TY - JOUR
T1 - Diagnostic test accuracy of pretreatment collateral score in predicting stroke outcomes after intra-arterial endovascular thrombectomy
T2 - a meta-analysis in DSA and CTA
AU - Lu, Wei Zhen
AU - Lin, Hui An
AU - Hou, Sen Kuang
AU - Bai, Chyi Huey
AU - Lin, Sheng Feng
N1 - Publisher Copyright:
© 2022, The Author(s), under exclusive licence to European Society of Radiology.
PY - 2022
Y1 - 2022
N2 - Objectives: This study compared the diagnostic accuracy of pretreatment circulation collateral scoring (CS) system using digital subtraction angiography (DSA) and computed tomography angiography (CTA) in predicting favorable functional outcome (FFO) after intra-arterial endovascular thrombectomy (IA-EVT). Subgroup analysis characterizing scoring systems within each category was additionally conducted. Materials and methods: We performed a diagnostic meta-analysis to assess the sensitivity and specificity of each CS system by using DSA and CTA, respectively. The hierarchical summary receiver operating characteristic curve (HSROC) models were used to estimate the diagnostic odds ratio (DOR) and area under the curve (AUC). The Bayes theorem was employed to determine posttest probability (PTP). Results: In total, 14 and 21 studies were assessed with DSA and CTA, respectively. In DSA, the pooled sensitivity and specificity were 0.72 (95% CI, 0.63–0.79) and 0.61 (0.53–0.68), respectively, and in the HSROC model, the DOR was 3.94 (2.71–5.73), and the AUC was 0.71 (90.67–0.75). CTA revealed a pooled sensitivity and specificity of 0.74 (0.64–0.82) and 0.53 (0.44–0.62), respectively, and in the HSROC model, the DOR was 3.17 (2.34–4.50), and the AUC was 0.67 (0.63–0.71). With a pretest probability of 26.3%, the CS in DSA and CTA exhibited limited increase of PTPs of 39% and 36%, respectively, in detecting the FFO on day 90. Conclusion: DSA and CTA have comparable accuracy and are limited in predicting the functional outcome. The collateral score systems assessed with DSA and CTA were more suitable for screening than diagnosis for patients before IA-EVT. Key Points: • Our study revealed the differences of various scoring systems for assessing collateral status. • DSA and CTA have comparable accuracy, but both imaging modalities played relatively limited roles in predicting functional outcome on day 90. • The collateral score systems assessed with DSA and CTA were more suitable for screening than diagnosis for patients before IA-EVT.
AB - Objectives: This study compared the diagnostic accuracy of pretreatment circulation collateral scoring (CS) system using digital subtraction angiography (DSA) and computed tomography angiography (CTA) in predicting favorable functional outcome (FFO) after intra-arterial endovascular thrombectomy (IA-EVT). Subgroup analysis characterizing scoring systems within each category was additionally conducted. Materials and methods: We performed a diagnostic meta-analysis to assess the sensitivity and specificity of each CS system by using DSA and CTA, respectively. The hierarchical summary receiver operating characteristic curve (HSROC) models were used to estimate the diagnostic odds ratio (DOR) and area under the curve (AUC). The Bayes theorem was employed to determine posttest probability (PTP). Results: In total, 14 and 21 studies were assessed with DSA and CTA, respectively. In DSA, the pooled sensitivity and specificity were 0.72 (95% CI, 0.63–0.79) and 0.61 (0.53–0.68), respectively, and in the HSROC model, the DOR was 3.94 (2.71–5.73), and the AUC was 0.71 (90.67–0.75). CTA revealed a pooled sensitivity and specificity of 0.74 (0.64–0.82) and 0.53 (0.44–0.62), respectively, and in the HSROC model, the DOR was 3.17 (2.34–4.50), and the AUC was 0.67 (0.63–0.71). With a pretest probability of 26.3%, the CS in DSA and CTA exhibited limited increase of PTPs of 39% and 36%, respectively, in detecting the FFO on day 90. Conclusion: DSA and CTA have comparable accuracy and are limited in predicting the functional outcome. The collateral score systems assessed with DSA and CTA were more suitable for screening than diagnosis for patients before IA-EVT. Key Points: • Our study revealed the differences of various scoring systems for assessing collateral status. • DSA and CTA have comparable accuracy, but both imaging modalities played relatively limited roles in predicting functional outcome on day 90. • The collateral score systems assessed with DSA and CTA were more suitable for screening than diagnosis for patients before IA-EVT.
KW - Acute ischemic stroke
KW - Collateral circulation
KW - Computed tomography angiography
KW - Digital subtraction angiography
KW - Thrombectomy
UR - http://www.scopus.com/inward/record.url?scp=85126886756&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85126886756&partnerID=8YFLogxK
U2 - 10.1007/s00330-022-08706-6
DO - 10.1007/s00330-022-08706-6
M3 - Article
AN - SCOPUS:85126886756
SN - 0938-7994
VL - 32
SP - 6097
EP - 6107
JO - European Radiology
JF - European Radiology
IS - 9
ER -