Department of Nuclear Medicine, Zigong First People's Hospital, Zigong Academy of Medical Sciences, 42 Haoyi Road, Shangyi District, Zigong, Sichuan, 643000, P. R. China.
BMC Med Imaging. 2024 Aug 14;24(1):215. doi: 10.1186/s12880-024-01390-6.
Due to the increasing incidence of ischaemic cerebrovascular diseases, the accurate assessment of internal carotid artery (ICA) stenosis is crucial for the development of treatment plans. This systematic review and meta-analysis aimed to evaluate the diagnostic value of computed tomography angiography (CTA) for severe ICAstenosis, thereby providing support for clinical decision-making and promoting diagnostic updates.
The PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Database for Chinese Technical Periodicals (VIP), and Chinese Biomedical Literature (CBM) electronic databases were searched from inception to March 21, 2024, to identify publicly available research literature on the use of CTA to diagnose severe ICA stenosis. Literature screening, data extraction, and quality assessment were conducted based on the inclusion and exclusion criteria as well as the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) standards. Data analysis was performed using Stata 17.0 and Meta-Disc 1.4 software. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of the included studies were calculated using Stata 17.0 software, and forest plots and summary receiver operating characteristic (SROC) curves were generated. The area under the curve (AUC) was calculated, and funnel plots were constructed to assess publication bias.
A total of 16 studies with 2368 vascular segments were included. The meta-analysis revealed that the combined sensitivity and specificity of CTA for severe ICA stenosis were 0.93 (95% CI: 0.88 ~ 0.96) and 0.99 (95% CI: 0.96 ~ 1.00), respectively. The combined positive likelihood ratio and negative likelihood ratio were 92.0 (95% CI: 24.2 ~ 349.6) and 0.07 (95% CI: 0.04 ~ 0.13), respectively. The diagnostic odds ratio was 1302 (95% CI: 257 ~ 6606), and the AUC of the SROC curve was 0.98. The Deeks funnel plot suggested no publication bias among the included studies.
CTA demonstrated high sensitivity and specificity for diagnosing severe ICA stenosis. Therefore, this study provided important evidence for the accurate diagnosis and treatment of severe ICA stenosis. However, there was considerable heterogeneity among the included studies, thus indicating the need for additional high-quality prospective studies to confirm the clinical applicability of CTA.
由于缺血性脑血管疾病的发病率不断上升，准确评估颈内动脉（ICA）狭窄对于制定治疗计划至关重要。本系统评价和荟萃分析旨在评估计算机断层血管造影（CTA）在重度 ICA 狭窄诊断中的价值，从而为临床决策提供支持并推动诊断更新。
检索了 PubMed、Embase、Cochrane 图书馆、中国知网（CNKI）、万方数据库、维普数据库（VIP）和中国生物医学文献数据库（CBM），以获取公开发表的关于 CTA 诊断重度 ICA 狭窄的研究文献，检索时间截至 2024 年 3 月 21 日。根据纳入和排除标准以及诊断准确性研究的质量评估（QUADAS）标准，进行文献筛选、数据提取和质量评估。使用 Stata 17.0 和 Meta-Disc 1.4 软件进行数据分析。使用 Stata 17.0 软件计算纳入研究的灵敏度、特异度、阳性似然比、阴性似然比和诊断比值比，并绘制森林图和汇总受试者工作特征（SROC）曲线。计算曲线下面积（AUC），并绘制漏斗图评估发表偏倚。
共纳入 16 项研究，涉及 2368 个血管节段。荟萃分析显示，CTA 诊断重度 ICA 狭窄的合并灵敏度和特异度分别为 0.93（95%CI：0.880.96）和 0.99（95%CI：0.961.00）。合并阳性似然比和阴性似然比分别为 92.0（95%CI：24.2349.6）和 0.07（95%CI：0.040.13）。诊断比值比为 1302（95%CI：257~6606），SROC 曲线的 AUC 为 0.98。Deeks 漏斗图提示纳入研究无发表偏倚。
CTA 对诊断重度 ICA 狭窄具有较高的灵敏度和特异度。因此，本研究为准确诊断和治疗重度 ICA 狭窄提供了重要证据。然而，纳入研究存在较大异质性，因此需要更多高质量的前瞻性研究来证实 CTA 的临床适用性。
