Beyond the stenosis degree, the carotid plaque morphology assessed by computed tomography may improve the stroke risk stratification and is recommended to be considered before interventional treatment according to current guidelines. This study aimed to systematically review the accuracy of computed tomography (CT) to detect carotid plaque characteristics compared to histology in patients with symptomatic and asymptomatic carotid plaques. We registered the protocol in PROSPERO and searched Medline Ovid, Embase.com, Cochrane Library, and Web of Science for diagnostic accuracy of CT in specific carotid plaque characteristic imaging compared to histology, without any search limitation up to May 27, 2022. Out of 8,168 studies, 20 studies that evaluated seven specific plaque characteristics were included in our systematic review. The best diagnostic performance was found for the detection of ulceration (sensitivity range 39.4-100% [mean 79.6%], specificity range 74-100% [mean 93.6%]), followed by calcification (72.7-100% [88.1%], 35.7-100% [80.1%]), lipid-rich necrotic core (63.2-95.6% [81.1%], 60-100% [80.1%]), and intraplaque hemorrhage (61.5-100% [86%], 20-99.5% [67.8%]). Only a few studies evaluated specifically vulnerable, mixed, and fibrous plaque. Diagnostic studies with larger sample sizes are needed, using novel available CT techniques that enable increasing diagnostic performance and decreasing radiation and amount of contrast agent. CT allows for highly accurate detection of carotid plaque features, particularly ulceration and calcification. These results underline the role of routine CT examinations to assess not only stenosis degree but also plaque morphology and individual patient stroke risk to better guide management. Registration: PROSPERO ID CRD42022329690 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=329690).

• Klíčová slova
• Carotid atherosclerosis, Carotid plaque, Carotid stenosis, Computed tomography, Diagnostic accuracy, Unstable plaque,
• Publikační typ
• časopisecké články MeSH
• přehledy 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 χ 2-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.

• Klíčová slova
• atherosclerosis, calcification, carotid artery disease, cerebrovascular disease, computed tomography, magnetic resonance imaging,
• Publikační typ
• časopisecké články MeSH