Evaluating the diagnostic accuracy of CT perfusion in patients with cerebral vasospasm after aneurysm rupture: a meta-analysis

Abstract

AIm: Computed tomography perfusion (CTP) has recently been used to identify regions of potential ischemia due to cerebral vasospasm, and CTP parameters are able to quantitatively evaluate brain parenchymal perfusion. We performed a meta-analysis as an update of a previous paper published in 2010 and aimed at evaluating the diagnostic accuracy of CTP and CTP parameters for vasospasm after aneurysm rupture. mATERIAL and mETHods: Relevant articles published between January 2005 and May 2013 were systematically searched for analysis without language restrictions from the PubMed/MEDLINE, Embase, and Cochrane databases. The data of CTP parameters, including CBV, CBF, MTT and TTP, were extracted for analysis, and the pooled sensitivity, specificity, PLR, NLR, DOR and the sROC curve were determined. REsuLTs:Three relevant articles and a total of 98 patients were finally involved in the analysis. The pooled sensitivity, specificity, PLR, NLR, DOR, and AUC of CTP for diagnosing cerebral vasospasm were 94%, 90%, 8.22, 0.06, 141.09, and 0.9802, respectively. Through the evaluation of CTP parameters, MTT had a higher sensitivity (91%) while CBF had a higher specificity (93%). CoNCLusIoN:CT perfusion has a great diagnostic value to detect cerebral vasospasm compared with DSA in patients with aneurysmal subarachnoid hemorrhage (aSAH). As CTP parameters, CBF and MTT quantitatively evaluate brain parenchymal perfusion. soNuÇ: BTP testinin anevrizmal subaraknoid hemorajili (aSAK) hastalarda serebral vazospazmı belirlemede anjiyografiye kıyasla önemli diyagnostik değeri vardır. BTP parametreleri olan CBF ve MTT beyin parankimi perfüzyonunu kantitatif olarak değerlendirirler.ANAHTAR sÖZCÜKLER: BTP, BT perfüzyon, BTP parametreleri, Vazospazm, Serebral vazospazm ABBREVIATIoNs: CTP: computed tomography perfusion, CBV: cerebral blood volume, CBF: cerebral blood flow, mTT: mean transit time, TTP: time to peak, PLR: positive likelihood ratio, NLR: negative likelihood ratio, doR: diagnostic odds ratio, CIs: confidence intervals, sRoC: summary receiver-operating characteristic, dsA: digital substraction angiography, asAH: aneurysmal subarachnoid hemorrhage.

Tavşanlarda Deneysel Subaraknoı̇d Kanama Modelı̇nde IV %20 Mannı̇tolün Serebral Vazospazm Üzerı̇ne Etkı̇lerı̇

“…SAK sonrası KI� BAS'dan intraventriküler kanama, intraparankimal kanama ve beyin ödemi gibi etkenler sorumlu tutulmaktadır. Hematomun boşaltılması, ventriküler kateter yerleştirilmesi, sedasyon, farmakolojik tedavi ve ventilasyonun düzenlenmesi uygulanabilecek tedavi yöntemlerindendir 7 . %20 mannitolün kafa içi basıncını azalttığı gösterildikten sonra KİBAS'da sıklıkla kullanılan bir ajan haline gelmiştir 8 .…”

Bleeding Brain Intraparenchymal

“…Therefore, in patients with HIP restricted to bed, it is recommended to start the mechanical prophylaxis of VTE, preferably with intermittent pneumatic compression devices, or if not available, compression stockings graduated at the time of admission. Associated with mechanical prophylaxis, the prophylactic doses of nonfractioned subcutaneous heparin or LMWH may be initiated after the first 48h in patients with documented stable hematoma 22,23 .…”