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. 2020 Mar;62(3):273-281.
doi: 10.1007/s00234-019-02349-z. Epub 2020 Jan 4.

Is four-dimensional CT angiography as effective as digital subtraction angiography in the detection of the underlying causes of intracerebral haemorrhage: a systematic review

C E Denby  1   2 , K Chatterjee  3 , R Pullicino  4 , S Lane  5 , M R Radon  4 , K V Das  4
Affiliations

Is four-dimensional CT angiography as effective as digital subtraction angiography in the detection of the underlying causes of intracerebral haemorrhage: a systematic review

C E Denby et al. Neuroradiology. 2020 Mar.

Abstract

Purpose: To determine whether the sensitivity and specificity of four-dimensional CTA (4D-CTA) are equivalent to digital subtraction angiography (DSA) in the detection of underlying vascular abnormalities in patients with intracerebral haemorrhage (ICH).

Methods: A systematic review of studies comparing 4D-CTA with DSA in the detection of the underlying structural causes of ICH was performed on the literature published between 1998 and 2019.

Results: We identified a total of 237 articles from PubMed, SCOPUS and Web of Science using the following Medical Subject Headings (MeSH) terms: primary intracerebral haemorrhage, 4D-CTA, DSA, cerebral haemorrhage, angiography, digital subtraction, arteriovenous malformations, 4D, CTA, dynamic-CTA and time-resolved CTA. Following the removal of duplicate publications and articles failing to meet our inclusion criteria, there were four articles potentially viable for analysis. Therefore, there were not sufficient studies to provide a statistically meaningful meta-analysis.

Conclusion: The review of current literature has demonstrated that there are few published studies comparing 4D-CTA with DSA in spontaneous ICH, with only four suitable studies identified for potential analysis. However, due to the restricted number of patients and high sensitivity and specificity of 3 studies (100%), performing a meta-analysis was not meaningful. Qualitative analysis of the data concluded that 4D-CTA has the diagnostic potential to replace invasive DSA in certain cases with vascular abnormalities. However, further research studies directly comparing 4D-CTA with DSA using larger prospective patient cohorts are required to strengthen the evidence base.

Keywords: Digital subtraction angiography (DSA); Four-dimensional CTA (4D-CTA); Haemorrhagic stroke; Intracerebral haemorrhage (ICH); Systematic review; Vascular abnormalities.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flowchart of the literature search and study selection of ICH patients, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (SAH, subarachnoid haemorrhage; TBI, traumatic brain injury). *Records excluded (n = 85) (SAH (n = 27), TBI (n = 2), case studies (n = 10), ischemic stroke (n = 6), no 4D-CTA (n = 14), no DSA (n = 14), review papers (n = 7), manuscript response letters (n = 1), non-neurological condition (n = 2), non-English (n = 2)). #Records excluded (n = 22): not performing DSA (n = 8) or 4D-CTA (n = 7), with further 5 studies failing to use 4D-CTA and DSA as part of the patient investigations. One study was a service audit, with another study presenting only case studies
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