Shen Jiantong, Li Xianglian, Li Youping, Wu Bing
Key Laboratory of Transplant Engineering and Immunology of the Ministry of Health of China, West China Hospital, Sichuan University, Chengdu, PR China.
Chinese Cochrane Center, West China Hospital, Sichuan University, Chengdu, PR China.
PLoS One. 2017 May 17;12(5):e0176622. doi: 10.1371/journal.pone.0176622. eCollection 2017.
To systematically evaluate and compare the diagnostic accuracy of CT perfusion (CTP), non-enhanced computed tomography (NCCT) and computed tomography angiography (CTA) in detecting acute ischemic stroke.
We searched seven databases and screened the reference lists of the included studies. The risk of bias in the study quality was assessed using QUADASII. We produced paired forest plots in RevMan to show the variation of the sensitivity and specificity estimates together with their 95% CI. We used a hierarchical summary ROC model to summarize the sensitivity and specificity of CTP in detecting ischemic stroke.
We identified 27 studies with a total of 2168 patients. The pooled sensitivity of CTP for acute ischemic stroke was 82% (95% CI 75-88%), and the specificity was 96% (95% CI 89-99%). CTP was more sensitive than NCCT and had a similar accuracy with CTA. There were no statistically significant differences in the sensitivity and specificity between patients who underwent CTP within 6 hours of symptom onset and beyond 6 hours after symptom onset. No adverse events were reported in the included studies.
CTP is more accurate than NCCT and has similar accuracy to CTA in detecting acute ischemic stroke. However, the evidence is not strong. There is potential benefit of using CTP to select stroke patients for treatment, but more high-quality evidence is needed to confirm this result.
系统评价和比较CT灌注成像（CTP）、非增强计算机断层扫描（NCCT）和计算机断层血管造影（CTA）在检测急性缺血性卒中方面的诊断准确性。
我们检索了七个数据库，并筛选了纳入研究的参考文献列表。使用QUADASII评估研究质量的偏倚风险。我们在RevMan中制作了配对森林图，以显示敏感性和特异性估计值及其95%置信区间的变化。我们使用分层汇总ROC模型来汇总CTP检测缺血性卒中的敏感性和特异性。
我们纳入了27项研究，共2168例患者。CTP检测急性缺血性卒中的合并敏感性为82%（95%置信区间75-88%），特异性为96%（95%置信区间89-99%）。CTP比NCCT更敏感，与CTA具有相似的准确性。症状发作后6小时内和症状发作后6小时以上接受CTP检查的患者之间，敏感性和特异性无统计学显著差异。纳入研究中未报告不良事件。
CTP在检测急性缺血性卒中方面比NCCT更准确，与CTA具有相似的准确性。然而，证据并不充分。使用CTP选择卒中患者进行治疗可能有益，但需要更多高质量证据来证实这一结果。
