Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.
South Western Sydney Clinical School, UNSW Medicine, University of New South Wales (UNSW), Sydney, NSW, Australia.
Eur J Neurol. 2021 Aug;28(8):2657-2668. doi: 10.1111/ene.14934. Epub 2021 Jun 12.
Computed tomography perfusion (CTP) imaging could be useful in the diagnosis of posterior circulation stroke (PCS) and in identifying patients who are likely to experience favorable outcomes following reperfusion therapy. The current study sought to investigate the diagnostic and prognostic capability of CTP in acute ischemic PCS by performing a systematic review and meta-analysis.
Medline/PubMed and the Cochrane Library were searched using the terms: "posterior circulation", "CT perfusion", "acute stroke", and "reperfusion therapy". The following studies were included: (1) patients aged 18 years or above; (2) patients diagnosed with PCS; and (3) studies with good methodological design. Pooled sensitivity (SENS), specificity (SPEC), and area under the curve (AUC), computed using the summary receiver operating characteristic (SROC) curves, were used to determine diagnostic/prognostic capability.
Out of 14 studies included, a meta-analysis investigating diagnostic accuracy of CTP was performed on nine studies. Meta-analysis demonstrated comparable diagnostic accuracy of CTP to non-contrast computed tomography (NCCT) (AUC : 0.90 [95% CI 0.87-0.92] vs. AUC : 0.96 [95% CI 0.94-0.97]); however, with higher pooled sensitivity (SENS : 72% [95% CI 57%-83%] vs. SENS : 25% [95% CI 17%-35%]) and lower specificity (SPEC : 90% [95% CI 83%-94%] vs. SPEC : 96% [95% CI 95%-98%]) than NCCT. Meta-analysis to determine prognostic capability of CTP could not be performed.
CTP has limited diagnostic utility in acute ischemic PCS, albeit with superior diagnostic sensitivity and inferior diagnostic specificity to NCCT. Further prospective trials are required to validate the prognostic capability of CTP-derived parameters in PCS.
计算机断层灌注成像（CTP）在诊断后循环卒中（PCS）和识别可能从再灌注治疗中获得良好预后的患者方面可能具有一定的作用。本研究旨在通过系统回顾和荟萃分析来评估 CTP 在急性缺血性 PCS 中的诊断和预后能力。
通过使用“后循环”、“CT 灌注”、“急性卒”和“再灌注治疗”等术语在 Medline/PubMed 和 Cochrane 图书馆进行检索。包括以下研究：（1）年龄 18 岁或以上的患者；（2）诊断为 PCS 的患者；（3）设计良好的研究。使用汇总受试者工作特征（SROC）曲线计算的合并敏感性（SENS）、特异性（SPEC）和曲线下面积（AUC）用于确定诊断/预后能力。
在纳入的 14 项研究中，有 9 项研究对 CTP 的诊断准确性进行了荟萃分析。荟萃分析显示，CTP 与非对比 CT（NCCT）具有相当的诊断准确性（AUC：0.90 [95%CI 0.87-0.92] vs. AUC：0.96 [95%CI 0.94-0.97]）；然而，CTP 具有更高的合并敏感性（SENS：72% [95%CI 57%-83%] vs. SENS：25% [95%CI 17%-35%]）和更低的特异性（SPEC：90% [95%CI 83%-94%] vs. SPEC：96% [95%CI 95%-98%]）。无法进行 CTP 预后能力的荟萃分析。
CTP 在急性缺血性 PCS 中具有有限的诊断作用，尽管与 NCCT 相比，具有更高的诊断敏感性和更低的诊断特异性。需要进一步的前瞻性试验来验证 CTP 衍生参数在 PCS 中的预后能力。
