The diagnostic accuracy of computed tomography angiography for traumatic or atherosclerotic lesions of the carotid and vertebral arteries: a systematic review. Eur J Radiol 2003 Oct;48(1):88-102
Date
09/27/2003Pubmed ID
14511863DOI
10.1016/s0720-048x(03)00200-6Scopus ID
2-s2.0-0141720712 (requires institutional sign-in at Scopus site) 101 CitationsAbstract
INTRODUCTION: Helical computed tomography angiography (CTA) has become an established technique for evaluating atherosclerosis of the cerebrovascular arteries. However, the role of CTA in penetrating and blunt trauma to the carotid and vertebral arteries is not well defined. We conducted a systematic literature review to determine the diagnostic accuracy of CTA for atherosclerotic, penetrating and blunt lesions in the carotid and vertebral arteries.
METHODS: We searched MEDLINE and EMBASE databases to identify studies evaluating the diagnostic accuracy of CTA of the carotid and vertebral arteries published between January 1, 1992 and December 31, 2002. Two reviewers independently assessed abstracts and full text to determine study eligibility. Information on methodological quality, imaging technique and diagnostic accuracy was abstracted from all eligible studies by three independent reviewers. We pooled sensitivity and specificity data from diagnostic accuracy studies of high methodological quality.
RESULTS: Forty-three articles met the inclusion criteria and were included in the review. Thirty studies examined atherosclerotic disease, two blunt trauma, two penetrating trauma and nine examined patients with other pathology. Pooled data from 15 higher quality studies demonstrated that CTA had a sensitivity of 95% (91-97% CI) for detecting severe (>70%) atherosclerotic stenosis of the carotid artery. The specificity of CTA for severe stenosis was also high 98% (96-99% CI). CTA remained a sensitive technique (95%; 93-97% CI) when the criterion for a positive result is relaxed to moderate or greater (>30%) stenosis. Two studies raised concerns about the use of CTA in the blunt trauma setting, suggesting that CTA may not be sensitive for detecting small intimal injuries, although both of these studies used older technologies for either obtaining or viewing images. Conversely, two penetrating trauma studies concluded that the sensitivity of CTA was high.
CONCLUSIONS: Our findings demonstrate that CTA is both a sensitive and specific imaging technique for identifying severe atherosclerotic stenosis and occlusion of the carotid arteries. However, there is currently not enough high quality evidence to accurately estimate the sensitivity and specificity of CTA in the setting of blunt or penetrating trauma.
Author List
Hollingworth W, Nathens AB, Kanne JP, Crandall ML, Crummy TA, Hallam DK, Wang MC, Jarvik JGAuthor
Marjorie Wang MD Clinical Transformation Officer, Chief, Professor in the Neurosurgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AngiographyArteriosclerosis
Carotid Artery Diseases
Carotid Artery Injuries
Humans
Reproducibility of Results
Tomography, Spiral Computed
Vertebral Artery
