Yu Zhiyuan, Zheng Jun, Xu Zhao, Li Mou, Wang Xiaoze, Lin Sen, Li Hao, You Chao
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
World Neurosurg. 2017 Dec;108:347-355. doi: 10.1016/j.wneu.2017.09.022. Epub 2017 Sep 12.
This systematic review and meta-analysis was aimed to evaluate the predictive values of shape irregularity and density heterogeneity of hematoma on noncontrast computed tomography (NCCT) for hematoma expansion (HE).
A literature search was performed in PubMed, Embase, Scopus, Web of Science, and Cochrane Library. Studies about predictive values of shape regularity or density heterogeneity of hematoma on NCCT for HE in spontaneous intracerebral hemorrhage were included. Meta-analysis was performed to pool the data. Publication bias assessment, subgroup analysis, and univariate meta-regression were conducted.
A total of 7 studies with 2294 patients were included. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of shape irregularity were 67%, 47%, 1.30, and 0.71, respectively. In contrast, the pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of density irregularity were 52%, 69%, 1.70, and 0.69, respectively.
Considering the relatively low sensitivity and specificity, the predictive values of shape irregularity and density heterogeneity of hematoma for HE are limited. Further studies are still needed to find optimal NCCT predictors for HE in spontaneous intracerebral hemorrhage patients.
本系统评价和荟萃分析旨在评估非增强计算机断层扫描（NCCT）上血肿的形态不规则性和密度异质性对血肿扩大（HE）的预测价值。
在PubMed、Embase、Scopus、Web of Science和Cochrane图书馆进行文献检索。纳入关于NCCT上血肿形态规则性或密度异质性对自发性脑出血中HE的预测价值的研究。进行荟萃分析以汇总数据。进行发表偏倚评估、亚组分析和单变量荟萃回归。
共纳入7项研究，涉及2294例患者。血肿形态不规则性的合并敏感性、特异性、阳性似然比和阴性似然比分别为67%、47%、1.30和0.71。相比之下，密度不规则性的合并敏感性、特异性、阳性似然比和阴性似然比分别为52%、69%、1.70和0.69。
考虑到相对较低的敏感性和特异性，血肿形态不规则性和密度异质性对HE的预测价值有限。仍需进一步研究以找到自发性脑出血患者中HE的最佳NCCT预测指标。
