CTA 和 CTP 检测远端中等大小血管闭塞：系统评价和荟萃分析。

CTA and CTP for Detecting Distal Medium Vessel Occlusions: A Systematic Review and Meta-analysis.

机构信息

From the Neurology Department (J.A.S., S.B.-C., J.S.-F.), Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal

Neurologeriatrie Department (A.S.), Christian-Albrechts-Universität zu Kiel, Kiel, Germany.

出版信息

AJNR Am J Neuroradiol. 2023 Dec 29;45(1):51-56. doi: 10.3174/ajnr.A8080.

DOI:10.3174/ajnr.A8080

PMID:38164544

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10756569/

Abstract

BACKGROUND

The optimal imaging method for detecting distal medium vessel occlusions (DMVOs) remains undefined.

PURPOSE

The objective of this study is to compare the diagnostic performance of CTA with CTP in detecting DMVOs.

DATA SOURCES

We searched PubMed, EMBASE, Web of Science Core Collection, and Cochrane Central Register of Controlled Trials up to March 31, 2023 (PROSPERO: CRD42022344006).

STUDY SELECTION

A total of 12 studies reporting accuracy values of CTA and/or CTP were included, comprising 2607 patients with 479 cases (18.3%) of DMVOs.

DATA ANALYSIS

Pooled sensitivity and specificity of both imaging methods were compared using a random-effects model. Subgroup analyses were performed based on the technique used in CTA (multi or single-phase) and the subtype of DMVOs (M2-only vs. M2 and other DMVOs). We applied Quality Assessment of Diagnostic Accuracy (QUADAS-2) tool and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) quality assessment criteria.

DATA SYNTHESIS

CTA demonstrated significantly lower sensitivity compared to CTP in detecting DMVOs [0.74, 95%CI (0.63-0.82) vs. 0.89, 95% CI (0.82-0.93), < 0.01]. When subgrouped into single-phase and multi-phase CTA, multi-phase CTA exhibited higher sensitivity for DMVO detection than single-phase CTA [0.91, 95%CI (0.85-0.94) vs. 0.64, 95%CI (0.56-0.71), < .01], while reaching similar levels to CTP. The sensitivity of single-phase CTA substantially decreased when extending from M2 to other non-M2 DMVOs [0.74, 95%CI (0.63-0.83) vs. 0.61, 0.95%CI (0.53-0.68), = .02].

LIMITATIONS

We identified an overall high risk of bias and low quality of evidence, attributable to the design and reference standards of most studies.

CONCLUSIONS

Our findings highlight a significantly lower sensitivity of single-phase CTA compared to multi-phase CTA and CTP in diagnosing DMVOs.

摘要

背景

检测远端中等血管闭塞（DMVO）的最佳成像方法仍未确定。

目的

本研究旨在比较 CTA 与 CTP 在检测 DMVO 中的诊断性能。

数据来源

我们检索了 PubMed、EMBASE、Web of Science 核心合集和 Cochrane 对照试验中心注册库，截至 2023 年 3 月 31 日（PROSPERO：CRD42022344006）。

研究选择

共纳入 12 项报告 CTA 和/或 CTP 准确性值的研究，共纳入 2607 名患者，其中 479 例（18.3%）存在 DMVO。

数据分析

使用随机效应模型比较两种成像方法的汇总敏感性和特异性。根据 CTA 中使用的技术（多期或单期）和 DMVO 亚型（仅 M2 与 M2 和其他 DMVO）进行亚组分析。我们应用了诊断准确性评估质量（QUADAS-2）工具和推荐分级、评估、制定与评价（GRADE）质量评估标准。

数据综合

与 CTP 相比，CTA 在检测 DMVO 时的敏感性显著降低[0.74，95%CI（0.63-0.82）与 0.89，95%CI（0.82-0.93），＜0.01]。当分为单期和多期 CTA 时，多期 CTA 对 DMVO 的检测敏感性高于单期 CTA[0.91，95%CI（0.85-0.94）与 0.64，95%CI（0.56-0.71），＜0.01]，同时与 CTP 达到相似水平。当从 M2 扩展到其他非 M2 DMVO 时，单期 CTA 的敏感性显著降低[0.74，95%CI（0.63-0.83）与 0.61，95%CI（0.53-0.68）， =0.02]。