Division of Cerebrovascular Diseases, Department of Neurology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA.
Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Neurocrit Care. 2019 Feb;30(1):62-71. doi: 10.1007/s12028-018-0572-2.
Cerebral catheter angiography is the gold standard for diagnosing cerebral artery vasospasm (vasospasm) in aneurysmal subarachnoid hemorrhage (SAH). We have previously published a meta-analysis of prediction of delayed cerebral ischemia (DCI) from transcranial Doppler (TCD) evidence of vasospasm. Analogous data relating to prediction of DCI have not been previously collated for cerebral angiography nor reconciled against TCD.
We searched PUBMED, the Cochrane database, and clinicaltrials.gov for studies that used cerebral angiography for diagnosis of vasospasm and evaluated DCI in patients with SAH. We performed a random-effects meta-analysis of prediction of DCI with cerebral angiography, reconciling its accuracy against that of TCD. We also report quality of evidence for the value of cerebral angiography and TCD in SAH based on pooled data from our meta-analyses.
A total of 15 studies (n = 5463) were included in the meta-analysis. Sensitivity (SN), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) of cerebral angiography for prediction of DCI are 57, 68, 32, and 90%. These metrics for TCD, based on our previous meta-analysis, are 90, 71, 57, and 92%. We report that test accuracy estimates are "moderate" for TCD and "low" for angiography based on pooled data from our meta-analyses.
TCD evidence of vasospasm is a better predictor of DCI than angiographic vasospasm. Future comparative effectiveness studies can better define the value of these diagnostic tools in patients with SAH.
脑导管血管造影术是诊断颅内动脉痉挛（痉挛）的金标准在蛛网膜下腔出血（SAH）的情况下。我们之前已经发表了一项关于经颅多普勒（TCD）对痉挛的证据预测迟发性脑缺血（DCI）的荟萃分析。以前没有对血管造影术进行过类似的数据预测DCI，也没有与 TCD 进行过协调。
我们在 PUBMED、Cochrane 数据库和 clinicaltrials.gov 中搜索了使用脑导管血管造影术诊断痉挛并评估蛛网膜下腔出血患者 DCI 的研究。我们对脑导管血管造影术预测 DCI 进行了随机效应荟萃分析，协调其准确性与 TCD 的准确性。我们还根据我们的荟萃分析汇总数据报告了脑导管血管造影术和 TCD 在 SAH 中的价值的证据质量。
共有 15 项研究（n=5463）纳入荟萃分析。脑导管血管造影术预测 DCI 的敏感性（SN）、特异性（SP）、阳性预测值（PPV）和阴性预测值（NPV）分别为 57、68、32 和 90%。基于我们之前的荟萃分析，TCD 的这些指标为 90、71、57 和 92%。我们报告说，基于我们荟萃分析的汇总数据，TCD 的测试准确性估计为“中等”，而血管造影术的测试准确性估计为“低”。
TCD 痉挛的证据是 DCI 的更好预测指标，而血管造影术的痉挛。未来的比较效果研究可以更好地定义这些诊断工具在蛛网膜下腔出血患者中的价值。
