Hollingworth William, Nathens Avery B, Kanne Jeffrey P, Crandall Marie L, Crummy Timothy A, Hallam Danial K, Wang Marjorie C, Jarvik Jeffrey G
Department of Radiology, Harborview Medical Center and the University of Washington, Box 359728, 325 Ninth Avenue, Seattle, WA 98104-2499, USA.
Eur J Radiol. 2003 Oct;48(1):88-102. doi: 10.1016/s0720-048x(03)00200-6.
Helical computed tomography angiography (CTA) has become an established technique for evaluating atherosclerosis of the cerebrovascular arteries. However, the role of CTA in penetrating and blunt trauma to the carotid and vertebral arteries is not well defined. We conducted a systematic literature review to determine the diagnostic accuracy of CTA for atherosclerotic, penetrating and blunt lesions in the carotid and vertebral arteries.
We searched MEDLINE and EMBASE databases to identify studies evaluating the diagnostic accuracy of CTA of the carotid and vertebral arteries published between January 1, 1992 and December 31, 2002. Two reviewers independently assessed abstracts and full text to determine study eligibility. Information on methodological quality, imaging technique and diagnostic accuracy was abstracted from all eligible studies by three independent reviewers. We pooled sensitivity and specificity data from diagnostic accuracy studies of high methodological quality.
Forty-three articles met the inclusion criteria and were included in the review. Thirty studies examined atherosclerotic disease, two blunt trauma, two penetrating trauma and nine examined patients with other pathology. Pooled data from 15 higher quality studies demonstrated that CTA had a sensitivity of 95% (91-97% CI) for detecting severe (>70%) atherosclerotic stenosis of the carotid artery. The specificity of CTA for severe stenosis was also high 98% (96-99% CI). CTA remained a sensitive technique (95%; 93-97% CI) when the criterion for a positive result is relaxed to moderate or greater (>30%) stenosis. Two studies raised concerns about the use of CTA in the blunt trauma setting, suggesting that CTA may not be sensitive for detecting small intimal injuries, although both of these studies used older technologies for either obtaining or viewing images. Conversely, two penetrating trauma studies concluded that the sensitivity of CTA was high.
Our findings demonstrate that CTA is both a sensitive and specific imaging technique for identifying severe atherosclerotic stenosis and occlusion of the carotid arteries. However, there is currently not enough high quality evidence to accurately estimate the sensitivity and specificity of CTA in the setting of blunt or penetrating trauma.
螺旋计算机断层血管造影（CTA）已成为评估脑血管动脉粥样硬化的既定技术。然而，CTA在颈动脉和椎动脉穿透伤和钝性伤中的作用尚不明确。我们进行了一项系统的文献综述，以确定CTA对颈动脉和椎动脉粥样硬化、穿透伤和钝性病变的诊断准确性。
我们检索了MEDLINE和EMBASE数据库，以识别1992年1月1日至2002年12月31日期间发表的评估颈动脉和椎动脉CTA诊断准确性的研究。两名审阅者独立评估摘要和全文以确定研究的合格性。三名独立审阅者从所有合格研究中提取有关方法学质量、成像技术和诊断准确性的信息。我们汇总了来自方法学质量高的诊断准确性研究的敏感性和特异性数据。
43篇文章符合纳入标准并被纳入综述。30项研究检查了动脉粥样硬化疾病，2项检查了钝性伤，2项检查了穿透伤，9项检查了患有其他病理情况的患者。来自15项高质量研究的汇总数据表明，CTA检测颈动脉严重（>70%）动脉粥样硬化狭窄的敏感性为95%（91-97%可信区间）。CTA对严重狭窄的特异性也很高，为98%（96-99%可信区间）。当阳性结果的标准放宽至中度或更大（>30%）狭窄时，CTA仍然是一种敏感的技术（95%；93-97%可信区间）。两项研究对CTA在钝性伤情况下的应用提出了担忧，表明CTA可能对检测小的内膜损伤不敏感，尽管这两项研究都使用了较旧的技术来获取或查看图像。相反，两项穿透伤研究得出结论，CTA的敏感性很高。
我们的研究结果表明，CTA是识别颈动脉严重动脉粥样硬化狭窄和闭塞的一种敏感且特异的成像技术。然而，目前没有足够的高质量证据来准确估计CTA在钝性或穿透伤情况下的敏感性和特异性。
