Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.
Bioimaging Center, Biomedical Research Center, Asan Institute for Life Sciences, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.
Eur Radiol. 2019 Aug;29(8):4077-4087. doi: 10.1007/s00330-018-5936-7. Epub 2019 Jan 7.
To investigate the diagnostic performance of perfusion CT for prediction of hemorrhagic transformation in acute ischemic stroke.
A computerized literature search of Ovid MEDLINE and EMBASE was conducted up to October 29, 2018. Search terms included acute ischemic stroke, hemorrhagic transformation, and perfusion CT. Studies assessing the diagnostic performance of perfusion CT for prediction of hemorrhagic transformation in acute ischemic stroke were included. Two reviewers independently evaluated the eligibility of the studies. A bivariate random effects model was used to calculate the pooled sensitivity and pooled specificity. Multiple subgroup analyses were performed.
Fifteen original articles with a total of 1134 patients were included. High blood-brain barrier permeability and hypoperfusion status derived from perfusion CT are associated with hemorrhagic transformation. The pooled sensitivity and specificity were 84% (95% CI, 71-91%) and 74% (95% CI, 67-81%), respectively. The area under the hierarchical summary receiver operating characteristic curve was 0.84 (95% CI, 0.81-0.87). The Higgins I statistic demonstrated that heterogeneity was present in the sensitivity (I = 80.21%) and specificity (I = 85.94%).
Although various perfusion CT parameters have been used across studies, the current evidence supports the use of perfusion CT to predict hemorrhagic transformation in acute ischemic stroke.
• High blood-brain barrier permeability and hypoperfusion status derived from perfusion CT were associated with hemorrhagic transformation. • Perfusion CT has moderate diagnostic performance for the prediction of hemorrhagic transformation in acute ischemic stroke. • The pooled sensitivity was 84%, and the pooled specificity was 74%.
研究灌注 CT 对急性缺血性脑卒中出血性转化的诊断性能。
计算机检索 Ovid MEDLINE 和 EMBASE 数据库，检索时限截至 2018 年 10 月 29 日。检索词包括“acute ischemic stroke”“hemorrhagic transformation”和“perfusion CT”。纳入评估灌注 CT 对急性缺血性脑卒中出血性转化预测价值的研究。由 2 名评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险。采用双变量随机效应模型计算敏感度和特异度的合并值，并进行亚组分析。
共纳入 15 项原始研究，包含 1134 例患者。灌注 CT 得出的高血脑屏障通透性和灌注不足状态与出血性转化相关。敏感度和特异度的合并值分别为 84%（95%CI：71%91%）和 74%（95%CI：67%81%），受试者工作特征曲线下面积为 0.84（95%CI：0.81~0.87）。Higgins I 统计量显示敏感度（I²=80.21%）和特异度（I²=85.94%）存在异质性。
虽然各项研究使用的灌注 CT 参数不同，但目前的证据支持使用灌注 CT 预测急性缺血性脑卒中的出血性转化。
• 灌注 CT 得出的高血脑屏障通透性和灌注不足状态与出血性转化相关。• 灌注 CT 对急性缺血性脑卒中出血性转化有中等程度的预测价值。• 敏感度的合并值为 84%，特异度的合并值为 74%。
