• Brad Bergin, Malavan Ragulojan, Arunachala Trivedi, Mohamad Kesserwan, Forough Farrokhyar, and Sunjay Sharma.
• Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada; CRANI Group, McMaster University, Hamilton, Ontario, Canada.
• World Neurosurg. 2023 Feb 1; 170: e340e350e340-e350.

IntroductionCerebral vasospasm (CV) is a serious complication after subarachnoid hemorrhage; however, swift identification can be challenging. Computed tomography perfusion (CTP) directly measures tissue perfusion and may better screen for CV compared with other modalities. This systematic review summarizes studies assessing the diagnostic performance of computed tomography angiography (CTA) and CTP in identifying CV.MethodsThe search strategy drew from English language publications in the PubMed, Embase, Medline, and Cochrane databases from January 1996 to September 2021. Diagnosis of CV by digital subtraction angiography was the reference standard. Pooled sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV), positive likelihood ratios, negative likelihood ratios, and summary receiver operating characteristic curve were calculated. The methodological index for nonrandomized studies tool was employed to assess the quality of the studies.ResultsThe search generated 22 studies. Seven CTA studies and 6 CTP investigations provided sufficient data for meta-analysis. Following pooled estimates, CTA carried a sensitivity of 0.76 (95% confidence interval [CI], 0.72-0.80), specificity of 0.93 (95% CI, 0.92-0.95), PPV of 0.77 (95%, 0.76-0.79), and NPV of 0.81 (95%, 0.79-0.82). CTP carried a sensitivity of 0.86 (95%, 0.81-0.92), specificity of 0.97 (95%, 0.95-0.98), PPV of 0.94 (0.89-0.98), and NPV of 0.94 (0.91-0.97). Using the methodological index for nonrandomized studies tool, the evidence was rated as overall moderate quality.ConclusionsThis meta-analysis on the diagnostic performance of CTA and CTP in identifying CV suggests that CTP may carry greater diagnostic accuracy compared with CTA. The clinical significance of this difference should be delineated through future prospective studies.Copyright © 2022. Published by Elsevier Inc.

19 keywords...

hide…