Perfusion CT for prediction of hemorrhagic transformation in acute ischemic stroke: a systematic review and meta-analysis
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To investigate the diagnostic performance of perfusion CT for prediction of hemorrhagic transformation in acute ischemic stroke.
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.
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%).
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.
• 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%.
KeywordsStroke Hemorrhage Perfusion
Diagnostic odds ratio
Hierarchical summary receiver operating characteristic
Magnetic resonance imaging
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Quality Assessment of Diagnostic Accuracy Studies-2
The research was supported by a grant from the Ministry of Food and Drug Safety in 2018 (No. 18182MFDS402).
Compliance with ethical standards
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).
Written informed consent was not required for this study because of the nature of our study, which was a systemic review and meta-analysis.
Institutional Review Board approval was not required because of the nature of our study, which was a systemic review and meta-analysis.
• a systemic review and meta-analysis
• performed at one institution
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