Diagnostic Performance Of Contrast-enhanced Ultrasound And High-resolution Magnetic Resonance Imaging For Carotid Plaques: A Meta-analysis

Background:Ischemic strokes are a serious risk to human health,and thromboembolism due to atherosclerotic plaques in the carotid arteries is an important risk factor for ischemic strokes.The degree of narrowing of the carotid lumen is a key indicator of risk stratification and surgical treatment in patients with atherosclerosis.However,a growing number of investigators have shown that the composition and morphology of plaque appears to be more closely related to ischemic stroke,making the use of imaging to identify the composition and therefore the stability of plaque particularly important for the timely and effective prevention of ischemic stroke.Currently,HR-MRI is considered the imaging standard for detecting vulnerable plaques in the carotid arteries,but it is expensive,has many contraindications and its clinical use is more limited.In recent years,the continuous improvement in the performance of ultrasound contrast agents,complemented by new contrast techniques,has led to a new phase in the diagnosis of carotid vulnerable plaque with CEUS.However,there is no Meta-analysis comparing the diagnostic ability of HR-MRI and CEUS for carotid vulnerable plaques.Purpose:To compare the accuracy of carotid artery vulnerable plaque detection by CEUS with that of HR-MRI and to provide a convenient,accurate and affordable imaging tool for the selection of treatment options for patients with carotid atherosclerosis and for the effective prevention of ischemic stroke.Methods:A systematic review was conducted in Pub Med,Embase,Cochrane Library using the search terms carotid artery,atherosclerotic plaque,CEUS,contrast-enhanced ultrasound,HR-MRI,high-resolution magnetic resonance.Studies published since the establishment of the library until June 2021.Literature that met the inclusion criteria was screened according to the inclusion and exclusion criteria developed,and true positive values,false negative values,false positive values and true negative values were extracted directly or indirectly from the included literature.The quality of the included literature was evaluated using the QUADAS-2 tool.In addition,subgroup analysis,meta-regression and sensitivity analysis were used to explore factors that may have caused study heterogeneity.Because of the heterogeneity among the included CEUS,HR-MRI-related studies,a random-effects model was used for statistical analysis.Results:A total of 12 articles with a total of 23 datasets were included in this Meta-analysis.The sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,and diagnostic ratio of CEUS and HR-MRI for the diagnosis of carotid vulnerable plaque were 73%/77%,71%/64%,2.40/2.23,0.35/0.40,and8.00/7.50,respectively.The SROC-AUC for CEUS and HR-MRI were 0.80 and 0.80,respectively.The meta-regression indicated that sample size may be the main source of heterogeneity between included CEUS-related studies.In sensitivity analysis,after removing literature affecting heterogeneity among included HR-MRI studies,the effect sizes of the remaining HR-MRI studies were combined using a fixed-effects model,and the sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,and diagnostic ratio of the remaining HR-MRI diagnostic carotid vulnerable plaques were found to be 72%,72%,2.84,0.35,and 7.09,respectively.And the remaining SROC-AUC for HR-MRI was 0.82.Conclusion:The diagnostic value of both CEUS and HR-MRI for carotid vulnerable plaque was high and the diagnostic efficacy of both diagnostic modalities was comparable.