title: Carotid plaque MRI and stroke risk: a systematic review and meta-analysis.
abstract: OBJECTIVE
  MRI characterization of carotid plaque has been studied recently as a potential tool to predict stroke caused by carotid atherosclerosis. We performed a systematic review and meta-analysis to summarize the association of MRI-determined intraplaque hemorrhage, lipid-rich necrotic core, and thinning/rupture of the fibrous cap with subsequent ischemic events.
  
  
  METHODS
  We performed a comprehensive literature search evaluating the association of carotid plaque composition on MRI with ischemic outcomes. We included cohort studies examining intraplaque hemorrhage, lipid-rich necrotic core, or thinning/rupture of the fibrous cap with mean follow-up of ≥1 month and an outcome measure of ipsilateral stroke or transient ischemic attack. A meta-analysis using a random-effects model with assessment of study heterogeneity and publication bias was performed.
  
  
  RESULTS
  Of the 3436 articles screened, 9 studies with a total of 779 subjects met eligibility for systematic review. The hazard ratios for intraplaque hemorrhage, lipid-rich necrotic core, and thinning/rupture of the fibrous cap as predictors of subsequent stroke/transient ischemic attack were 4.59 (95% confidence interval, 2.91-7.24), 3.00 (95% confidence interval, 1.51-5.95), and 5.93 (95% confidence interval, 2.65-13.20), respectively. No statistically significant heterogeneity or publication bias was present in the 3 main meta-analyses performed.
  
  
  CONCLUSIONS
  The presence of intraplaque hemorrhage, lipid-rich necrotic core, and thinning/rupture of the fibrous cap on MRI of carotid plaque is associated with increased risk of future stroke or transient ischemic attack in patients with carotid atherosclerotic disease. Dedicated MRI of plaque composition offers stroke risk information beyond measurement of luminal stenosis in carotid atherosclerotic disease.
authors.affiliation: From the Departments of Radiology (A.G., H.B., A.D.S., P.C.S.), Neurology (H.K.), and Public Health (A.P., A.D., A.I.M., P.C.S.) and Samuel J. Wood Library & C.V. Starr Biomedical Information Center (D.D.), Weill Cornell Medical College, New York, NY.
authors.forename: Ajay
authors.initials: A
authors.lastname: Gupta
authors.forename: Hediyeh
authors.initials: H
authors.lastname: Baradaran
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Schweitzer
authors.forename: Hooman
authors.initials: H
authors.lastname: Kamel
authors.forename: Ankur
authors.initials: A
authors.lastname: Pandya
authors.forename: Diana
authors.initials: D
authors.lastname: Delgado
authors.forename: Allison
authors.initials: A
authors.lastname: Dunning
authors.forename: Alvin I
authors.initials: AI
authors.lastname: Mushlin
authors.forename: Pina C
authors.initials: PC
authors.lastname: Sanelli
mesh_terms: D016893:Carotid Stenosis / Q000150:complications / Q000473:pathology*; D015331:Cohort Studies; D006801:Humans; D008055:Lipids / Q000737:chemistry; D008279:Magnetic Resonance Imaging; D009336:Necrosis; D058226:Plaque, Atherosclerotic / Q000150:complications / Q000473:pathology*; D016016:Proportional Hazards Models; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000473:pathology* / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D008055:Lipids
keywords: MRI; carotid arteries; carotid artery plaque ▪ ischemic attack, transient; risk; stroke