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.
- MeSH
- Carotid Arteries * diagnostic imaging pathology MeSH
- Plaque, Atherosclerotic * diagnostic imaging MeSH
- Humans MeSH
- Magnetic Resonance Imaging * methods MeSH
- Carotid Artery Diseases * diagnostic imaging pathology MeSH
- Reproducibility of Results MeSH
- Sensitivity and Specificity MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
- Comparative Study MeSH
- Systematic Review MeSH
INTRODUCTION: Extracranial carotid calcification is a common marker of advanced atherosclerosis. However, its impact on stroke risk is not consistent across studies, and examining the type of calcification and the presence of systemic diseases might be helpful. We aimed to investigate extracranial carotid calcification and its association with risk factors for ischemic cerebrovascular diseases. MATERIALS AND METHODS: Among 1,863 consecutive patients in the Atherosclerotic Plaque Characteristics Associated with a Progression Rate of the Plaque and a Risk of Stroke in Patients with the Carotid Bifurcation Plaque Study (ANTIQUE), 132 symptomatic or asymptomatic patients (177 carotid plaques) with >30% carotid stenosis examined through computed tomography (CT) and magnetic resonance imaging (MRI) were included. Statistical data were assessed using the χ2-test, Fisher's exact test, t-test, and Mann-Whitney test to investigate the calcification risk factors. RESULTS: Compared to the absence of calcifications, spotty calcifications were associated with male sex [odds ratio (OR): 3.72, 95% confidence interval (CI): 1.06-13.05], while large calcifications were associated with older patients (OR: 1.60 per 5 years of age, 95% CI: 1.20-2.13). Large calcifications were also strongly associated with coronary heart disease (OR: 4.07, 95% CI: 1.15-14.44) and atrial fibrillation (p = 0.025). In comparison between only spotty and large calcifications, spotty calcifications were associated with male sex (OR: 3.72, 95% CI: 1.06-13.05), smoking (p = 0.020) in more significant quantities (p = 0.014), and lipid plaque (p < 0.001), while large calcifications with contralateral stenosis degree (p = 0.044). No significant relationship was found between cerebrovascular events and the type of calcification. CONCLUSION: Although the presence and type of extracranial carotid calcification were not related to ipsilateral ischemic events, large calcifications were strongly associated with coronary heart disease and atrial fibrillation. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, identifier NCT02360137.
- Publication type
- Journal Article MeSH
BACKGROUND: Carotid plaque composition plays a key role in plaque stability and patient risk stratification. Of unstable plaque features, intraplaque hemorrhage (IPH) is considered the main risk factor for stroke development. AIMS: We aimed to assess an association between the presence of IPH and other plaque characteristics detectable by computed tomography (CT) or magnetic resonance imaging (MRI) and stroke. MATERIAL AND METHODS: Of all consecutive patients from the ANTIQUE study, 132 (91 males; aged 70.0 [8.6] years) with 59 symptomatic and 157 asymptomatic stable carotid plaques were included in the retrospective analysis of prospectively collected data. Plaques in the vascular territory of ischemic stroke within 90 days were classified as symptomatic and were diagnosed by CT and MRI after symptoms occurred. Plaques without progression and clinical infarction were classified as asymptomatic stable. Univariate and multivariate logistic regression analyses were performed to identify risk factors. RESULTS: The presence, age, location, and volume of IPH were not related to stroke risk (P >0.05). Patients with symptomatic plaque were more likely to consume alcohol (P = 0.005), had more severe stenosis (CT median: 80% vs. 72%; P = 0.005; MRI median: 79% vs. 72%; P = 0.01), lower American Heart Association grade (P = 0.03), and more frequent lipid plaque (89.8% vs. 76.4%; P = 0.04) compared to patients with asymptomatic stable plaques. Stenosis severity (odds ratio [OR], 1.037; 95% CI, 1.015-1.059) and additionally alcohol consumption (OR, 3.571; 95% CI, 1.694-7.527) were found to be the only significant predictors of a recent stroke. CONCLUSIONS: In this cohort, no IPH or other plaque characteristics were associated with stroke risk. The degree of stenosis and alcohol consumption were the only factors associated with ipsilateral stroke. Larger prospective studies considering plaque characteristics are needed.
- MeSH
- Plaque, Atherosclerotic * diagnostic imaging complications MeSH
- Stroke * etiology diagnostic imaging MeSH
- Middle Aged MeSH
- Humans MeSH
- Magnetic Resonance Imaging MeSH
- Tomography, X-Ray Computed MeSH
- Retrospective Studies MeSH
- Risk Factors MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Carotid Stenosis * diagnostic imaging complications MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
Cíl: Automaticky předpovídat stabilitu aterosklerotického plátu v karotidě ze standardních transverzálních ultrazvukových obrazů v B-modu za použití hlubokého učení. Spolehlivý prediktor by snížil potřebu klinických kontrol i farmakologické či chirurgické léčby. Metody: Automaticky byla lokalizována oblast zájmu obsahující karotidu. Adversariální metoda segmentace byla natrénována na kombinaci malého kompletně anotovaného datasetu a většího slabě anotovaného datasetu. Multikriteriální regrese s automatickou adaptací vah byla použita k predikci série klinicky relevantních atributů, vč. nárůstu tloušťky plátu během 3 let. Výsledky: Současnou šíři plátu bylo možno odhadnout s vysokou korelací (ρ = 0,32) a velmi vysokou statistickou signifikancí. Odhadovaný budoucí nárůst šíře plátu byl korelován méně (ρ = 0,22), ale stále statisticky významně (p < 0,01). Korelace mezi automatickým a expertním hodnocením echogenicity, hladkosti a kalcifikací byla ještě nižší. Závěr: Potvrdili jsme závislost mezi vzhledem plátu v ultrazvukovém obraze a pravděpodobností jeho budoucího růstu, ale je příliš slabá, než aby byla využitelná v klinické praxi jako jediný prediktor stability plátu.
Aim: To automatically predict the stability of carotid artery plaque from standard B-mode transversal ultrasound images using deep learning. A reliable predictor would reduce the need for follow-up examination and pharmacological and surgical treatment. Methods: A region of interest containing the carotid artery was automatically localized. An adversarial segmentation method was trained on a combination of a small pixelwise annotated dataset and a larger weakly annotated dataset. A multicriterion regression with automatic weight adaptation was applied to predict a series of clinically relevant attributes, including the plaque width increase over 3 years. Results: The current plaque width could be estimated with a high correlation (ρ = 0.32) and a very high statistical significance. The estimated future increase of the plaque width was correlated less (ρ = 0.22) but statistically significantly (P < 0.01). The correlation between automatic and expert assessments of echogenicity, smoothness and calcification was even smaller. Conclusion: We confirmed a relationship between the plaque appearance in ultrasound and the probability of its future growth, but it is too weak to be used in clinical practice as the sole predictor of the plaque stability.
- MeSH
- Algorithms MeSH
- Plaque, Atherosclerotic * diagnostic imaging pathology MeSH
- Deep Learning MeSH
- Humans MeSH
- Computing Methodologies MeSH
- Prognosis MeSH
- Regression Analysis MeSH
- Statistics as Topic MeSH
- Ultrasonography, Carotid Arteries * statistics & numerical data MeSH
- Check Tag
- Humans MeSH
- Publication type
- Clinical Study MeSH
- Research Support, Non-U.S. Gov't MeSH
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 < 0.001 and 82%, 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.
- MeSH
- Plaque, Atherosclerotic * diagnostic imaging MeSH
- Risk Assessment MeSH
- Humans MeSH
- Magnetic Resonance Imaging methods MeSH
- Carotid Artery Diseases diagnostic imaging MeSH
- Tomography, X-Ray Computed methods MeSH
- Carotid Stenosis diagnostic imaging MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Meta-Analysis MeSH
- Systematic Review MeSH
BACKGROUND: This study investigates changes in cognitive function in patients with severe carotid stenosis who underwent carotid endarterectomy (CEA) and carotid stenting (CAS) over two decades. METHODS: We compared cognitive function within 30 days after the procedure in 267 patients (first 100 each for CEA and CAS in two periods: 2008-2012 and 2018-2022) in a single institution. Assessments used Adenbrooke's Cognitive Examination-Revised (ACE-R), the Mini-Mental State Examination (MMSE), Speech Fluency Test (SFT), and Clock Drawing Test (CDT), conducted before and 30 ± 2 days after surgery. RESULTS: Patients (mean age 67.2 years, 70%+ carotid stenosis) exhibited different cognitive changes over periods. In 2008-2012, significant declines in MMSE (CEA, p = 0.049) and CDT (CAS, p = 0.015) were observed among asymptomatic patients. On the contrary, in 2018-2022, improvements were observed in ACE-R and MMSE for symptomatic and asymptomatic patients undergoing CEA and CAS. CONCLUSION: Over a decade, advances in interventional techniques and patient management have reduced risks of cognitive decline in patients with asymptomatic carotid stenosis and also have improved cognitive functions in both symptomatic and asymptomatic individuals.
- Publication type
- Journal Article MeSH
Ultrazvukové vyšetření se stalo díky své neinvazivitě a relativně nízké ceně nedílnou součástí lékařské praxe. V posledním desetiletí se díky tlaku na rychlejší a přesnější diagnostiku, především u akutních onemocnění, rozvíjí nový koncept ultrazvukového vyšetření přímo v místě péče o pacienta, a to pomocí mobilních ultrazvukových přístrojů. Tento nový koncept dostal název point-of‐care ultrasound neboli POCUS a v posledních letech se rozšiřuje i do neurologie pod názvem Neuro‐POCUS.
Due to its non-invasiveness and relatively low cost, ultrasound examination has become an integral part of medical practice. Thanks to the pressure for faster and more accurate diagnosis in the last decade, especially for acute diseases, a new concept of ultrasound examination is being developed directly at the point of care of the patient using mobile ultrasound devices. This new concept was named point-of-care ultrasound or POCUS, and it has also been extended to neurology in recent years under the name Neuro-POCUS. Neuro POCUS is defined as a targeted ultrasound examination of the head, neck, orbit, or musculoskeletal system performed at the patient's bedside to obtain a rapid answer to a specific clinical question related to neurological symptoms in real time. Currently, Neuro POCUS examination appears to be a very promising alternative to a complex neurosonological examination, especially for patients in the emergency room, ICU, infectious or unstable patients, or when perioperative patient monitoring is required. Detailed examination protocols are still lacking, but working groups are beginning to create lists of clinical questions and indications.
- MeSH
- Acute Disease MeSH
- Humans MeSH
- Ultrasonography, Doppler, Transcranial * MeSH
- Point-of-Care Systems MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
BACKGROUND: Accurate assessment of carotid stenosis severity is important for proper patient management. The present study aimed to compare the evaluation of carotid stenosis severity using four duplex sonography (DUS) measurements, including peak systolic velocity (PSV), PSV ratio in stenosis and distal to stenosis (PSVICA/ICA ratio), end-diastolic velocity (EDV), and B-mode, with computed tomography angiography (CTA), and to evaluate the impact of plaque morphology on correlation between DUS and CTA. METHODS: Consecutive patients with carotid stenosis of ≥40% examined using DUS and CTA were included. Plaque morphology was also determined using magnetic resonance imaging. Spearman's correlation and Kendall's rank correlation were used to evaluate the results. RESULTS: A total of 143 cases of internal carotid artery stenosis of ≥40% based on DUS were analyzed. The PSVICA/ICA ratio showed the highest correlation [Spearman's correlation r = 0.576) with CTA, followed by PSV (r = 0.526), B-mode measurement (r = 0.482), and EDV (r = 0.441; p < 0.001 in all cases]. The worst correlation was found for PSV when the plaque was calcified (r = 0.238), whereas EDV showed a higher correlation (r = 0.523). Correlations of B-mode measurement were superior for plaques with smooth surface (r = 0.677), while the PSVICA/ICA ratio showed the highest correlation in stenoses with irregular (r = 0.373) or ulcerated (r = 0.382) surfaces, as well as lipid (r = 0.406), fibrous (r = 0.461), and mixed (r = 0.403; p < 0.01 in all cases) plaques. Nevertheless, differences between the mentioned correlations were not statistically significant (p > 0.05 in all cases). CONCLUSION: PSV, PSVICA/ICA ratio, EDV, and B-mode measurements showed comparable correlations with CTA in evaluation of carotid artery stenosis based on their correlation with CTA results. Heavy calcifications and plaque surface irregularity or ulceration negatively influenced the measurement accuracy.
- Publication type
- Journal Article MeSH
