ultrasound; CT; MRI; carotid plaques; meta-analysis;

Background and aimsIntraplaque hemorrhage (IPH) is a stronger prediction of stroke then any known clinical risk factors. Non-invasive imaging might help identify patients benefit from revascularization. The aim was to estimate the diagnostic accuracy of IPH using ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) when compared to histology in patients with symptomatic/asymptomatic carotid plaques.MethodsMedline Ovid, Embase, Cochrane Library, and Web of Science were searched for diagnostic accuracy of detection of carotid IPH compared to the gold standard of histology. We used QUADAS-2 to assess the quality of included studies and univariate and bivariate random-effect meta-analysis to analyze the results.Results67 studies investigated carotid IPH using three different imaging methods (4 CT, 41 MRI, 22 US studies) were included. In univariate meta-analysis, CT and MRI showed equal accuracy (86% [CT 95%CI: 67–95; MRI 95%CI: 84–88]), however, CT had a higher sensitivity (86% [95%CI: 52–97] vs 83% [95%CI: 80–86]) and MRI higher specificity (89% [95%CI: 86–92] vs 85% [95%CI: 46–98]). Furthermore, only MRI can identify the age of IPH (acute/fresh, subacute/recent, old: 6 more comparisons). US proved the lowest sensitivity (78% [95%CI: 68–86]), specificity (75% [95%CI: 65–83] and accuracy (77% [95%CI: 69–83]). Bivariate analysis showed that CT and MRI performed much better than US at all levels of specificity (MRI vs US: p < 0.001; CT vs US p = 0.50 due to the small number of CT studies).ConclusionsMRI and CT showed high and similar accuracy for IPH detection but only MRI can visualize the age of IPH. US proved to have the lowest accuracy.

Background and aimsIntraplaque hemorrhage (IPH) is a stronger prediction of stroke then any known clinical risk factors. Non-invasive imaging might help identify patients benefit from revascularization. The aim was to estimate the diagnostic accuracy of IPH using ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) when compared to histology in patients with symptomatic/asymptomatic carotid plaques.MethodsMedline Ovid, Embase, Cochrane Library, and Web of Science were searched for diagnostic accuracy of detection of carotid IPH compared to the gold standard of histology. We used QUADAS-2 to assess the quality of included studies and univariate and bivariate random-effect meta-analysis to analyze the results.Results67 studies investigated carotid IPH using three different imaging methods (4 CT, 41 MRI, 22 US studies) were included. In univariate meta-analysis, CT and MRI showed equal accuracy (86% [CT 95%CI: 67–95; MRI 95%CI: 84–88]), however, CT had a higher sensitivity (86% [95%CI: 52–97] vs 83% [95%CI: 80–86]) and MRI higher specificity (89% [95%CI: 86–92] vs 85% [95%CI: 46–98]). Furthermore, only MRI can identify the age of IPH (acute/fresh, subacute/recent, old: 6 more comparisons). US proved the lowest sensitivity (78% [95%CI: 68–86]), specificity (75% [95%CI: 65–83] and accuracy (77% [95%CI: 69–83]). Bivariate analysis showed that CT and MRI performed much better than US at all levels of specificity (MRI vs US: p < 0.001; CT vs US p = 0.50 due to the small number of CT studies).ConclusionsMRI and CT showed high and similar accuracy for IPH detection but only MRI can visualize the age of IPH. US proved to have the lowest accuracy.