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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 [Internet].

Computed tomographic angiography for patients with acute spontaneous intracerebral hemorrhage

GK Wong, DY Siu, JM Abrigo, AT Ahuja, and WS Poon.

Review published: 2012.

Link to full article: [Journal publisher]

CRD summary

This review concluded that computed tomography angiography and venography could replace digital subtraction angiography as the initial investigation in patients with acute spontaneous intracerebral haemorrhage. The number participants was small, only one of the three studies included venography, the methodological quality of included studies was unknown and review methods were poorly reported. The conclusions should be interpreted with caution.

Authors' objectives

To assess the diagnostic accuracy of computed tomography (CT) angiography for detection of underlying vascular pathologies in patients with acute spontaneous intracerebral haemorrhage.

Searching

MEDLINE and EMBASE were searched without restrictions from inception to July 2011; search terms were reported. Bibliographies of identified studies and related articles were screened for additional studies.

Study selection

Case series studies that assessed multislice CT angiography for detection of underlying vascular pathologies in patients with acute spontaneous (non-traumatic) intracerebral haemorrhage were eligible for inclusion. Included studies were required to use digital subtraction angiography (DSA) as the reference standard to confirm diagnosis.

All included studies used 16- or 64-slice CT. One of the three included studies used DSA and/or intraoperative findings and/or autopsy as the reference standard. All three studies imaged the arterial circulation phase and one also included the venous circulation phase. Vascular lesions were the cause of acute spontaneous (non-traumatic) intracerebral haemorrhage in 33% of included study participants.

The authors did not state how many reviewers assessed studies for inclusion.

Assessment of study quality

The authors did not state that they assessed the methodological quality of included studies.

Data extraction

Data were extracted on the numbers of true positive, false negative, false positive and true negative test results for each study. These data were used to calculate estimates of sensitivity, specificity, positive and negative predictive values and accuracy.

The authors did not state how many reviewers extracted data.

Methods of synthesis

Pooled estimates of sensitivity, specificity, positive and negative predictive value and accuracy, with 95% confidence intervals (CIs), were calculated. The method used to generate the pooled estimates was not specified.

Results of the review

Three studies (397 participants, range 78 to 210) were included in the review: one retrospective and two prospective studies.

Pooled estimates: Sensitivity was 97.0% (95% CI 93.2 to 99.1%), specificity was 98.9% (95% CI 97.0 to 99.7%), positive predictive value was 97.8% (95% CI 94.2 to 99.5%), negative predictive value was 98.5% (95% CI 96.6 to 99.5%) and overall accuracy was 98.2% (95% CI 96.6 to 99.2%).

Pathologies associated with the four false negative results observed were a 6mm parietal arteriovenous malformation, an arteriovenous malformation (<1cm), an arteriovenous fistula (<1cm) and a 2mm distal middle cerebral artery aneurysm.

Authors' conclusions

The authors concluded that CT angiography and venography could replace DSA as the initial investigation in patients with acute spontaneous intracerebral haemorrhage.

CRD commentary

A clear research question was defined. Several sources were searched. There were no restrictions on language and publication status. No assessment of the methodological quality of included studies was reported and the authors did not report any measures to minimise error and bias in the review process so it was not possible to assess the extent to which weaknesses in the included studies or in the review process may have influenced findings. The results of meta-analyses were presented but the methods used to generate pooled estimates of test performance were not described.

All of the included studies reported high estimates of sensitivity but numbers of studies and participants were small and only one of the three studies included venography which, along with the lack of any methodological quality assessment and poor reporting of review methods, mean that the authors' conclusions should be interpreted with caution.

Implications of the review for practice and research

Practice: The authors stated that CT angiography and venography could replace DSA as the initial investigation in patients with acute spontaneous intracerebral haemorrhage.

Research: The authors stated that future studies should focus on whether refinement of CT angiography techniques could preclude the false negative results.

Funding

Health and Health Services Research Fund, Government of the Hong Kong Special Administrative Region.

Bibliographic details

Wong GK, Siu DY, Abrigo JM, Ahuja AT, Poon WS. Computed tomographic angiography for patients with acute spontaneous intracerebral hemorrhage. Journal of Clinical Neuroscience 2012; 19(4): 498-500. [PubMed: 22321368]

Indexing Status

Subject indexing assigned by NLM

MeSH

Cerebral Angiography; Cerebral Hemorrhage /radiography; Humans; Sensitivity and Specificity; Tomography, X-Ray Computed /methods

AccessionNumber

12012013956

Database entry date

20/10/2012

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

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

Copyright © 2014 University of York.

PMID: 22321368

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