Jazayeri Seyed Behnam, Nejad Mohammad Mehdi Mehrabi, Ghozy Sherief, Hamouda Noha, Ahmad Baria, Kadirvel Ramanathan, Kallmes David F
Tehran University of Medical Sciences, Tehran, Iran.
Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran.
Interv Neuroradiol. 2025 Jun 2:15910199251345631. doi: 10.1177/15910199251345631.
BackgroundAccurate and timely prehospital detection of large vessel occlusion (LVO) is critical for optimizing patient triage and initiating appropriate reperfusion therapies. Recent advances in portable stroke detection technologies, such as electroencephalography (EEG) and transcranial Doppler (TCD) ultrasound, offer potential solutions but their diagnostic performance remains unclear.MethodsWe searched PubMed, Scopus, Embase, and Web of Science, following the PRISMA guidelines. Studies were included if they assessed the diagnostic performance of non-invasive prehospital LVO detection tools compared to CT or MR angiography. Risk of bias was assessed using the QUADAS-2 tool.ResultsA total of 13 studies were included, examining various portable detection tools including EEG or neurophysiological monitoring, ultrasound-based techniques including TCD or TCCD, portable Openwater optical blood flow monitor and cranial accelerometry. The pooled diagnostic odds ratio (DOR) was 52.7 (95% CI: 28.3-97.8), indicating strong diagnostic performance, with significant heterogeneity among studies (I = 67.3%, < 0.001). Subgroup analysis revealed that TCD-based methods had the highest DOR (120.4, 95% CI: 76.9-188.7), followed by other tools (26.8, 95% CI: 13.7-52.6), and EEG (18.2, 95% CI: 9.1-36.3). The pooled sensitivity was 87.4% (95% CI: 82.5-91.0) and specificity was 89.39% (95% CI: 83.0-93.5) across all methods. TCD-based methods showed the highest specificity (95.0%, 95% CI: 91.8-97.0).ConclusionNon-invasive prehospital LVO detection tools show promising diagnostic performance, particularly TCD-based methods. Future studies should focus on validating these tools in larger, diverse populations to enhance prehospital stroke triage and improve patient outcomes.
背景
准确及时地在院前检测出大血管闭塞（LVO）对于优化患者分诊和启动适当的再灌注治疗至关重要。便携式中风检测技术的最新进展，如脑电图（EEG）和经颅多普勒（TCD）超声，提供了潜在的解决方案，但其诊断性能仍不明确。
方法
我们按照PRISMA指南检索了PubMed、Scopus、Embase和Web of Science。如果研究评估了与CT或磁共振血管造影相比的非侵入性院前LVO检测工具的诊断性能，则纳入研究。使用QUADAS-2工具评估偏倚风险。
结果
共纳入13项研究，检查了各种便携式检测工具，包括EEG或神经生理监测、基于超声的技术，如TCD或TCCD、便携式Openwater光学血流监测仪和颅骨加速度测量。汇总诊断比值比（DOR）为52.7（95%CI：28.3 - 97.8），表明诊断性能较强，但各研究之间存在显著异质性（I = 67.3%，P < 0.001）。亚组分析显示，基于TCD的方法具有最高的DOR（120.4，95%CI：76.9 - 188.7），其次是其他工具（26.8，95%CI：13.7 - 52.6）和EEG（18.2，95%CI：9.1 - 36.3）。所有方法的汇总敏感性为87.4%（95%CI：82.5 - 91.0），特异性为89.39%（95%CI：83.0 - 93.5）。基于TCD的方法显示出最高的特异性（95.0%，95%CI：91.8 - 97.0）。
结论
非侵入性院前LVO检测工具显示出有前景的诊断性能，特别是基于TCD的方法。未来的研究应侧重于在更大、更多样化的人群中验证这些工具，以加强院前中风分诊并改善患者预后。
