Diagnosing Cerebral Aneurysms by Computed Tomographic Angiography: Meta-Analysis
Diagnosing Cerebral Aneurysms by Computed Tomographic Angiography: Meta-Analysis
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DOI：
10.1002/ana.22270
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发表时间：
2011-04-01
影响因子：
11.2
通讯作者：
Kallenberg, Kai
中科院分区：
文献类型：
--
作者：
Menke, Jan;Larsen, Joerg;Kallenberg, Kai
目的：脑动脉瘤可导致大量的发病率和死亡率，特别是如果它们破裂，导致非创伤性蛛网膜下腔出血（SAH）。本荟萃分析总结了证据的准确性无创计算机断层扫描（CT）血管造影诊断颅内动脉瘤的症状patients.Methods：四个数据库，包括PubMed检索无语言限制，从1995年1月至2010年2月。两名独立评审员选择并提取了45项研究，这些研究比较了疑似脑动脉瘤患者的CT血管造影与数字减影血管造影（DSA）和/或术中发现。从符合条件的研究数据被用来重建2 × 2列联表在每个病人的基础上，在至少5患病和5非患病patients，与额外的数据在每个动脉瘤的基础上，当available.Results：45纳入研究一般是高质量的方法。在纳入的3，643例患者中，约86%患有非创伤性SAH，77%患有脑动脉瘤。总体而言，CT血管造影检测脑动脉瘤的合并灵敏度为97.2%（95%置信区间，95.8-98.2%），排除脑动脉瘤的特异性为97.9%（95.7-99.0%）。在每个动脉瘤的基础上，汇总灵敏度为95.0%（93.2-96.4%），特异性为96.2%（92.9-98.0%）。16排或64排多层螺旋CT血管造影的诊断准确性明显高于单排CT，特别是在检测小动脉瘤方面，
Objective: Cerebral aneurysms can cause substantial morbidity and mortality, specifically if they rupture, leading to nontraumatic subarachnoid hemorrhage (SAH). This meta-analysis summarizes evidence about the accuracy of noninvasive computed tomographic (CT) angiography for diagnosing intracranial aneurysms in symptomatic patients.Methods: Four databases including PubMed were searched without language restrictions from January 1995 to February 2010. Two independent reviewers selected and extracted 45 studies that compared CT angiography with digital subtraction angiography (DSA) and/or intraoperative findings in patients suspected of having cerebral aneurysms. Data from eligible studies were used to reconstruct 2 x 2 contingency tables on a per-patient basis in at least 5 diseased and 5 nondiseased patients, with additional data on a per-aneurysm basis when available.Results: The 45 included studies generally were of high methodological quality. Among the 3,643 patients included, about 86% had nontraumatic SAH, and 77% had cerebral aneurysms. Overall, CT angiography had a pooled sensitivity of 97.2% (95% confidence interval, 95.8-98.2%) for detecting and specificity of 97.9% (95.7-99.0%) for ruling out cerebral aneurysms on a per-patient basis. On a per-aneurysm basis, the pooled sensitivity was 95.0% (93.2-96.4%), and the specificity 96.2% (92.9-98.0%). The diagnostic accuracy of CT angiography with 16- or 64-row multidetector CT was significantly higher than that of single-detector CT, especially in detecting small aneurysms of