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Meta-Analysis
. 2014 May;35(5):866-71.
doi: 10.3174/ajnr.A3787. Epub 2013 Dec 5.

CT perfusion for detection of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis

D I A Mir  1 , A Gupta  1 , A Dunning  2 , L Puchi  1 , C L Robinson  1 , H-A B Epstein  3 , P C Sanelli  4
Affiliations
Meta-Analysis

CT perfusion for detection of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis

D I A Mir et al. AJNR Am J Neuroradiol. 2014 May.

Abstract

Background and purpose: Delayed cerebral ischemia is a significant cause of morbidity and mortality after aneurysmal SAH, leading to poor outcomes. The purpose of this study was to evaluate the usefulness of CTP in determining delayed cerebral ischemia in patients with aneurysmal SAH.

Materials and methods: We conducted a systematic review evaluating studies that assessed CTP in patients with aneurysmal SAH for determining delayed cerebral ischemia. Studies using any of the following definitions of delayed cerebral ischemia were included in the systematic review: 1) new onset of clinical deterioration, 2) cerebral infarction identified on follow-up CT or MR imaging, and 3) functional disability. A random-effects meta-analysis was performed assessing the strength of association between a positive CTP result and delayed cerebral ischemia.

Results: The systematic review identified 218 studies that met our screening criteria, of which 6 cohort studies met the inclusion criteria. These studies encompassed a total of 345 patients, with 155 (45%) of 345 patients classified as having delayed cerebral ischemia and 190 (55%) of 345 patients as not having delayed cerebral ischemia. Admission disease severity was comparable across all groups. Four cohort studies reported CTP test characteristics amenable to the meta-analysis. The weighted averages and ranges of the pooled sensitivity and specificity of CTP in the determination of delayed cerebral ischemia were 0.84 (0.7-0.95) and 0.77 (0.66-0.82), respectively. The pooled odds ratio of 23.14 (95% CI, 5.87-91.19) indicates that patients with aneurysmal SAH with positive CTP test results were approximately 23 times more likely to experience delayed cerebral ischemia compared with patients with negative CTP test results.

Conclusions: Perfusion deficits on CTP are a significant finding in determining delayed cerebral ischemia in aneurysmal SAH. This may be helpful in identifying patients with delayed cerebral ischemia before development of infarction and neurologic deficits.

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Figures

Fig 1.
Fig 1.
Study selection flow diagram. Figure adapted from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Group Statement.
Fig 2.
Fig 2.
Percentage of studies included in the systematic review scoring “Yes,” “No,” or “Unknown” on QUADAS tool criteria. Questions truncated in figure according to information provided from previously published work.
Fig 3.
Fig 3.
Forest plot of data used to tabulate the pooled odds ratios for studies included in the meta-analysis.
See this image and copyright information in PMC

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