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Meta-Analysis
. 2024 Mar 11;19(3):e0295558.
doi: 10.1371/journal.pone.0295558. eCollection 2024.

The prevalence of non-contrast CT imaging abnormalities in reversible cerebral vasoconstriction syndrome: A systematic review and meta-analysis

Ryan Daniel Gotesman  1 , Naomi Niznick  2 , Brian Dewar  3 , Dean A Fergusson  3   4 , Ranjeeta Mallick  3   4 , Risa Shorr  5   6 , Michel Shamy  3   4 , Dar Dowlatshahi  3   4
Affiliations
Meta-Analysis

The prevalence of non-contrast CT imaging abnormalities in reversible cerebral vasoconstriction syndrome: A systematic review and meta-analysis

Ryan Daniel Gotesman et al. PLoS One. .

Abstract

Background: Reversible cerebral vasoconstriction syndrome (RCVS) is a syndrome of recurrent thunderclap headaches and reversible vasoconstriction of the cerebral arteries on neuroimaging within 3 months of onset. Initial non-contrast computed tomography (CT) can reveal abnormalities such as ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage (SAH) can be present in patients with RCVS and may delay diagnosis.

Aims: We conducted a systematic review and meta-analysis in accordance with the PRISMA guidelines. We aimed to estimate the prevalence of imaging abnormalities on initial non-contrast CT head in adult patients with RCVS.

Data sources & eligibility criteria: We searched electronic databases including MEDLINE, EMBASE, and the Cochrane Register of Clinical Trials from inception to August 2, 2022. Eligible studies included articles reporting the prevalence of non-contrast CT abnormalities on initial neuroimaging in patients with RCVS, aged 18 and older. Case series, observational studies and clinical trials were included. Data was extracted directly from included papers using a standardized data charting form.

Results: The search yielded 722 titles with duplicates removed. Twenty studies that included 379 patients with RCVS met inclusion criteria. We classified non-contrast CT abnormalities as either ischemic stroke, ICH, or SAH. We pooled prevalence data using a random effects model with the inverse-variance weighted method. The most common imaging finding was SAH with a pooled prevalence of 24% (95% CI:17%-33%), followed by ICH at 14% (95% CI:8%-22%), and ischemic stroke at 10% (95% CI:7%-14%). The pooled prevalence of any of these imaging abnormalities on initial non-contrast CT was 31% (95% CI:23%-40%). Risk of bias was moderate to very-high-risk for case-series and low-risk for observational studies.

Conclusion: Our review demonstrates that one-third of patients with RCVS will have an abnormality on initial non-contrast CT head, including either an ischemic stroke, ICH, or SAH. These findings highlight the diagnostic challenges of RCVS imaging and contribute to our understanding of this disease.

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Conflict of interest statement

The authors declare that there are no conflicts of interest.

Figures

Fig 1
Fig 1. Preferred reporting items for systematic reviews and meta analyses flow diagram.
Fig 2
Fig 2. Prevalence of subarachnoid hemorrhage on initial non-contrast CT.
Fig 3
Fig 3. Prevalence of intracerebral hemorrhage on initial non-contrast CT.
Fig 4
Fig 4. Prevalence of ischemic stroke on initial non-contrast CT.
Fig 5
Fig 5. Prevalence of either ischemic stroke, intracerebral hemorrhage, or subarachnoid hemorrhage on initial non-contrast CT.
See this image and copyright information in PMC

References

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