Abstract
This meta-analysis summarizes the accuracy of magnetic resonance angiography (MRA) for diagnosing residuals in coiled cerebral aneurysms by using the threefold Roy classification (residuals: none, neck, or sac). Four databases were searched from 2000 to June 2013 for eligible studies that compared MRA to digital subtraction angiography (DSA) and reported 3 × 3 count data of threefold Roy classification, or a reduced scheme of 2 × 2 count data. Bivariate and trivariate Bayesian random-effects models were used for meta-analysis. Among 27 included studies (2,119 coiled aneurysms in 1,809 patients) the average prevalence of DSA-confirmed sac residuals was 18.2 % (range 0–43 %). The pooled sensitivity was 88.0 % (95 % CI 81.4−94.0) and specificity was 97.2 % (94.6−99.0 %) for assessing sac residuals by MRA. In the trivariate meta-analysis, a “sac residual” finding at MRA had a high positive likelihood ratio of 28.2 (14.0–79.0). A “neck residual” finding had a moderate negative likelihood ratio of 0.246 (0.111–0.426), and the MRA finding of “no residual” had a good negative likelihood ratio of 0.044 (0.013–0.096). Subgroup analyses identified no significant influence of covariates on diagnostic accuracy (P > 0.05). In conclusion, in coiled cerebral aneurysms MRA with application of the threefold Roy classification is well suited for detecting or excluding sac residuals that might require retreatment.Electronic supplementary materialThe online version of this article (doi:10.1007/s00415-013-7053-5) contains supplementary material, which is available to authorized users.
Highlights
Cerebral aneurysms can cause substantial morbidity and mortality, especially if they rupture, leading to non-traumatic subarachnoid haemorrhage [1]
The 19 included prospective studies showed results similar to those reported in Tables 1 and 2. This meta-analysis confirms that noninvasive magnetic resonance angiography (MRA) is generally well suited for assessing flow residuals in coiled cerebral aneurysms
This is relevant both to imaging specialists and referring clinicians, since both partners decide about using digital subtraction angiography (DSA) or MRA for the follow-up of the coiled aneurysms, and about how to proceed with the obtained imaging results
Summary
Cerebral aneurysms can cause substantial morbidity and mortality, especially if they rupture, leading to non-traumatic subarachnoid haemorrhage [1]. In both standard assessments the 3 9 3 count data are reduced to bivariate 2 9 2 count data, causing some loss of information This prevents assessing likelihood ratios and predictive values of MRA for the three Roy classes. This requires a trivariate analysis of the 3 9 3 count data, not performed so far. The purpose of the present meta-analysis was to determine the diagnostic accuracy and predictive value of MRA for assessing flow residuals in coiled cerebral aneurysms compared to DSA, by applying bivariate and trivariate statistical approaches, and by including primary studies that have not been meta-analyzed before
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