Diagnostic performance of MRI for detecting intraplaque hemorrhage in the carotid arteries: a meta-analysis

  • Tao Zhou
  • Shouqiang Jia
  • Xiu Wang
  • Bin Wang
  • Zhiguo Wang
  • Ting Wu
  • Ying Li
  • Ying Chen
  • Chenxiao Yang
  • Qingguo Li
  • Zhen Yang
  • Min LiEmail author
  • Gang SunEmail author
Magnetic Resonance



To investigate the diagnostic performance of MRI in diagnosing carotid atherosclerotic intraplaque hemorrhage (IPH) and to provide a clinical guide for MRI application.


We searched MEDLINE, Embase, and Cochrane library from the earliest available date of indexing through November 30, 2017. All investigators screened and selected studies comparing the use of MRI with histology. The accuracy to diagnose pathological IPH was expressed by sensitivity, specificity, negative likelihood ratios (LRs), positive LRs, and the area under summary receiver-operating characteristic (SROC) curve. We calculated the post-test probability to assess the clinical utility of MRI.


We analyzed 696 patients from 20 articles. The sensitivity and specificity were 87% (95% CI, 81–91%) and 92% (95% CI, 87–95%), respectively. The positive and negative LRs were 10.27 (95% CI, 6.76–15.59) and 0.15 (95% CI, 0.10–0.21), respectively. The area under SROC curve was 0.95 (95% CI, 0.93–0.97). MRI was accurate in confirming or in ruling out disease over a wide range of pre-test probabilities of IPH: MRI could increase the post-test probability to > 80% in patients with a pre-test probability > 27% and could decrease the post-test probability to < 20% in patients with a pre-test probability < 64%.


Non-invasive MRI has excellent specificity and good sensitivity for diagnosing IPH. MRI is a tool for confirming or ruling out carotid atherosclerotic IPH.

Key Points

• Non-invasive MRI has excellent performance for diagnosing IPH, which is a component of vulnerable plaque.

• The high accuracy of MRI for IPH helps clinicians analyze the prognosis of clinical events and plan personalized treatment.


Carotid artery plaque Hemorrhage Stroke Magnetic resonance imaging 



Area under receiver of operating characteristic


Contrast enhanced


Confidence interval


Direct thrombus imaging


Fast field echo


Fast-spin echo


Gradient recalled echo


Intraplaque hemorrhage


Likelihood ratio


MR angiography


Magnetic resonance imaging


Proton density weighted imaging


Quality Assessment of Diagnostic Accuracy Studies


Rapid acquisition gradient echo


Spin echo


Summary receiver-operating characteristic


T1-weighted imaging


T2-weighted imaging


Turbo field echo


Time of flight


Turbo spin echo



This study has received funding by grants from the National Key R&D Program of China (2016YFC1300300).

Compliance with ethical standards


The scientific guarantor of this publication is Gang Sun.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

The author Min Li has significant statistical expertise.

Informed consent

Written informed consent was not required for this study because all analyses were based on previously published studies; thus, no patient consent is required.

Ethical approval

Institutional Review Board approval was not required because all analyses were based on previously published studies; thus, no ethical approval is required.


• prospective

• diagnostic study

• multicenter study

Supplementary material

330_2019_6053_MOESM1_ESM.docx (422 kb)
ESM 1 (DOCX 421 kb)


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Department of RadiologyLaiwu Affiliated Hospital of Taishan Medical UniversityLaiwuChina
  2. 2.Department of ICULaiwu Affiliated Hospital of Taishan Medical UniversityLaiwuChina
  3. 3.Department of Health CareShandong University Affiliated Jinan Center HospitalJinanChina
  4. 4.Department of Medical Imaging, 960 Hospital of PLAJinanChina

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