Diagnosing residual or recurrent cerebral aneurysms after clipping by computed tomographic angiography: Meta-analysis

Abstract

A cerebral aneurysm with incomplete treatment may re-grow and cause new bleeding. This meta-analysis calculates the sensitivity and specificity of computed tomographic angiography (CTA) in the detection of the residual or recurrent cerebral aneurysms after clipping, in comparison with digital subtraction angiography (DSA). Between October 1997 and October 2012, relevant data were systematically and prospectively collected without language restrictions from the PUBMED and EMBASE databases for analysis. A total of 10 eligible studies compared CTA with DSA in the detection of the residual or recurrent cerebral aneurysms after clipping by two independent observers. The sensitivity, specificity, positive likelihood ratio (+LR), and negative likelihood ratio (-LR) were calculated on a per-aneurysm basis, and the area under the sROC curve (AUC), heterogeneity, and publication bias also were evaluated. A total of 487 aneurysms were included for meta-analysis. The pooled sensitivity, specificity, +LR, -LR, DOR, and AUC of CTA for detecting the residual or recurrent aneurysms after clipping were 71%, 94%, 9.39, 0.32, 28.32, and 0.8558, respectively. The between-study heterogeneity of DOR and the presence of publication bias were not statistically significant. As a noninvasive and convenient screening method, CTA has a high diagnostic value for the detection of the residual or recurrent aneurysms after clipping. In the future, it may be used as a routine diagnostic tool for evaluation of aneurysms after clipping.