Yield of Computed Tomography (CT) Angiography in Patients with Acute Headache, Normal Neurological Examination, and Normal Non Contrast CT: A Meta-Analysis

Alons, Imanda M.E.; Goudsmit, Ben F.J.; Jellema, Korné; Walderveen, Marianne A.A. van; Wermer, Marieke J.H.; Algra, Ale

doi:10.1016/j.jstrokecerebrovasdis.2017.11.016

Cited by 18 publications

(12 citation statements)

References 27 publications

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“…Among patients with these neurologic symptoms, the prevalence of CVT is low. 3,4 Misdiagnosis and delays in diagnosis are not infrequent. 5,6 To rule out CVT, additional imaging with MRI and magnetic resonance venography (MRV), or with CT venography (CTV), is required.…”

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confidence: 99%

Diagnostic accuracy of noncontrast CT imaging markers in cerebral venous thrombosis

et al. 2019

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ObjectiveTo assess the added diagnostic value of semiquantitative imaging markers on noncontrast CT scans in cerebral venous thrombosis (CVT).MethodsIn a retrospective, multicenter, blinded, case-control study of patients with recent onset (<2 weeks) CVT, 3 readers assessed (1) the accuracy of the visual impression of CVT based on a combination of direct and indirect signs, (2) the accuracy of attenuation values of the venous sinuses in Hounsfield units (with adjustment for hematocrit levels), and (3) the accuracy of attenuation ratios of affected vs unaffected sinuses in comparison with reference standard MRI or CT angiography. Controls were age-matched patients with (sub)acute neurologic presentations.ResultsWe enrolled 285 patients with CVT and 303 controls from 10 international centers. Sensitivity of visual impression of thrombosis ranged from 41% to 73% and specificity ranged from 97% to 100%. Attenuation measurement had an area under the curve (AUC) of 0.78 (95% confidence interval [CI] 0.74–0.81). After adjustment for hematocrit, the AUC remained 0.78 (95% CI 0.74–0.81). The analysis of attenuation ratios of affected vs unaffected sinuses had AUC of 0.83 (95% CI 0.8–0.86). Adding this imaging marker significantly improved discrimination, but sensitivity when tolerating a false-positive rate of 20% was not higher than 76% (95% CI 0.70–0.81).ConclusionSemiquantitative analysis of attenuation values for diagnosis of CVT increased sensitivity but still failed to identify 1 out of 4 CVT.Classification of evidenceThis study provides Class II evidence that visual analysis of plain CT with or without attenuation measurements has high specificity but only moderate sensitivity for CVT.

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confidence: 99%

Diagnostic accuracy of noncontrast CT imaging markers in cerebral venous thrombosis

et al. 2019

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“…Surprisingly, despite of strong recommendation against routine scanning of headache patients our patients were scanned usually more than once for an uncomplicated headache by their GPs or primary care physicians including neurologists. The diagnostic yield of plain CT and contrast-enhanced CT scans (apart from emergency situations such as probable subarachnoideal hemorrhage or brain injury) is very limited in the diagnotic work-up of headache 13,14 . Furthermore, ionizing radiation can cause damage to deoxyribonucleic acid (DNA), increasing the risk of malignancies, especially in the case of recurrent scannings or dose exceedings [15][16][17] .…”

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confidence: 99%

Characteristics of Patients Referred To A Specialized Headache Clinic

Fejes

Fehér

Gurdán

et al. 2020

Sci Rep

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Headache is a common problem with great effect both on the individual and on the society. Recent studies raised the possibility of increasing rate of specialty referrals, inappropiate treatment and advanced imaging for simple headache. The aim of our study was to analyze the characteritics of patients (including duration of symptoms, headache type, brain imaging, treatment) referred to our specialized headache clinic between 01/01/2014 and 01/01/2015 by their general practitioners and primary care neurologists due to chronic/treatment-resistant headache syndromes. 202 patients (mean age 53.6 ± 17.6 years) were evaluated in our clinic (102 females, mean age 50.14 ± 16.11 years and 100 males, mean age 57 ± 18.1 years). Migraine (84/202) and tension-type (76/202) were the most common syndromes. 202 plain brain CT, 60 contrast-enhanced CT and 128 MRI were carried out by their general practitioners or other healthcare professioners including neurologists before referral to our headache centre. Despite of extensive brain imaging appropiate treatment was started less than 1/3 of all patients and significant proportion received benzodiazepines or opioid therapy. Furthermore, more than 10% of referred patients presented with secondary headache including one meningitis. The management of headache is still a challenge for primary care physicians leading to medical overuse. Vast majority of our patients should not be referred to our specialized headache clinic as they had uncomplicated headache or other underlying conditions than pain.

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“…However, the use of CTA in an emergency may be reasonable due to possible disease consequences. Of course, these results must be studied prospectively, including a cost-bene t analysis [29]. Therefore, the correct diagnosis rate of primary headache by emergency physicians is low, and a lack of understanding of primary headache has been noted.…”

Section: Discussionmentioning

confidence: 99%

Headache in the emergency department in Chongqing Province, China: A multicentre study

Tao

et al. 2020

Preprint

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Background: To investigate the present situation of emergency headache in many general hospitals in Chongqing Province, China.Methods: From January 1 to December 31, 2017, we studied patients who complained of headaches as the main symptom in the emergency department of 17 general hospitals in Chongqing Province. Each patient with a headache was interviewed and the medical history was collected by administering a questionnaire. The diagnosis of headache is based on the third edition of the International Classification of Headache Disorders (ICHD-3 beta). Results: In 2017, 16434 patients complained of headache in 17 general hospitals in Chongqing, accounting for 2.3% of all emergency patients. Eight thousand one male patients (48.7%) and 8433 female patients (51.3%) experienced a headache. The average age was (41.8 ± 13.2) years, and the course of disease was 3 hours to 15.2 years. Regarding the initial diagnosis, 7299 patients (44.4%) were diagnosed secondary headache, 5076 (30.9%) were diagnosed with primary headache and 4059 (24.865%) could not be diagnosed. The hospitalization rates for these patients were 60.3%, 12.2%, and 41.5%, respectively. Migraine is still the most common type of primary headache. Conclusions: This study shows that the misdiagnosis rate and missed diagnosis rate of patients with an emergency headache are high, and the emergency department still performs overtesting and hospitalizations.

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Yield of Computed Tomography (CT) Angiography in Patients with Acute Headache, Normal Neurological Examination, and Normal Non Contrast CT: A Meta-Analysis

Cited by 18 publications

References 27 publications

Diagnostic accuracy of noncontrast CT imaging markers in cerebral venous thrombosis

Diagnostic accuracy of noncontrast CT imaging markers in cerebral venous thrombosis

Characteristics of Patients Referred To A Specialized Headache Clinic

Headache in the emergency department in Chongqing Province, China: A multicentre study

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