Vessel wall magnetic resonance imaging of symptomatic middle cerebral artery atherosclerosis: A systematic review and meta-analysis

ObjectiveA comprehensive understanding of atherosclerotic middle cerebral artery (MCA) plaques aids physicians in diagnosis and treatment of ischemic stroke. High-resolution magnetic resonance imaging (MRI) has been used to identify imaging biomarkers of symptomatic MCA plaque. We performed this systematic review and meta-analysis to evaluate which characteristics of MCA plaque are markers of culprit lesions.Materials and methodsThe PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched for publications up to March 2022. Two independent reviewers extracted data on study design, high-resolution MRI parameters, and imaging end points. Odds ratios (ORs) for the prevalence of stroke with atherosclerotic MCA plaque features were pooled in the meta-analysis by using a random-effects model. Subgroup analysis, sensitivity analysis, and evaluation of publication bias were also conducted.ResultsSeventeen articles were included in this review. Symptomatic MCA plaques were significantly associated with contrast enhancement (OR, 9.4; 95 % CI, 4.3–20.4) and T1 hyperintensity (OR, 6.2; 95 % CI, 2.7–14.3). However, there was no association between symptomatic plaques and T2 hyperintensity (OR, 1.4; 95 % CI, 0.8–2.3). Plaque enhancement was significantly associated with downstream ischemic events in subgroup analyses based on different study designs and MR sequence types.ConclusionBased on current evidence, contrast enhancement and T1 hyperintensity on high-resolution MRI have high potential as imaging biomarkers of patients with MCA plaques at risk of ischemic events. Future prospective, longitudinal studies of intracranial-plaque high-resolution MRI are required to improve decision-making for the management of intracranial atherosclerotic plaques.