Anubhav Katyal1,2, Zeljka Calic1,3,2,4, Murray Killingsworth1,2,5,6, Sonu Bhaskar1,3,4,5. 1. Neurovascular Imaging Laboratory, Ingham Institute for Applied Medical Research, Clinical Sciences Stream, Sydney, Australia. 2. University of New South Wales (UNSW), Sydney Clinical School, UNSW Medicine, South Western, Sydney, NSW, Australia. 3. Liverpool Hospital & South Western Sydney Local Health District, Department of Neurology & Neurophysiology, Sydney, Australia. 4. Ingham Institute for Applied Medical Research, Stroke & Neurology Research Group, Sydney, Australia. 5. NSW Brain Clot Bank, NSW Health Pathology, NSW Health Statewide Biobank, Sydney, NSW, Australia. 6. Correlative Microscopy Facility, Ingham Institute for Applied Medical Research, Department of Anatomical Pathology, NSW Health Pathology and Liverpool Hospital, Liverpool, NSW, Australia.
Abstract
BACKGROUND: Computed tomography perfusion (CTP) imaging could be useful in the diagnosis of posterior circulation stroke (PCS) and in identifying patients who are likely to experience favourable outcomes following reperfusion therapy. The current study sought to investigate the diagnostic and prognostic capability of CTP in acute ischemic PCS by performing a systematic review and meta-analysis. METHODS: Medline/PubMed and the Cochrane library were searched using the terms: "Posterior circulation" "CT perfusion", "acute stroke" and "reperfusion therapy". The following studies were included: (1) patients aged 18 years or above; (2) patients diagnosed with PCS; and (3) studies with good methodological design. Pooled sensitivity (SENS), specificity (SPEC), and area under the curve (AUC), computed using the summary receiver operating characteristic (SROC) curves, were used to determine diagnostic/prognostic capability. RESULTS: Out of 14 studies included, a meta-analysis investigating diagnostic accuracy of CTP was performed on 9 studies. Meta-analysis demonstrated comparable diagnostic accuracy of CTP to non-contrast computed tomography (NCCT) (AUCCTP : 0.90 [95% CI 0.87 - 0.92] vs AUCNCCT : 0.96 [95% CI 0.94-0.97]), however, with higher pooled sensitivity (SENSCTP : 72% [95% CI 57-83%] vs SENSNCCT : 25% [95% CI 17-35%]) and lower specificity (SPECCTP : 90% [95% CI 83 - 94%] vs SPECNCCT : 96% [95% CI 95-98%]) than NCCT. Meta-analysis to determine prognostic capability of CTP couldn't be performed. CONCLUSIONS: CTP has limited diagnostic utility in acute ischemic PCS, albeit with superior diagnostic sensitivity and inferior diagnostic specificity to NCCT. Further prospective trials are required to validate the prognostic capability of CTP-derived parameters in PCS. This article is protected by copyright. All rights reserved.
BACKGROUND: Computed tomography perfusion (CTP) imaging could be useful in the diagnosis of posterior circulation stroke (PCS) and in identifying patients who are likely to experience favourable outcomes following reperfusion therapy. The current study sought to investigate the diagnostic and prognostic capability of CTP in acute ischemic PCS by performing a systematic review and meta-analysis. METHODS: Medline/PubMed and the Cochrane library were searched using the terms: "Posterior circulation" "CT perfusion", "acute stroke" and "reperfusion therapy". The following studies were included: (1) patients aged 18 years or above; (2) patients diagnosed with PCS; and (3) studies with good methodological design. Pooled sensitivity (SENS), specificity (SPEC), and area under the curve (AUC), computed using the summary receiver operating characteristic (SROC) curves, were used to determine diagnostic/prognostic capability. RESULTS: Out of 14 studies included, a meta-analysis investigating diagnostic accuracy of CTP was performed on 9 studies. Meta-analysis demonstrated comparable diagnostic accuracy of CTP to non-contrast computed tomography (NCCT) (AUCCTP : 0.90 [95% CI 0.87 - 0.92] vs AUCNCCT : 0.96 [95% CI 0.94-0.97]), however, with higher pooled sensitivity (SENSCTP : 72% [95% CI 57-83%] vs SENSNCCT : 25% [95% CI 17-35%]) and lower specificity (SPECCTP : 90% [95% CI 83 - 94%] vs SPECNCCT : 96% [95% CI 95-98%]) than NCCT. Meta-analysis to determine prognostic capability of CTP couldn't be performed. CONCLUSIONS:CTP has limited diagnostic utility in acute ischemic PCS, albeit with superior diagnostic sensitivity and inferior diagnostic specificity to NCCT. Further prospective trials are required to validate the prognostic capability of CTP-derived parameters in PCS. This article is protected by copyright. All rights reserved.