Salvador Cruz-Flores, MD, MPH
Is computed tomographic (CT) angiography (CTA) accurate for identifying cerebral aneurysms in symptomatic patients?
Included studies compared contrast-enhanced helical CTA with digital subtraction angiography (DSA), alone or with neurosurgical findings, to make a primary diagnosis of cerebral aneurysms of any type or in any location, in patients with suspected cerebral aneurysms. Outcomes included sensitivity and specificity for detecting cerebral aneurysms.
PubMed, Scopus, Biosis Previews, and Web of Science (1995 to Feb 2010) and reference lists of retrieved articles were searched for studies that included ≥ 5 patients with and ≥ 5 patients without aneurysms, had nonarbitrary patient enrollment, and reported sufficient data to construct 2 x 2 contingency tables. 45 studies (n = 3643, mean/median age 45 to 62 y, mean 59% women) met the selection criteria. 16 studies used 1-row, 9 used 4-row, 12 used 16-row, and 8 used 64-row CT. 24 studies used DSA alone as the reference standard, and 21 used DSA and neurosurgical findings. 43 studies had high scores on the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool (range 10.5 to 13.5 out of 14).
Mean prevalence of nontraumatic subarachnoid hemorrhage was 86%, and mean prevalence of cerebral aneurysmal disease was 77%. The Table shows the overall diagnostic test characteristics for CTA by patient and by aneurysm. 64-row CT had the highest sensitivity for both per-patient (99%, 95% CI 98 to 100) and per-aneurysm (98%, CI 95 to 99) units of diagnosis.
Computed tomographic angiography has high sensitivity and specificity for diagnosing cerebral aneurysms, by patient and by aneurysm, in symptomatic patients.
Test characteristics of computed tomographic angiography for diagnosing cerebral aneurysm in symptomatic patients*
*Abbreviations and diagnostic terms defined in Glossary. Gold standard was digital subtraction angiography with or without neurosurgical findings.
Cruz-Flores S. Review: Computed tomographic angiography is highly accurate for diagnosing cerebral aneurysms in symptomatic patients. Ann Intern Med. ;155:JC3–10. doi: 10.7326/0003-4819-155-6-201109200-02010
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Published: Ann Intern Med. 2011;155(6):JC3-10.
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