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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews.

Computed tomographic angiography for detecting cerebral aneurysms: implications of aneurysm size distribution for the sensitivity, specificity, and likelihood ratios

Review published: 2003.

Bibliographic details: van Gelder J M.  Computed tomographic angiography for detecting cerebral aneurysms: implications of aneurysm size distribution for the sensitivity, specificity, and likelihood ratios. Neurosurgery 2003; 53(3): 597-605. [PubMed: 12943576]

Quality assessment

This review aimed to determine the diagnostic accuracy of computed tomographic angiography (CTA), compared with intra-arterial digital subtraction angiography or surgical findings, for the detection of cerebral aneurysms after adjusting for size distributions. The author concluded that CTA is useful in the descriptive imaging of a known aneurysm. Although the author's conclusions appear consistent with the results obtained, methodological limitations may restrict interpretation. Full critical summary

Abstract

OBJECTIVE: This study examined the efficacy of computed tomographic angiography (CTA) for detection of ruptured and unruptured aneurysms after adjustment for their size distributions under various conditions of aneurysm prevalence.

METHODS: A systematic review was used to estimate 1) the aneurysm size-specific sensitivity and specificity of CTA, and 2) the size distributions of ruptured and unruptured aneurysms. Probabilistic computer simulation was used to estimate the efficacy of CTA in the detection of aneurysms.

RESULTS: The sensitivity of CTA ranged from 53% (95% confidence interval [CI], 44-62%) for 2-mm aneurysms to 95% (95% CI, 92-97%) for 7-mm aneurysms. The overall specificity was 98.9% (95% CI, 91.5-99.99%), but there was between-study heterogeneity. The estimated negative likelihood ratios for ruptured, unruptured, and at least 6-mm unruptured aneurysms were 0.081, 0.18, and 0.012, respectively. The positive likelihood ratio for CTA was sensitive to the pretest probability, the size of the positive finding, and the clinical context. With a small pretest probability, the positive likelihood ratio for unruptured aneurysms ranged from 15 for 2-mm aneurysms to 61 for 5-mm aneurysms. The positive likelihood ratio for ruptured aneurysms with an intermediate pretest probability (50%) ranged from 3.9 to 56 for 2- to 5-mm aneurysms.

CONCLUSION: Small aneurysms detected on CTA should be investigated further unless there is a high pretest probability of a ruptured aneurysm. During screening for ruptured aneurysms, a negative CTA should be investigated further. During screening for unruptured aneurysms, a negative CTA results in a very low probability of a clinically important aneurysm.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

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