Gadolinium Enhancement in Intracranial Atherosclerotic Plaque and Ischemic Stroke: A Systematic Review and Meta‐Analysis

Abstract

BackgroundGadolinium 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.Methods and ResultsWe 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.ConclusionsIntracranial 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.

Effect of Time Elapsed since Gadolinium Administration on Atherosclerotic Plaque Enhancement in Clinical Vessel Wall MR Imaging Studies

“…6 Enhancement of ICAD plaques is a particularly instructive feature, and this characteristic, in particular, is prone to variability. [6][7][8] These results confirm our early clinical observation that lesion enhancement was accentuated by increased duration between contrast administration and acquisition of postcontrast DANTE images. The association between time and T1 signal changes is independent of changes in the pituitary gland.…”

“…[1][2][3][4][5][6] In the evaluation of ICAD with vwMRI, an important diagnostic finding is plaque enhancement, a characteristic widely believed to reflect inflammation. 7,8 Inconsistencies in acquisition parameters and image interpretation have limited progress in the development of these promising MR imaging techniques. 6,7,[9][10][11][12] Reproducible quantitative interpretation techniques could help overcome these limitations, particularly with respect to enhancement, but standardization of acquisition parameters is also needed.…”

“…7,8 Inconsistencies in acquisition parameters and image interpretation have limited progress in the development of these promising MR imaging techniques. 6,7,[9][10][11][12] Reproducible quantitative interpretation techniques could help overcome these limitations, particularly with respect to enhancement, but standardization of acquisition parameters is also needed. 6 Duration between contrast administration and image acquisition affects the degree of measured enhancement in other pathologies.…”

Atherosclerosis in stroke‐related vascular beds and stroke risk: A 3‐D MR vessel wall imaging study

“…Fifth, gadolinium‐based contrast agent was not administrated in this study. Since contrast enhancement of vessel wall in atherosclerotic disease may reflect the activity and vulnerability of plaques,31, 32 it is warranted to introduce contrast agent in future studies. Finally, the longitudinal coverage of our intracranial vessel wall imaging was near 40 mm, which cannot cover the whole V4 segment of vertebral artery for some patients.…”

New Concept in Stroke Diagnosis

“…A systematic review and meta-analysis to evaluate the association between abnormal plaque enhancement on high-resolution MRI and acute ischemic stroke has been performed [25]. The results indicate that intracranial plaque enhancement on high-resolution vessel wall MRI is strongly associated with ischemic stroke.…”