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Perfusion CT for prediction of hemorrhagic transformation in acute ischemic stroke: a systematic review and meta-analysis

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Abstract

Objective

To investigate the diagnostic performance of perfusion CT for prediction of hemorrhagic transformation in acute ischemic stroke.

Methods

A computerized literature search of Ovid MEDLINE and EMBASE was conducted up to October 29, 2018. Search terms included acute ischemic stroke, hemorrhagic transformation, and perfusion CT. Studies assessing the diagnostic performance of perfusion CT for prediction of hemorrhagic transformation in acute ischemic stroke were included. Two reviewers independently evaluated the eligibility of the studies. A bivariate random effects model was used to calculate the pooled sensitivity and pooled specificity. Multiple subgroup analyses were performed.

Results

Fifteen original articles with a total of 1134 patients were included. High blood-brain barrier permeability and hypoperfusion status derived from perfusion CT are associated with hemorrhagic transformation. The pooled sensitivity and specificity were 84% (95% CI, 71–91%) and 74% (95% CI, 67–81%), respectively. The area under the hierarchical summary receiver operating characteristic curve was 0.84 (95% CI, 0.81–0.87). The Higgins I2 statistic demonstrated that heterogeneity was present in the sensitivity (I2 = 80.21%) and specificity (I2 = 85.94%).

Conclusion

Although various perfusion CT parameters have been used across studies, the current evidence supports the use of perfusion CT to predict hemorrhagic transformation in acute ischemic stroke.

Key Points

• High blood-brain barrier permeability and hypoperfusion status derived from perfusion CT were associated with hemorrhagic transformation.

• Perfusion CT has moderate diagnostic performance for the prediction of hemorrhagic transformation in acute ischemic stroke.

• The pooled sensitivity was 84%, and the pooled specificity was 74%.

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Abbreviations

CI:

Confidence interval

CT:

Computed tomography

DOR:

Diagnostic odds ratio

HSROC:

Hierarchical summary receiver operating characteristic

MRI:

Magnetic resonance imaging

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

QUADAS-2:

Quality Assessment of Diagnostic Accuracy Studies-2

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Funding

The research was supported by a grant from the Ministry of Food and Drug Safety in 2018 (No. 18182MFDS402).

Author information

Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea

    Chong Hyun Suh, Seung Chai Jung, Se Jin Cho, Donghyun Kim, Jung Bin Lee & Kyung Won Kim

  2. Bioimaging Center, Biomedical Research Center, Asan Institute for Life Sciences, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea

    Dong-Cheol Woo

  3. Clinical Research Division, National Institute of Food and Drug Safety Evaluation, MFDS, Cheongju, Republic of Korea

    Woo Yong Oh & Jong Gu Lee

  4. Asan Image Metrics, Clinical Trial Center, Asan Institute for Life Sciences, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea

    Kyung Won Kim

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  1. Chong Hyun Suh
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Corresponding author

Correspondence to Seung Chai Jung.

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Guarantor

The scientific guarantor of this publication is Seung Chai Jung.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors (Chong Hyun Suh) has significant statistical expertise (5 years of experience in a systematic review and meta-analysis).

Informed consent

Written informed consent was not required for this study because of the nature of our study, which was a systemic review and meta-analysis.

Ethical approval

Institutional Review Board approval was not required because of the nature of our study, which was a systemic review and meta-analysis.

Methodology

• a systemic review and meta-analysis

• performed at one institution

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Suh, C.H., Jung, S.C., Cho, S.J. et al. Perfusion CT for prediction of hemorrhagic transformation in acute ischemic stroke: a systematic review and meta-analysis. Eur Radiol 29, 4077–4087 (2019). https://doi.org/10.1007/s00330-018-5936-7

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  • DOI: https://doi.org/10.1007/s00330-018-5936-7

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