Saturday, June 22, 2024

CTP’s Diagnostic Accuracy in Detecting Delayed Cerebral Ischemia and Vasospasm Post-Aneurysmal SAH

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In the aftermath of an aneurysmal subarachnoid hemorrhage (SAH), delayed cerebral ischemia and vasospasm are predominant causes of late-stage morbidity, presenting significant diagnostic challenges. A recent systematic review and meta-analysis sheds light on the diagnostic efficacy of computed tomography perfusion (CTP) in identifying these conditions, offering hope for improved patient outcomes.

Study Methodology

Researchers meticulously searched various databases, including Cochrane and PubMed, up to September 2023, to identify studies that evaluated CTP’s diagnostic performance in the context of aneurysmal SAH. A total of 30 studies involving 1,786 patients and 2,302 CTP procedures were included. The selected studies compared CTP’s diagnostic accuracy against established reference standards such as clinical or radiologic delayed cerebral ischemia and angiographic spasm.

Using bivariate random effects models, the team pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio outcomes. They also performed subgroup analyses based on individual CTP parameters and timing of the studies.

Results and Analysis

The pooled sensitivity for detecting delayed cerebral ischemia with CTP was 82.1% (95% CI, 74.5%-87.8%), and specificity was 79.6% (95% CI, 73.0%-84.9%). For vasospasm, CTP demonstrated a pooled sensitivity of 85.6% (95% CI, 74.2%-92.5%) and specificity of 87.9% (95% CI, 79.2%-93.3%). The positive likelihood ratio for delayed cerebral ischemia detection was 4.01 (95% CI, 2.94-5.47), while the negative likelihood ratio was 0.23 (95% CI, 0.12-0.33). For vasospasm, these values were 7.10 (95% CI, 3.87-13.04) and 0.16 (95% CI, 0.09-0.31), respectively.

Bias and applicability assessments revealed 12 articles with low risk, 11 with moderate risk, and 7 with a high risk of bias. This variability underscores the need for standardized CTP techniques and higher-quality randomized trials to validate the findings further.

Clinical Implications

– CTP shows potential as a diagnostic tool for delayed cerebral ischemia and vasospasm, with high sensitivity and specificity rates.
– The technique could be particularly useful in clinical settings where rapid and accurate diagnosis is crucial for patient management.
– Standardizing CTP protocols is essential to ensure consistent and reliable diagnostic outcomes across different clinical settings.
– Future research should focus on randomized trials to evaluate CTP’s impact on clinical practice and patient outcomes.

In conclusion, CTP demonstrates promising diagnostic capabilities for delayed cerebral ischemia and vasospasm following aneurysmal SAH. Despite its potential, the need for standardized techniques and further high-quality trials remains crucial to establish its clinical utility comprehensively.

Original Article: AJNR Am J Neuroradiol. 2024 May 30. doi: 10.3174/ajnr.A8249. Online ahead of print.

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