PT  - JOURNAL ARTICLE
AU  - Sousa, João André
AU  - Sondermann, Anton
AU  - Bernardo-Castro, Sara
AU  - Varela, Ricardo
AU  - Donato, Helena
AU  - Sargento-Freitas, João
TI  - CTA and CTP for Detecting Distal Medium Vessel Occlusions: A Systematic Review and Meta-analysis
AID  - 10.3174/ajnr.A8080
DP  - 2024 Jan 01
TA  - American Journal of Neuroradiology
PG  - 51--56
VI  - 45
IP  - 1
4099  - http://www.ajnr.org/content/45/1/51.short
4100  - http://www.ajnr.org/content/45/1/51.full
SO  - Am. J. Neuroradiol.2024 Jan 01; 45
AB  - BACKGROUND: The optimal imaging method for detecting distal medium vessel occlusions (DMVOs) remains undefined.PURPOSE: The objective of this study is to compare the diagnostic performance of CTA with CTP in detecting DMVOs.DATA SOURCES: We searched PubMed, EMBASE, Web of Science Core Collection, and Cochrane Central Register of Controlled Trials up to March 31, 2023 (PROSPERO: CRD42022344006).STUDY SELECTION: A total of 12 studies reporting accuracy values of CTA and/or CTP were included, comprising 2607 patients with 479 cases (18.3%) of DMVOs.DATA ANALYSIS: Pooled sensitivity and specificity of both imaging methods were compared using a random-effects model. Subgroup analyses were performed based on the technique used in CTA (multi or single-phase) and the subtype of DMVOs (M2-only vs. M2 and other DMVOs). We applied Quality Assessment of Diagnostic Accuracy (QUADAS-2) tool and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) quality assessment criteria.DATA SYNTHESIS: CTA demonstrated significantly lower sensitivity compared to CTP in detecting DMVOs [0.74, 95%CI (0.63–0.82) vs. 0.89, 95% CI (0.82–0.93), P < 0.01]. When subgrouped into single-phase and multi-phase CTA, multi-phase CTA exhibited higher sensitivity for DMVO detection than single-phase CTA [0.91, 95%CI (0.85–0.94) vs. 0.64, 95%CI (0.56–0.71), P < .01], while reaching similar levels to CTP. The sensitivity of single-phase CTA substantially decreased when extending from M2 to other non-M2 DMVOs [0.74, 95%CI (0.63–0.83) vs. 0.61, 0.95%CI (0.53–0.68), P = .02].LIMITATIONS: We identified an overall high risk of bias and low quality of evidence, attributable to the design and reference standards of most studies.CONCLUSIONS: Our findings highlight a significantly lower sensitivity of single-phase CTA compared to multi-phase CTA and CTP in diagnosing DMVOs.DMVOdistal medium vessel occlusionEVTendovascular treatmentGRADEGrading of Recommendations, Assessment, Development and EvaluationmpCTAmultiphase CT angiographyQUADAS-2Quality Assessment of Diagnostic AccuracySCAsuperior cerebellar arteryspCTAsingle-phase CTATmaxtime-to-maximum