From the Department of Radiology (A.M.H.S., B.A.J.M.W., R.d.G., W.H.v.Z.), and Department of Epidemiology (P.J.N.), Maastricht University Medical Centre, Maastricht, The Netherlands.
Stroke. 2014 Jan;45(1):119-26. doi: 10.1161/STROKEAHA.113.003133. Epub 2013 Dec 10.
The aim of this study was to evaluate the sensitivity and specificity of MR angiography (MRA) in the diagnosis of ruptured and unruptured intracranial aneurysms.
A systematic search was performed on 4 electronic databases on relevant articles that were published from January 1998 to October 2013. Inclusion criteria were met by 12 studies that compared MRA with digital subtraction angiography as reference standard. Two independent reviewers evaluated the methodological quality of the studies. Data from eligible studies were extracted and used to construct 2×2 contingency tables on a per-aneurysm level. Pooled estimates of sensitivity and specificity were calculated for all studies and subgroups of studies. Heterogeneity was tested, and risk for publication bias was assessed.
Included studies were of high methodological quality. Studies with larger sample size tended to have higher diagnostic performance. Most studies used time-of-flight MRA technique. Among the 960 patients assessed, 772 aneurysms were present. Heterogeneity with reference to sensitivity and specificity was moderate to high. Pooled sensitivity of MRA was 95% (95% confidence interval, 89%-98%), and pooled specificity was 89% (95% confidence interval, 80%-95%). False-negative and false-positive aneurysms detected on MRA were mainly located at the skull base and middle cerebral artery. Freehand 3-dimensional reconstructions performed by the radiologist significantly increased diagnostic performance. Studies performed on 3 Tesla showed a trend toward higher performance (P=0.054).
Studies on diagnostic performance of MRA show high sensitivity with large variation in specificity in the detection of intracranial aneurysms.
本研究旨在评估磁共振血管造影（MRA）诊断破裂和未破裂颅内动脉瘤的敏感性和特异性。
对 4 个电子数据库进行了系统检索，检索了 1998 年 1 月至 2013 年 10 月发表的相关文章。有 12 项研究符合纳入标准，这些研究将 MRA 与数字减影血管造影作为参考标准进行比较。两位独立的审查员评估了研究的方法学质量。从合格研究中提取数据，并用于构建基于每一个动脉瘤的 2×2 四格表。对所有研究和亚组研究计算了敏感性和特异性的汇总估计值。测试了异质性，并评估了发表偏倚的风险。
纳入的研究具有较高的方法学质量。样本量较大的研究往往具有较高的诊断性能。大多数研究使用时间飞跃 MRA 技术。在评估的 960 例患者中，有 772 例存在动脉瘤。敏感性和特异性的异质性为中至高。MRA 的汇总敏感性为 95%（95%置信区间，89%-98%），汇总特异性为 89%（95%置信区间，80%-95%）。MRA 检测到的假阴性和假阳性动脉瘤主要位于颅底和大脑中动脉。放射科医生进行的徒手 3 维重建显著提高了诊断性能。在 3 Tesla 上进行的研究显示出较高性能的趋势（P=0.054）。
MRA 诊断性能的研究显示出较高的敏感性，特异性有较大的变化，可用于检测颅内动脉瘤。
