Diagnosing cerebral aneurysms by computed tomographic angiography: Meta‐analysis

Menke, Jan; Larsen, Jörg; Kallenberg, Kai

doi:10.1002/ana.22270

Cited by 112 publications

(89 citation statements)

References 77 publications

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“…Our findings are concordant with those in previous reports [8][9][10][11] and compare well with a meta-analysis of twelve 16 -detector row BSCTA studies. 10 The sensitivity and specificity of BSCTA for small aneurysms (Ͻ3.0 mm) were lower than those in our population.…”

Section: Discussionsupporting

confidence: 93%

“…10 Similar results were seen in a 64 -detector row multidetector CT study with 89 patients. 7 Our study results are also in line with those in 2 other studies by using modern dual-source and 320 -detector row BSCTA.…”

Section: Discussionsupporting

confidence: 77%

“…10 The sensitivity and specificity of BSCTA for small aneurysms (Ͻ3.0 mm) were lower than those in our population.…”

Section: Discussioncontrasting

confidence: 69%

“…5,6 Multidetector CT angiography with high spatial resolution and bone-subtraction CTA (BSCTA) approaches the diagnostic accuracy of DSA in the detection of intracranial aneurysms. [7][8][9][10][11][12] Thus, BSCTA can be considered an alternative to DSA in treatment planning. 13,14 Some authors already recommend BSCTA as the primary imaging in acute SAH.…”

mentioning

confidence: 99%

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Diagnostic Impact of Bone-Subtraction CT Angiography for Patients with Acute Subarachnoid Hemorrhage

Aulbach

Mucha

Engellandt

et al. 2015

AJNR Am J Neuroradiol

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 77%

“…10 The sensitivity and specificity of BSCTA for small aneurysms (Ͻ3.0 mm) were lower than those in our population.…”

Section: Discussioncontrasting

confidence: 69%

mentioning

confidence: 99%

See 2 more Smart Citations

Diagnostic Impact of Bone-Subtraction CT Angiography for Patients with Acute Subarachnoid Hemorrhage

Aulbach

Mucha

Engellandt

et al. 2015

AJNR Am J Neuroradiol

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show abstract

“…These false-negative interpretations can therefore be categorized as perceptual in nature and could have been substantially bypassed by double reading. The I 2 statistic for sensitivity indicated the presence of notable heterogeneity, a finding that is consistent with previous meta-analyses investigating CTA and cerebral aneurysms (7,28). The Spearman correlation coefficient on a per-patient basis was 0.558 (P= 0.151), which suggested the absence of a significant threshold effect.…”

Section: Discussionsupporting

confidence: 87%

Subtraction CT angiography for the detection of intracranial aneurysms: A meta-analysis

Feng

Han

Lang

et al. 2016

Experimental and Therapeutic Medicine

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Abstract. The aim of this meta-analysis was to investigate the accuracy of subtraction computed tomography angiography (CTA) for diagnosing intracranial aneurysms. A systematic literature search up to January 1, 2013 was performed in PubMed. Two independent reviewers selected 8 studies that compared subtraction CTA with digital subtraction angiography. Data from the studies were used to construct a 2x2 contingency table on a per-patient basis in ≥5 diseased and 5 non-diseased patients, with additional data on a per-aneurysm basis. Overall, subtraction CTA had a pooled sensitivity of 99% [95% confidence interval (CI), 95-100%] and specificity of 94% (95% CI, 86-97%) for detecting and ruling out cerebral aneurysms, respectively, on a per-patient basis. On a per-aneurysm basis, the pooled sensitivity was 96% (95% CI, 90-99%), and the specificity was 91% (95% CI, 85-95%).In conclusion, subtraction CTA is a highly sensitive, specific and non-inva sive method for the diagnosis and evaluation of intracranial aneurysms. IntroductionThe prevalence of cerebral aneurysm in the general population is estimated to be 1-5% (1). Ruptured intracranial aneurysms are the most important cause of non-traumatic subarachnoid hemorrhage, which is a medical emergency and can result in severe disability or mortality (2). Thus, the prompt diagnosis and treatment of intracranial aneurysm are of considerable importance for the outcome of the patient.Conventional digital subtraction angiography (DSA) has been considered the gold standard for the detection and characterization of intracranial aneurysms due to its high spatial resolution and large field of view (3,4); however, it also has several disadvantages, including the relatively high cost and the high skill level required to perform the procedure. Furthermore, DSA is an invasive procedure associated with a small but definite risk of neurological morbidity (5). There is a requirement, therefore, to find an accurate, minimally invasive imaging method that is free from these complications. Computed tomography angiography (CTA), as a relatively non-invasive imaging method, has been widely used in the screening of patients with suspected intracranial aneurysms (6). As a result of the rapid improvement in multi-detector CTA technology, the diagnostic performance of multi-detector CTA for the detection of intracranial aneurysms is now approaching that of DSA (7); however, it exhibits a disadvantage in the detection of small-sized aneurysms that are located near the skull base due to the influence of overprojecting bone structures (8).As CT technology has evolved and various subtraction and post-processing techniques have been developed, subtraction CTA, allowing bone-free visualization of aneurysms, has become possible for the diagnosis of intracranial aneurysms. There have been several reports on the potential usefulness of subtraction CTA in evaluating intracranial aneurysms; however, the results of these studies have been varied (6-8). The purpose of this meta-analysis was to calculate the ...

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Shifts in Diagnostic Testing for Headache in the Emergency Department, 2015 to 2021

Mark,

Horton,

Reed

2024

JAMA Netw Open

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ImportanceSubarachnoid hemorrhage is typically diagnosed by noncontrast head computed tomography (CT); lumbar puncture is recommended if computed tomography is nondiagnostic, although CT cerebral angiography has been promoted as an alternative to lumbar puncture in this diagnostic pathway. The outcomes of this debate in practice have not been studied.ObjectiveTo determine whether CT cerebral angiography use has increased in lieu of lumbar puncture among emergency department (ED) patients with headache, with an increase in unruptured intracranial aneurysm detection.Design, Setting, and ParticipantsThis retrospective cohort study took place in 21 community EDs of an integrated health care system in Northern California between 2015 and 2021. Participants were adult (aged &gt;17 years) health plan members with a chief concern of headache. Exclusions were prior diagnoses of subarachnoid hemorrhage, unruptured intracranial aneurysm, cerebral arteriovenous malformation, or cerebrospinal fluid shunt. Data were analyzed from October to November 2023.ExposuresCT cerebral angiography and/or lumbar puncture during the ED encounter.Main Outcomes and MeasuresPrimary and secondary outcomes were 14-day and 90-day unruptured intracranial aneurysm detection, respectively. Safety outcomes were missed diagnoses of subarachnoid hemorrhage or bacterial meningitis. The annual incidence of unruptured intracranial aneurysm detection was normalized to the incidence of subarachnoid hemorrhage (UIA:SAH ratio). Average annualized percentage changes were quantified using joinpoint regression analysis.ResultsAmong 198 109 included ED encounters, the mean (SD) age was 47.5 (18.4) years; 140 001 patients (70.7%) were female; 29 035 (14.7%) were Black or African American, 59 896 (30.2%) were Hispanic or Latino, and 75 602 (38.2%) were White. Per year, CT cerebral angiography use increased (18.8%; 95% CI, 17.7% to 20.3%) and lumbar punctures decreased (−11.1%; 95% CI, −12.0% to −10.4%), with a corresponding increase in the 14-day UIA:SAH ratio (3.5%; 95% CI, 0.9% to 7.4%). Overall, computed tomography cerebral angiography use increased 6-fold relative to lumbar puncture, with a 33% increase in the detection of UIA. Results were similar at 90 days and robust to sensitivity analyses. Subarachnoid hemorrhage (1004 cases) and bacterial meningitis (118 cases) were misdiagnosed in 5% and 18% of cases, respectively, with no annual trends (P = .34; z1003 = .95 and P = .74; z117 = −.34, respectively).Conclusions and RelevanceIn this cohort study of ED patients with headache, increases in CT cerebral angiography use were associated with fewer lumbar punctures and higher detection of unruptured intracranial aneurysms, with no significant change in missed diagnoses of subarachnoid hemorrhage or bacterial meningitis. While this shift in diagnostic strategy appeared safe in the short-term, the long-term consequences remain unclear.

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Diagnosing cerebral aneurysms by computed tomographic angiography: Meta‐analysis

Abstract: CT angiography has a high accuracy in diagnosing cerebral aneurysms, specifically when using modern multidetector CT. In the future, CT angiography may increasingly supplement or selectively replace DSA in patients suspected of having a cerebral aneurysm.

Cited by 112 publications

References 77 publications

Diagnostic Impact of Bone-Subtraction CT Angiography for Patients with Acute Subarachnoid Hemorrhage

Diagnostic Impact of Bone-Subtraction CT Angiography for Patients with Acute Subarachnoid Hemorrhage

Subtraction CT angiography for the detection of intracranial aneurysms: A meta-analysis

Shifts in Diagnostic Testing for Headache in the Emergency Department, 2015 to 2021

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