Abstract
ObjectiveTo systematically evaluate and compare the diagnostic accuracy of CT perfusion (CTP), non-enhanced computed tomography (NCCT) and computed tomography angiography (CTA) in detecting acute ischemic stroke.MethodsWe searched seven databases and screened the reference lists of the included studies. The risk of bias in the study quality was assessed using QUADASII. We produced paired forest plots in RevMan to show the variation of the sensitivity and specificity estimates together with their 95% CI. We used a hierarchical summary ROC model to summarize the sensitivity and specificity of CTP in detecting ischemic stroke.ResultsWe identified 27 studies with a total of 2168 patients. The pooled sensitivity of CTP for acute ischemic stroke was 82% (95% CI 75–88%), and the specificity was 96% (95% CI 89–99%). CTP was more sensitive than NCCT and had a similar accuracy with CTA. There were no statistically significant differences in the sensitivity and specificity between patients who underwent CTP within 6 hours of symptom onset and beyond 6 hours after symptom onset. No adverse events were reported in the included studies.ConclusionsCTP is more accurate than NCCT and has similar accuracy to CTA in detecting acute ischemic stroke. However, the evidence is not strong. There is potential benefit of using CTP to select stroke patients for treatment, but more high-quality evidence is needed to confirm this result.
Highlights
Stroke is the second leading cause of death and the third leading cause of disability in the world [1, 2]
The pooled sensitivity of CT perfusion (CTP) for acute ischemic stroke was 82%, and the specificity was 96%
CTP was more sensitive than Non-enhanced computed tomography (NCCT) and had a similar accuracy with computed tomography angiography (CTA)
Summary
The studies were eligible that met the following inclusion criteria. 1) The studies either focused on CTP or compared CTP with other imaging methods. 2) The absolute numbers of the observations of true positives, false positives, false negatives, and true negatives were either available or derivable from the data which was reported in the primary studies. 3) Human subjects were the focus of analysis. 4) The studies were either prospective or retrospective. The studies were eligible that met the following inclusion criteria. 1) The studies either focused on CTP or compared CTP with other imaging methods. 2) The absolute numbers of the observations of true positives, false positives, false negatives, and true negatives were either available or derivable from the data which was reported in the primary studies. 3) Human subjects were the focus of analysis. 4) The studies were either prospective or retrospective. We excluded the following studies that addressed specific anatomical, metabolic, or microvascular aspects of stroke; focused on the specific technical parameters of CTP; location of final infarct; distinguished ischemic core from the salvageable brain tissue. If several reports were based on the same study, we selected the most recent or most complete publication available
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