Mengxue Li1, Wenzhao Liang1, Peng Yue2, Xinzhao Jiang1, Zhongyu Zhao1, Bingyang Zhao1, Zhongxin Xu3, Jing Mang4. 1. Department of Neurology, China-Japan Union Hospital of Jilin University, No.126 Xiantai Road, Nanguan District, Changchun, China. 2. Department of Emergency, The First Hospital of Zibo, Zibo, China. 3. Department of Neurology, China-Japan Union Hospital of Jilin University, No.126 Xiantai Road, Nanguan District, Changchun, China. xuzhongxin@jlu.edu.cn. 4. Department of Neurology, China-Japan Union Hospital of Jilin University, No.126 Xiantai Road, Nanguan District, Changchun, China. mangjing@jlu.edu.cn.
Abstract
BACKGROUND AND PURPOSE: The diagnostic value of non-contrast CT (NCCT) in acute stroke imaging remains indispensable, especially under emergency conditions with limited resources. The radiological conjugate eye deviation (RCED) has been demonstrated as a NCCT sign to predict acute ischemic stroke (AIS) or AIS secondary to large vessel occlusion (LVO) in recent studies. We performed a meta-analysis to gain a better understanding into the predictive role of RCED for AISs and LVO-AISs. METHODS: We conducted a systematic literature search using PubMed, Embase, and Cochrane. The search focused on studies published between January 2000 and August 2020 that reported the predictive value of RCED for the diagnosis of AIS or LVO-AIS. Principal measurements of the meta-analysis were the overall sensitivity, specificity, the positive likelihood ratio (PLR), and the negative likelihood ratio (NLR) of RCED in predicting AIS and LVO-AIS. RESULTS: We included 11 studies (n = 2304). For AIS, RCED had a sensitivity of 0.37 (95% CI 0.27-0.47), a specificity of 0.86 (95% CI 0.73-0.93), the area under the receiver operating characteristic curve (AUC) was 0.58 (95% CI 0.53-0.62), PLR was 2.5 (95% CI 1.5-4.4), and NLR was 0.74 (95% CI 0.65-0.84). For LVO-AIS, RCED had a sensitivity of 0.63 (95% CI 0.46-0.77), a specificity of 0.77 (95% CI 0.71-0.82), AUC was 0.63 (95% CI 0.46-0.77), PLR was 2.7 (95% CI 1.7-4.3), and NLR was 0.49 (95% CI 0.3-0.78). CONCLUSION: RCED can be used to predict LVO-AIS. It is expected that this method will be extensively used and validated in acute stroke imaging, especially under emergency conditions with limited resources.
BACKGROUND AND PURPOSE: The diagnostic value of non-contrast CT (NCCT) in acute stroke imaging remains indispensable, especially under emergency conditions with limited resources. The radiological conjugate eye deviation (RCED) has been demonstrated as a NCCT sign to predict acute ischemic stroke (AIS) or AIS secondary to large vessel occlusion (LVO) in recent studies. We performed a meta-analysis to gain a better understanding into the predictive role of RCED for AISs and LVO-AISs. METHODS: We conducted a systematic literature search using PubMed, Embase, and Cochrane. The search focused on studies published between January 2000 and August 2020 that reported the predictive value of RCED for the diagnosis of AIS or LVO-AIS. Principal measurements of the meta-analysis were the overall sensitivity, specificity, the positive likelihood ratio (PLR), and the negative likelihood ratio (NLR) of RCED in predicting AIS and LVO-AIS. RESULTS: We included 11 studies (n = 2304). For AIS, RCED had a sensitivity of 0.37 (95% CI 0.27-0.47), a specificity of 0.86 (95% CI 0.73-0.93), the area under the receiver operating characteristic curve (AUC) was 0.58 (95% CI 0.53-0.62), PLR was 2.5 (95% CI 1.5-4.4), and NLR was 0.74 (95% CI 0.65-0.84). For LVO-AIS, RCED had a sensitivity of 0.63 (95% CI 0.46-0.77), a specificity of 0.77 (95% CI 0.71-0.82), AUC was 0.63 (95% CI 0.46-0.77), PLR was 2.7 (95% CI 1.7-4.3), and NLR was 0.49 (95% CI 0.3-0.78). CONCLUSION: RCED can be used to predict LVO-AIS. It is expected that this method will be extensively used and validated in acute stroke imaging, especially under emergency conditions with limited resources.
Authors: Olvert A Berkhemer; Puck S S Fransen; Debbie Beumer; Lucie A van den Berg; Hester F Lingsma; Albert J Yoo; Wouter J Schonewille; Jan Albert Vos; Paul J Nederkoorn; Marieke J H Wermer; Marianne A A van Walderveen; Julie Staals; Jeannette Hofmeijer; Jacques A van Oostayen; Geert J Lycklama à Nijeholt; Jelis Boiten; Patrick A Brouwer; Bart J Emmer; Sebastiaan F de Bruijn; Lukas C van Dijk; L Jaap Kappelle; Rob H Lo; Ewoud J van Dijk; Joost de Vries; Paul L M de Kort; Willem Jan J van Rooij; Jan S P van den Berg; Boudewijn A A M van Hasselt; Leo A M Aerden; René J Dallinga; Marieke C Visser; Joseph C J Bot; Patrick C Vroomen; Omid Eshghi; Tobien H C M L Schreuder; Roel J J Heijboer; Koos Keizer; Alexander V Tielbeek; Heleen M den Hertog; Dick G Gerrits; Renske M van den Berg-Vos; Giorgos B Karas; Ewout W Steyerberg; H Zwenneke Flach; Henk A Marquering; Marieke E S Sprengers; Sjoerd F M Jenniskens; Ludo F M Beenen; René van den Berg; Peter J Koudstaal; Wim H van Zwam; Yvo B W E M Roos; Aad van der Lugt; Robert J van Oostenbrugge; Charles B L M Majoie; Diederik W J Dippel Journal: N Engl J Med Date: 2014-12-17 Impact factor: 91.245
Authors: Kevin S Attenhofer; Lovella Hailey; Melissa Mortin; Karen S Rapp; Kunal Agrawal; Branko Huisa-Garate; Royya Modir; Dawn M Meyer; Thomas M Hemmen; Brett C Meyer Journal: J Stroke Cerebrovasc Dis Date: 2018-02-15 Impact factor: 2.136