title: Gadolinium Enhancement in Intracranial Atherosclerotic Plaque and Ischemic Stroke: A Systematic Review and Meta-Analysis.
abstract: Gadolinium enhancement on high-resolution magnetic resonance imaging (MRI) has been proposed as a marker of inflammation and instability in intracranial atherosclerotic plaque. We performed a systematic review and meta-analysis to summarize the association between intracranial atherosclerotic plaque enhancement and acute ischemic stroke.
  
  
  
  We searched the medical literature to identify studies of patients undergoing intracranial vessel wall MRI for evaluation of intracranial atherosclerotic plaque. We recorded study data and assessed study quality, with disagreements in data extraction resolved by a third reader. A random-effects odds ratio was used to assess whether, in any given patient, cerebral infarction was more likely in the vascular territory supplied by an artery with MRI-detected plaque enhancement as compared to territory supplied by an artery without enhancement. We calculated between-study heterogeneity using the Cochrane Q test and publication bias using the Begg-Mazumdar test. Eight articles published between 2011 and 2015 met inclusion criteria. These studies provided information about plaque enhancement characteristics from 295 arteries in 330 patients. We found a significant positive relationship between MRI enhancement and cerebral infarction in the same vascular territory, with a random effects odds ratio of 10.8 (95% CI 4.1-28.1, P<0.001). No significant heterogeneity (Q=11.08, P=0.14) or publication bias (P=0.80) was present.
  
  
  
  Intracranial plaque enhancement on high-resolution vessel wall MRI is strongly associated with ischemic stroke. Evaluation for plaque enhancement on MRI may be a useful test to improve diagnostic yield in patients with ischemic strokes of undetermined etiology.
authors.affiliation: Department of Radiology, Weill Cornell Medicine, New York, NY Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY ajg9004@med.cornell.edu hok9010@med.cornell.edu.
authors.forename: Ajay
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Department of Radiology, Weill Cornell Medicine, New York, NY.
authors.forename: Hediyeh
authors.initials: H
authors.lastname: Baradaran
authors.affiliation: Department of Radiology, Weill Cornell Medicine, New York, NY.
authors.forename: Khalid
authors.initials: K
authors.lastname: Al-Dasuqi
authors.affiliation: Department of Radiology, Weill Cornell Medicine, New York, NY.
authors.forename: Ashley
authors.initials: A
authors.lastname: Knight-Greenfield
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY.
authors.forename: Ashley E
authors.initials: AE
authors.lastname: Giambrone
authors.affiliation: Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, NY.
authors.forename: Diana
authors.initials: D
authors.lastname: Delgado
authors.affiliation: Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, NY.
authors.forename: Drew
authors.initials: D
authors.lastname: Wright
authors.affiliation: Department of Radiology, University of Cambridge, UK.
authors.forename: Zhongzhao
authors.initials: Z
authors.lastname: Teng
authors.affiliation: Department of Radiology, Weill Cornell Medicine, New York, NY Dalio Institute of Cardiovascular Imaging, Weill Cornell Medicine, New York, NY.
authors.forename: James K
authors.initials: JK
authors.lastname: Min
authors.affiliation: Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY Department of Neurology, Weill Cornell Medicine, New York, NY.
authors.forename: Babak B
authors.initials: BB
authors.lastname: Navi
authors.affiliation: Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY Department of Neurology, Weill Cornell Medicine, New York, NY.
authors.forename: Costantino
authors.initials: C
authors.lastname: Iadecola
authors.affiliation: Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY Department of Neurology, Weill Cornell Medicine, New York, NY.
authors.forename: Hooman
authors.initials: H
authors.lastname: Kamel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000473:pathology*; D002544:Cerebral Infarction / Q000473:pathology; D003287:Contrast Media; D005260:Female; D005682:Gadolinium; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000473:pathology*; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000473:pathology*; D011446:Prospective Studies; D012189:Retrospective Studies; D020521:Stroke / Q000473:pathology*
chemical_list: D003287:Contrast Media; D005682:Gadolinium
keywords: cerebral infarction; culprit artery; enhancement gadolinium; ischemic stroke; magnetic resonance imaging; plaque; vessel wall imaging