Share this content in WeChat
Clinical Article
Meta analysis of correlation between characteristics of vulnerable intracranial plaque and occurrence and recurrence of ischemic stroke
WANG Zehua  GAO Yang  WU Qiong  HE Jinlong  LUO Tong  WANG Liwen 

Cite this article as: WANG Z H, GAO Y, WU Q, et al. Meta analysis of correlation between characteristics of vulnerable intracranial plaque and occurrence and recurrence of ischemic stroke[J]. Chin J Magn Reson Imaging, 2023, 14(4): 16-21. DOI:10.12015/issn.1674-8034.2023.04.004.

[Abstract] Objective Meta analysis was used to qualitatively evaluate the correlation between the characteristics of intracranial vulnerable plaques and the occurrence and recurrence of ischemic stroke.Materials and Methods PubMed, The Cochrane Library, Embase and Medline were searched by computer, and high-resolution vascular wall imaging was collected to evaluate the correlation between the characteristics of intracranial vulnerable plaques and the occurrence and recurrence of ischemic stroke. Two independent evaluators extracted data on study design, vascular wall magnetic resonance imaging techniques, and population characteristics. The odds ratio (OR) or hazard ratio (HR) of different vulnerable plaque features were calculated and combined using fixed effects models. Subgroup analysis, sensitivity analysis and publication bias assessment were also performed.Results Twenty-four articles met the inclusion criteria. In 19 retrospective studies, plaque enhancement (OR: 8.84, 95% CI: 6.21-12.59) and intra-plaque bleeding (OR: 5.23, 95% CI: 3.60-7.59) were significantly associated with ischemic stroke. In five prospective studies, plaque enhancement (HR: 5.21, 95% CI: 2.92-9.31) and intra-plaque bleeding (HR: 2.07, 95% CI: 1.41-3.02) were significantly associated with recurrent ischemic stroke.Conclusions According to the existing studies on symptomatic intracranial atherosclerotic plaque, plaque enhancement and intracplaque hemorrhage are closely related to the occurrence and recurrence of ischemic stroke. Prospective, large-sample size, high-resolution magnetic resonance vascular wall imaging studies on intracranial plaques are needed in the future to improve clinical decision making for intracranial atherosclerotic plaques.
[Keywords] vulnerable plaque;stroke;stroke recurrence;magnetic resonance imaging;high-resolution vessel wall imaging;Meta analysis

WANG Zehua   GAO Yang*   WU Qiong   HE Jinlong   LUO Tong   WANG Liwen  

Department of Radiology, the First Clinical Medical College of Inner Mongolia Medical University, Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China

Corresponding author: Gao Y, E-mail:

Conflicts of interest   None.

ACKNOWLEDGMENTS Healthcare and Technology Plan Project of Inner Mongolia Autonomous Region (No. 202201250).
Received  2023-01-24
Accepted  2023-04-07
DOI: 10.12015/issn.1674-8034.2023.04.004
Cite this article as: WANG Z H, GAO Y, WU Q, et al. Meta analysis of correlation between characteristics of vulnerable intracranial plaque and occurrence and recurrence of ischemic stroke[J]. Chin J Magn Reson Imaging, 2023, 14(4): 16-21. DOI:10.12015/issn.1674-8034.2023.04.004.

TANG M, GAO J, MA N, et al. Radiomics Nomogram for Predicting Stroke Recurrence in Symptomatic Intracranial Atherosclerotic Stenosis[J/OL]. Front Neurosci, 2022, 16:851353 [2023-01-23]. DOI: 10.3389/fnins.2022.851353.
GAO P. Expert consensus on imaging evaluation of intracranial atherosclerotic stenosis[J]. Chinese Journal of Cerebrovascular Diseases, 2021, 18(8): 575-584. DOI: 10.3969/j.issn.1672-5921.2021.08.008.
TIAN X, FANG H, LAN L, et al. Risk stratification in symptomatic intracranial atherosclerotic disease with conventional vascular risk factors and cerebral haemodynamics[J]. Stroke Vasc Neurol, 2023, 8(1): 77-85. DOI: 10.1136/svn-2022-001606.
PRABHAKARAN S, LIEBESKIND D S, COTSONIS G, et al. Predictors of Early Infarct Recurrence in Patients With Symptomatic Intracranial Atherosclerotic Disease[J]. Stroke, 2021, 52(6): 1961-1966. DOI: 10.1161/STROKEAHA.120.032676.
WU G, WANG H, ZHAO C, et al. Large Culprit Plaque and More Intracranial Plaques Are Associated with Recurrent Stroke: A Case-Control Study Using Vessel Wall Imaging[J]. AJNR Am J Neuroradiol, 2022, 43(2): 207-215. DOI: 10.3174/ajnr.A7402.
SUN B, WANG L, LI X, et al. Intracranial Atherosclerotic Plaque Characteristics and Burden Associated With Recurrent Acute Stroke: A 3D Quantitative Vessel Wall MRI Study[J]. Front Aging Neurosci, 2021, 13(3): 706-720. DOI: 10.3389/fnagi.2021.706544.
LUO W, LIU X, BAO K, et al. Ischemic stroke associated with COVID-19: a systematic review and meta-analysis[J]. J Neurol, 2022, 269(4): 1731-1740. DOI: 10.1007/s00415-021-10837-7.
JIANG H, REN K, LI T, et al. Correlation of the characteristics of symptomatic intracranial atherosclerotic plaques with stroke types and risk of stroke recurrence: a cohort study[J]. Ann Transl Med, 2022, 10(12): 658. DOI: 10.21037/atm-22-2586.
REN K, JIANG H, LI T, et al. Predictive value of the combination between the intracranial arterial culprit plaque characteristics and the Essen Stroke Risk Score for short-term stroke recurrence[J/OL]. J Stroke Cerebrovasc Dis, 2022, 31(9): 106624 [2023-01-23]. DOI: 10.1016/j.jstrokecerebrovasdis.2022.106624.
ZHANG D, WANG M, WU L, et al. Assessing the characteristics and diagnostic value of plaques for patients with acute stroke using high-resolution magnetic resonance imaging[J]. Quant Imaging Med Surg, 2022, 12(2): 1529-1538. DOI: 10.21037/qims-21-531.
LIN X, GUO W, SHE D, et al. Follow-up assessment of atherosclerotic plaques in acute ischemic stroke patients using high-resolution vessel wall MR imaging[J]. Neuroradiology, 2022, 64(12): 2257-2266. DOI: 10.1007/s00234-022-03002-y.
XU C, QIN J, YU J, et al. Association of plaque enhancement on vessel wall MRI and the phosphodiesterase 4D variant with stroke recurrence in patients with symptomatic intracranial atherosclerosis[J]. Neuroradiology, 2022, 64(9): 1781-1794. DOI: 10.1007/s00234-022-02948-3.
LU Y, YE M F, ZHAO J J, et al. Gadolinium enhancement of atherosclerotic plaque in the intracranial artery[J]. Neurol Res, 2021, 43(12): 1040-1049. DOI: 10.1080/01616412.2021.1949682.
SONG X, ZHAO X, LIEBESKIND D S, et al. Incremental value of plaque enhancement in predicting stroke recurrence in symptomatic intracranial atherosclerosis[J]. Neuroradiology, 2020, 62(9): 1123-1131. DOI: 10.1007/s00234-020-02418-8.
SHI Z, LI J, ZHAO M, et al. Quantitative Histogram Analysis on Intracranial Atherosclerotic Plaques: A High-Resolution Magnetic Resonance Imaging Study[J]. Stroke, 2020, 51(7): 2161-2169. DOI: 10.1161/STROKEAHA.120.029062.
HUANG J, JIAO S, ZHAO X, et al. Characteristics of patients with enhancing intracranial atherosclerosis and association between plaque enhancement and recent cerebrovascular ischemic events: a high-resolution magnetic resonance imaging study[J]. Acta Radiol, 2019, 60(10): 1301-1307. DOI: 10.1177/0284185118822645.
ZHU C, TIAN X, DEGNAN A J, et al. Clinical Significance of Intraplaque Hemorrhage in Low- and High-Grade Basilar Artery Stenosis on High-Resolution MRI[J]. AJNR Am J Neuroradiol, 2018, 39(7): 1286-1292. DOI: 10.3174/ajnr.A5676.
LU S S, GE S, SU C Q, et al. Plaque Distribution and Characteristics in Low-Grade Middle Cerebral Artery Stenosis and Its Clinical Relevance: A 3-Dimensional High-Resolution Magnetic Resonance Imaging Study[J]. J Stroke Cerebrovasc Dis, 2018, 27(8): 2243-2249. DOI: 10.1016/j.jstrokecerebrovasdis.2018.04.010.
LU S S, XIE J, SU C Q, et al. Plasma homocysteine levels and intracranial plaque characteristics: association and clinical relevance in ischemic stroke[J]. BMC Neurol, 2018, 18(1): 200. DOI: 10.1186/s12883-018-1203-4.
WU F, MA Q, SONG H, et al. Differential Features of Culprit Intracranial Atherosclerotic Lesions: A Whole-Brain Vessel Wall Imaging Study in Patients With Acute Ischemic Stroke[J]. J Am Heart Assoc, 2018, 7(15): 705. DOI: 10.1161/JAHA.118.009705.
WANG W, YANG Q, LI D, et al. Incremental Value of Plaque Enhancement in Patients with Moderate or Severe Basilar Artery Stenosis: 3.0 T High-Resolution Magnetic Resonance Study[J/OL]. Biomed Res Int, 2017, 17: 4281629 [2023-01-23]. DOI: 10.1155/2017/4281629.
TENG Z, PENG W, ZHAN Q, et al. An assessment on the incremental value of high-resolution magnetic resonance imaging to identify culprit plaques in atherosclerotic disease of the middle cerebral artery[J]. Eur Radiol, 2016, 26(7): 2206-2214. DOI: 10.1007/s00330-015-4008-5.
KIM J M, JUNG K H, SOHN C H, et al. Intracranial plaque enhancement from high resolution vessel wall magnetic resonance imaging predicts stroke recurrence[J]. Int J Stroke, 2016, 11(2): 171-179. DOI: 10.1177/1747493015609775.
YU J H, KWAK H S, CHUNG G H, et al. Association of Intraplaque Hemorrhage and Acute Infarction in Patients With Basilar Artery Plaque[J]. Stroke, 2015, 46(10): 2768-2772. DOI: 10.1161/STROKEAHA.115.009412.
ZOU X D, CHUNG Y C, ZHANG L, et al. Middle Cerebral Artery Atherosclerotic Plaques in Recent Small Subcortical Infarction: A Three-Dimensional High-resolution MR Study[J/OL]. Biomed Res Int, 2015, 15: 540217 [2023-01-23]. DOI: 10.1155/2015/540217.
XU P, LV L, LI S, et al. Use of high-resolution 3.0-T magnetic resonance imaging to characterize atherosclerotic plaques in patients with cerebral infarction[J]. Exp Ther Med, 2015, 10(6): 2424-2428. DOI: 10.3892/etm.2015.2815.
YANG W Q, HUANG B, LIU X T, et al. Reproducibility of high-resolution MRI for the middle cerebral artery plaque at 3T[J]. Eur J Radiol, 2014, 83(1): 49-55. DOI: 10.1016/j.ejrad.2013.10.003.
QIAO Y, ZEILER S R, MIRBAGHERI S, et al. Intracranial plaque enhancement in patients with cerebrovascular events on high-spatial- resolution MR images[J]. Radiology, 2014, 271(2): 534-542. DOI: 10.1148/radiol.13122812.
VAKIL P, VRANIC J, HURLEY M C, et al. T1 gadolinium enhancement of intracranial atherosclerotic plaques associated with symptomatic ischemic presentations[J]. AJNR Am J Neuroradiol, 2013, 34(12): 2252-2258. DOI: 10.3174/ajnr.A3606.
XU W H, LI M L, GAO S, et al. Middle cerebral artery intraplaque hemorrhage: prevalence and clinical relevance[J]. Ann Neurol, 2012, 71(2):195-198. DOI: 10.1002/ana.22626.
CHUNG G H, KWAK H S, HWANG S B, et al. High resolution MR imaging in patients with symptomatic middle cerebral artery stenosis[J]. Eur J Radiol, 2012, 81(12): 4069-4074. DOI: 10.1016/j.ejrad.2012.07.001.
YANG R, YUAN J, CHEN X, et al. Vessel wall magnetic resonance imaging of symptomatic middle cerebral artery atherosclerosis: A systematic review and meta-analysis[J/OL]. Clin Imaging, 2022, 90: 90-96 [2023-01-23]. DOI: 10.1016/j.clinimag.2022.08.001.
SONG J W, PAVLOU A, XIAO J, et al. Vessel Wall Magnetic Resonance Imaging Biomarkers of Symptomatic Intracranial Atherosclerosis: A Meta-Analysis[J]. Stroke, 2021, 52(1): 193-202. DOI: 10.1161/STROKEAHA.120.031480.
ZHANG X, CHEN L, LI S, et al. Enhancement Characteristics of Middle Cerebral Arterial Atherosclerotic Plaques Over Time and Their Correlation With Stroke Recurrence[J]. J Magn Reson Imaging, 2021, 53(3): 953-962. DOI: 10.1002/jmri.27351.
YANG D, LIU J, YAO W, et al. The MRI enhancement ratio and plaque steepness may be more accurate for predicting recurrent ischemic cerebrovascular events in patients with intracranial atherosclerosis[J]. Eur Radiol, 2022, 32(10): 7004-7013. DOI: 10.1007/s00330-022-08893-2.
XIAO J, SONG S S, SCHLICK K H, et al. Disparate trends of atherosclerotic plaque evolution in stroke patients under 18-month follow-up: a 3D whole-brain magnetic resonance vessel wall imaging study[J]. Neuroradiol J, 2022, 35(1): 42-52. DOI: 10.1177/19714009211026920.
LEE U Y, KWAK H S. Evaluation of Plaque Vulnerability via Combination of Hemodynamic Analysis and Simultaneous Non-Contrast Angiography and Intraplaque Hemorrhage (SNAP) Sequence for Carotid Intraplaque Hemorrhage[J]. J Pers Med, 2021, 11(9):856. DOI: 10.3390/jpm11090856.
LIU S, TANG R, XIE W, et al. Plaque characteristics and hemodynamics contribute to neurological impairment in patients with ischemic stroke and transient ischemic attack[J]. Eur Radiol, 2021, 31(4): 2062-2072. DOI: 10.1007/s00330-020-07327-1.

PREV Changes of functional connectivity density in different severity of nicotine addicts: A functional magnetic resonance imaging study
NEXT Study on quantitative monitoring of occult injury in normal white matter regions of WMHs with different Fazekas based on DTI combined with ASL technique

Tel & Fax: +8610-67113815    E-mail: