnerable plaque, similar to CT 86% (95% CI: 76-92%); P > 0.05, whereas US showed less accuracy 80% (95% CI: 75-84%); P = 0.013. CT showed high diagnostic accuracy in visualizing characteristics of vulnerable or stable plaques (89% and 90%) similar to MRI (86% and 89%; P > 0.05); however, US had lower accuracy (77%, P 0.05). CONCLUSION: CT and MRI have a similar, high performance in detecting vulnerable carotid plaques, whereas US showed significantly less diagnostic accuracy. Moreover, MRI visualized all vulnerable plaque characteristics allowing for a better stroke risk assessment. REGISTRATION: PROSPERO ID CRD42022329690.
Pakizer et al. (Fri,) conducted a meta-analysis in symptomatic and asymptomatic carotid atherosclerosis. Noninvasive imaging (CT, MRI, US) vs. Histology was evaluated on Diagnostic accuracy in the detection of vulnerable plaque (95% CI 82-95, p=> 0.05). MRI and CT had similar high diagnostic accuracy for detecting vulnerable carotid plaques (90% and 86%; P>0.05), whereas ultrasound showed significantly lower accuracy (80%; P=0.013).