Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA.
J Neurointerv Surg. 2012 May;4(3):219-25. doi: 10.1136/neurintsurg-2011-010025. Epub 2011 Jul 18.
Computed tomographic angiography (CTA) has recently emerged as a non-invasive alternative to digital subtraction angiography (DSA) for the detection of residual cerebral aneurysms (RA).
To compare the diagnostic accuracy of CTA with the current 'gold standard', DSA, in the postoperative detection of RA.
Patient data from this single institution were prospectively gathered, and imaging results retrospectively blinded and analyzed. Between 2001 and 2005 eligible patients received microsurgical repair of cerebral aneurysms and were evaluated postoperatively by DSA and CTA. These single-institutional data were compiled with qualified studies published from 1997 to 2009, and a meta-analysis was performed.
This institutional series reports sensitivity, specificity, positive (PPV) and negative predictive values (NPV) of 100%. Eleven studies met the inclusion criteria for the meta-analysis. A total of 427 patients with 513 aneurysms were included, with 61 RA detected by DSA and 40 detected by CTA. Unweighted analysis resulted in pooled sensitivity of 73.8%, specificity of 96.3%, PPV of 91.0% and NPV of 86.1%. Stratified analysis of studies using 16-slice CTA versus 2D DSA reported pooled sensitivity of 92.6%, specificity of 99.3%, PPV of 95.8%, and NPV of 97.8%.
This meta-analysis supports CTA as an acceptable modality for postoperative detection of RA, although DSA remains the gold standard. By implementing multidetector CTA technology in experienced centers, the sensitivity and specificity of CTA may approach that of traditional DSA for detecting RA. As a cost-effective, non-invasive modality, CTA is a promising alternative to DSA for initial and long-term evaluation of RA.
计算机断层血管造影术（CTA）最近作为一种替代数字减影血管造影术（DSA）的非侵入性方法，用于检测残余脑动脉瘤（RA）。
比较 CTA 与目前的“金标准”DSA 在术后检测 RA 中的诊断准确性。
本单中心前瞻性收集患者数据，对影像学结果进行回顾性盲法分析。2001 年至 2005 年间，符合条件的患者接受了脑动脉瘤的显微手术修复，并接受了 DSA 和 CTA 术后评估。将这些单中心数据与 1997 年至 2009 年发表的合格研究进行了汇总，并进行了荟萃分析。
本机构系列报告灵敏度、特异性、阳性（PPV）和阴性预测值（NPV）均为 100%。11 项研究符合荟萃分析的纳入标准。共有 427 例患者（513 个动脉瘤）纳入研究，其中 61 个动脉瘤通过 DSA 检测，40 个动脉瘤通过 CTA 检测。未加权分析得到的汇总灵敏度为 73.8%，特异性为 96.3%，PPV 为 91.0%，NPV 为 86.1%。对使用 16 层 CTA 与 2D DSA 的研究进行分层分析，得到的汇总灵敏度为 92.6%，特异性为 99.3%，PPV 为 95.8%，NPV 为 97.8%。
这项荟萃分析支持 CTA 作为术后检测 RA 的一种可接受的方法，尽管 DSA 仍然是金标准。在有经验的中心实施多排螺旋 CTA 技术后，CTA 的灵敏度和特异性可能接近传统 DSA 检测 RA 的水平。作为一种具有成本效益的非侵入性方法，CTA 是 DSA 用于初始和长期评估 RA 的有前途的替代方法。
