Key result
Superb microvascular imaging detects carotid intraplaque neovascularization with ~93% sensitivity and ~80% specificity.
Why the study?
Carotid atherosclerotic plaques cause stenosis and vulnerable plaques lead to ischemic stroke, motivating assessment of the accuracy of superb microvascular imaging for detecting carotid intraplaque neovascularization.
What is the diagnostic accuracy of superb microvascular imaging (SMI) compared with contrast-enhanced ultrasonography or histology for detecting intraplaque neovascularization in patients with carotid atherosclerotic plaques?
Meta-Analysis (n=1,225)
Yes
What is the diagnostic accuracy of superb microvascular imaging (SMI) compared with contrast-enhanced ultrasonography or histology for detecting intraplaque neovascularization in patients with carotid atherosclerotic plaques?
Answers are grounded in this paper and cite their sources.
Superb microvascular imaging (SMI) demonstrates high sensitivity (93%) and good specificity (80%) for detecting carotid intraplaque neovascularization, supporting its use as a non-invasive, contrast-free screening alternative to contrast-enhanced ultrasound.
Background: Atherosclerotic plaques can cause carotid artery stenosis, and "vulnerable plaques" can even lead to ischemic stroke. The objective of this study was to assess the accuracy of superb microvascular imaging (SMI) for the detection of carotid intraplaque neovascularization (IPN) in patients with atherosclerotic plaques. Methods: We searched the Cochrane Library, Embase, Medline, and Wanfang databases until January 17, 2023. We included original studies with information on diagnostic accuracy of SMI for the evaluation of carotid IPN. The primary outcome was the accuracy of SMI for detecting carotid IPN. A meta-analysis was performed to estimate the accuracy of each parameter. We used the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) to assess the risk of bias for each included article. Meta-regression was performed to determine items that may have contributed to heterogeneity in the sensitivity or specificity of the test. Results: This meta-analysis included 20 studies with 1,589 carotid plaques in 1,225 patients. The analysis showed a sensitivity and specificity of SMI for detecting IPN of 93% [95% confidence interval (CI): 87-96%] and 80% (95% CI: 71-87%), respectively. The risk of bias across the QUADAS-2 domains was low. Only the proportion of dyslipidemia influenced the estimates of sensitivity and specificity. Conclusions: This review suggests that SMI has a good diagnostic performance for detecting carotid IPN. The very high sensitivity with excellent post-test probability indicated that SMI can be recommended to screen for carotid IPN among patients with carotid plaques.
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Zhao et al. (2023) conducted a meta-analysis in Carotid atherosclerotic plaques (n=1,225). Superb microvascular imaging (SMI) vs. Pathologic evaluation (plaque histology) or contrast-enhanced ultrasonography (CEUS) was evaluated on Diagnostic accuracy of superb microvascular imaging (SMI) for detecting carotid intraplaque neovascularization (IPN) (DOR 52.4, 95% CI 26.6-103.0). Superb microvascular imaging demonstrated a pooled sensitivity of 93% (95% CI: 87-96%) and specificity of 80% (95% CI: 71-87%) for detecting carotid intraplaque neovascularization.
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