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Intracranial atherosclerotic plaque features on vessel wall imaging predict first ever and recurrence of stroke: a meta-analysis.

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Title: Intracranial atherosclerotic plaque features on vessel wall imaging predict first ever and recurrence of stroke: a meta-analysis.
Authors: Zhang, Jinhuan1,2 (AUTHOR), Sun, Beibei2,3 (AUTHOR) alisabeibei@163.com, Wang, Huayu2 (AUTHOR), Shi, Hanrui2 (AUTHOR), Wen, Qiuting4,5 (AUTHOR), Mossa-Basha, Mahmud2 (AUTHOR), Zhu, Chengcheng2 (AUTHOR) zhucheng@uw.edu
Source: European Radiology. Aug2025, Vol. 35 Issue 8, p5017-5026. 10p.
Subjects: Ischemic stroke, Transient ischemic attack, Computer-assisted image analysis (Medicine), Intracranial arterial diseases, Blood vessels
Abstract: Objectives: Intracranial atherosclerotic disease (ICAD) features on vessel wall magnetic resonance imaging (VW-MRI) are associated with first-ever or recurrent ischemic stroke (IS) or transient ischemic attack (TIA). There are multiple longitudinal ICAD VW-MRI studies, but they are limited by small sample size, non-standardized imaging acquisition and analysis, and some controversial results. Hence, we conducted the current meta-analysis of intracranial plaque features predicting recurrence of IS. Materials and methods: PubMed, Web of Science, and EMBASE databases were searched through March 2024. Two independent reviewers extracted data on study design, VW-MRI techniques, and patient outcome. Quality assessment was used by the NOS tool. Subgroup analyses, sensitivity analysis, and evaluation of publication bias were also performed. Results: For recurrent IS, eighteen studies were included for meta-analysis, comprising 2240 participants, and 472 participants had recurrent IS during an average of 16-month follow-up. All studies were of high quality with an NOS score ≥ 7. Plaque enhancement (OR 2.18, [95% CI 1.70–4.65]), plaque enhancement ratio (SMD 0.46, [95% CI 0.15–0.77]), plaque thickness, (SMD 0.271, [95% CI 0.047–0.496]), T1-weighted (T1W) hyperintensity, (OR 2.58, [95% CI 1.56–4.26]), and degree of stenosis (SMD 0.41, [95% CI 0.03–0.79]) significantly predicted IS recurrence. Subgroup analyses found plaque enhancement was significantly higher in the IS and TIA recurrence group as compared to the non-recurrence group (OR 3.39, 95% CI 1.84–6.22). Conclusion: Plaque enhancement, plaque enhancement ratio, plaque thickness, T1W hyperintensity and degree of stenosis emerged as strong imaging biomarkers of recurrence of stroke. Clinical trial registration: Clinical trial registration no: CRD42023479678. Key Points: Questions Several studies suggest that vessel wall MRI (VWMRI) features of intracranial atherosclerotic disease (ICAD) may be associated with first-time or recurrent ischemic strokes, though this remains a debated topic. Findings Our study demonstrates that plaque enhancement, plaque enhancement ratio, plaque thickness, T1W hyperintensity, and degree of stenosis are strong imaging biomarkers for predicting stroke recurrence. Clinical relevance Incorporating these features into post-stroke evaluations using VWMRI could help guide patient management more effectively, enabling more targeted treatments for secondary stroke prevention. [ABSTRACT FROM AUTHOR]
Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Intracranial atherosclerotic plaque features on vessel wall imaging predict first ever and recurrence of stroke: a meta-analysis.
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  Data: <searchLink fieldCode="JN" term="%22European+Radiology%22">European Radiology</searchLink>. Aug2025, Vol. 35 Issue 8, p5017-5026. 10p.
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  Data: <searchLink fieldCode="DE" term="%22Ischemic+stroke%22">Ischemic stroke</searchLink><br /><searchLink fieldCode="DE" term="%22Transient+ischemic+attack%22">Transient ischemic attack</searchLink><br /><searchLink fieldCode="DE" term="%22Computer-assisted+image+analysis+%28Medicine%29%22">Computer-assisted image analysis (Medicine)</searchLink><br /><searchLink fieldCode="DE" term="%22Intracranial+arterial+diseases%22">Intracranial arterial diseases</searchLink><br /><searchLink fieldCode="DE" term="%22Blood+vessels%22">Blood vessels</searchLink>
– Name: Abstract
  Label: Abstract
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  Data: Objectives: Intracranial atherosclerotic disease (ICAD) features on vessel wall magnetic resonance imaging (VW-MRI) are associated with first-ever or recurrent ischemic stroke (IS) or transient ischemic attack (TIA). There are multiple longitudinal ICAD VW-MRI studies, but they are limited by small sample size, non-standardized imaging acquisition and analysis, and some controversial results. Hence, we conducted the current meta-analysis of intracranial plaque features predicting recurrence of IS. Materials and methods: PubMed, Web of Science, and EMBASE databases were searched through March 2024. Two independent reviewers extracted data on study design, VW-MRI techniques, and patient outcome. Quality assessment was used by the NOS tool. Subgroup analyses, sensitivity analysis, and evaluation of publication bias were also performed. Results: For recurrent IS, eighteen studies were included for meta-analysis, comprising 2240 participants, and 472 participants had recurrent IS during an average of 16-month follow-up. All studies were of high quality with an NOS score ≥ 7. Plaque enhancement (OR 2.18, [95% CI 1.70–4.65]), plaque enhancement ratio (SMD 0.46, [95% CI 0.15–0.77]), plaque thickness, (SMD 0.271, [95% CI 0.047–0.496]), T1-weighted (T1W) hyperintensity, (OR 2.58, [95% CI 1.56–4.26]), and degree of stenosis (SMD 0.41, [95% CI 0.03–0.79]) significantly predicted IS recurrence. Subgroup analyses found plaque enhancement was significantly higher in the IS and TIA recurrence group as compared to the non-recurrence group (OR 3.39, 95% CI 1.84–6.22). Conclusion: Plaque enhancement, plaque enhancement ratio, plaque thickness, T1W hyperintensity and degree of stenosis emerged as strong imaging biomarkers of recurrence of stroke. Clinical trial registration: Clinical trial registration no: CRD42023479678. Key Points: Questions Several studies suggest that vessel wall MRI (VWMRI) features of intracranial atherosclerotic disease (ICAD) may be associated with first-time or recurrent ischemic strokes, though this remains a debated topic. Findings Our study demonstrates that plaque enhancement, plaque enhancement ratio, plaque thickness, T1W hyperintensity, and degree of stenosis are strong imaging biomarkers for predicting stroke recurrence. Clinical relevance Incorporating these features into post-stroke evaluations using VWMRI could help guide patient management more effectively, enabling more targeted treatments for secondary stroke prevention. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1007/s00330-025-11451-1
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        Text: English
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    Subjects:
      – SubjectFull: Ischemic stroke
        Type: general
      – SubjectFull: Transient ischemic attack
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      – SubjectFull: Computer-assisted image analysis (Medicine)
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      – SubjectFull: Intracranial arterial diseases
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      – SubjectFull: Blood vessels
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              Text: Aug2025
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