Predictive value of contrast-enhanced carotid ultrasound features for stroke risk: a systematic review and meta-analysis

Objective: To elucidate the contrast-enhanced ultrasound (CEUS) features of carotid artery plaques in patients who have experienced an ischemic stroke (IS). Methods: A computerized search was conducted in databases such as Pub-Med, EMSCO, and Ovid to identify studies reporting CEUS findings of carotid artery plaques. Patients were categorized as IS and non-IS based on clinical and radiological diagnosis, and the quantitative and semi-quantitative CEUS data were analyzed for differences between the two groups. Results: After the computerized search, a total of 13 eligible studies, comprising 3,092 participants (1,953 with stroke), were included for analysis. IS patients exhibited significantly higher plaque enhancement intensity versus control group (SMD = 0.71, 95% CI: 0.32, 1.11). The positive rate of plaque enhancement within the plaques was significantly higher in IS patients versus non-IS patients (OR = 3.25, 95% CI: 1.86, 5.68). The sensitivity of hyperintense lesion-based diagnosis of stroke was 0.68 (95% CI: 0.54, 0.80), and the specificity was 0.61 (95% CI: 0.47, 0.73), with an area under the curve (AUC) of 0.697. Conclusion: There are significant differences in CEUS characteristics of carotid artery plaques between IS and non-IS patients. IS patients display markedly augmented plaque enhancement intensity and a higher rate of positive enhancement compared to non-stroke individuals. These noteworthy findings have critical implications in enhancing the accuracy of IS diagnosis and improving the stratification of stroke risk for patients. Systematic review registration: This study is registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY), 202540006.