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<title>Intracranial aneurysms in patients with subarachnoid hemorrhage: CT angiography as a primary examination tool for diagnosis; systematic review and meta-analysis - Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews - NCBI Bookshelf</title>
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<meta name="robots" content="INDEX,NOFOLLOW,NOARCHIVE,NOIMAGEINDEX" /><meta name="author" content="HE Westerlaan, MJ van Dijk, MC Jansen-van der Weide, JC de Groot, RJ Groen, JJ Mooij, M Oudkerk" /><meta name="citation_inbook_title" content="Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]" /><meta name="citation_title" content="Intracranial aneurysms in patients with subarachnoid hemorrhage: CT angiography as a primary examination tool for diagnosis; systematic review and meta-analysis" /><meta name="citation_publisher" content="Centre for Reviews and Dissemination (UK)" /><meta name="citation_date" content="2010" /><meta name="citation_author" content="HE Westerlaan" /><meta name="citation_author" content="MJ van Dijk" /><meta name="citation_author" content="MC Jansen-van der Weide" /><meta name="citation_author" content="JC de Groot" /><meta name="citation_author" content="RJ Groen" /><meta name="citation_author" content="JJ Mooij" /><meta name="citation_author" content="M Oudkerk" /><meta name="citation_pmid" content="20935079" /><meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK78889/" /><meta name="citation_keywords" content="Algorithms" /><meta name="citation_keywords" content="Aneurysm, Ruptured /radiography /therapy" /><meta name="citation_keywords" content="Angiography, Digital Subtraction" /><meta name="citation_keywords" content="Cerebral Angiography /methods" /><meta name="citation_keywords" content="Humans" /><meta name="citation_keywords" content="Intracranial Aneurysm /complications /radiography /therapy" /><meta name="citation_keywords" content="Radiation Dosage" /><meta name="citation_keywords" content="Sensitivity and Specificity" /><meta name="citation_keywords" content="Tomography, X-Ray Computed /methods" /><link rel="schema.DC" href="http://purl.org/DC/elements/1.0/" /><meta name="DC.Title" content="Intracranial aneurysms in patients with subarachnoid hemorrhage: CT angiography as a primary examination tool for diagnosis; systematic review and meta-analysis" /><meta name="DC.Type" content="Text" /><meta name="DC.Publisher" content="Centre for Reviews and Dissemination (UK)" /><meta name="DC.Contributor" content="HE Westerlaan" /><meta name="DC.Contributor" content="MJ van Dijk" /><meta name="DC.Contributor" content="MC Jansen-van der Weide" /><meta name="DC.Contributor" content="JC de Groot" /><meta name="DC.Contributor" content="RJ Groen" /><meta name="DC.Contributor" content="JJ Mooij" /><meta name="DC.Contributor" content="M Oudkerk" /><meta name="DC.Date" content="2010" /><meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK78889/" /><meta name="DC.Language" content="en" /><meta name="description" content="This review concluded that computed tomographic angiography had a very high diagnostic value for detection of ruptured intracranial aneurysms in patients with subarachnoid haemorrhage. 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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="About" href="/books/n/dare/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-dare-lrg.png" alt="Cover of Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK78889_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK78889_dtls__"><div>York (UK): <a href="http://www.crd.york.ac.uk/CRDWeb/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">Centre for Reviews and Dissemination (UK)</a>; 1995-.</div></div><div class="half_rhythm"></div><div class="bk_noprnt"><form method="get" action="/books/n/dare/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK78889_"><span class="title" itemprop="name">Intracranial aneurysms in patients with subarachnoid hemorrhage: CT angiography as a primary examination tool for diagnosis; systematic review and meta-analysis</span></h1><p class="contrib-group"><span itemprop="author">HE Westerlaan</span>, <span itemprop="author">MJ van Dijk</span>, <span itemprop="author">MC Jansen-van der Weide</span>, <span itemprop="author">JC de Groot</span>, <span itemprop="author">RJ Groen</span>, <span itemprop="author">JJ Mooij</span>, and <span itemprop="author">M Oudkerk</span>.</p><p class="small">Review published: <span itemprop="datePublished">2010</span>.</p></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="d12011000878.summary"><h2 id="_d12011000878_summary_">CRD summary</h2><p>This review concluded that computed tomographic angiography had a very high diagnostic value for detection of ruptured intracranial aneurysms in patients with subarachnoid haemorrhage. The conclusions should be interpreted with caution due to the possibility of missing studies, lack of details on study quality and unclear generalisability of the review findings.</p></div><div id="d12011000878.objectives"><h2 id="_d12011000878_objectives_">Authors' objectives</h2><p>To calculate the sensitivity and specificity of computed tomographic (CT) angiography for the diagnosis of cerebral aneurysms in patients with acute subarachnoid haemorrhage at presentation.</p></div><div id="d12011000878.searching"><h2 id="_d12011000878_searching_">Searching</h2><p>MEDLINE and EMBASE were searched from 1997 to September 2009 for published studies that included an abstract. Search terms were reported and included a diagnostic filter. Reference lists of retrieved studies were screened. No language restrictions were applied.</p></div><div id="d12011000878.selection"><h2 id="_d12011000878_selection_">Study selection</h2><p>Studies that evaluated the accuracy of CT angiography for the diagnosis of cerebral aneurysms in patients with subarachnoid haemorrhage were eligible for inclusion. Where studies also included patients with other other diagnosis, data had to be available separately for patients with subarachnoid haemorrhage. All patients had to undergo a reference standard of selective cerebral angiography, surgery, endovascular treatment or autopsy. Studies had to include at least 20 patients and provide sufficient data to construct a 2x2 table of test performance. </p><p>Included studies were prospective and retrospective and some enrolled consecutive patients. Most studies used four CT detector rows and some used eight, 16 or 64 rows. </p><p>Two reviewers independently selected studies for inclusion.</p></div><div id="d12011000878.quality-assessment"><h2 id="_d12011000878_quality-assessment_">Assessment of study quality</h2><p>Two reviewers independently assessed study quality using the 14-item QUADAS tool. Studies were assigned a score from zero to 14 based on the number of items fulfilled. Disagreements were resolved through consensus.</p></div><div id="d12011000878.data-extraction"><h2 id="_d12011000878_data-extraction_">Data extraction</h2><p>Data were extracted to populate 2x2 tables of test performance on a per patient basis and these data were used to calculate sensitivity and specificity together with 95% confidence intervals (CIs). Patients who did not receive a reference standard were excluded from the analysis.</p><p>The authors did not state how many reviewers performed the data extraction. </p></div><div id="d12011000878.synthesis-methods"><h2 id="_d12011000878_synthesis-methods_">Methods of synthesis</h2><p>Summary sensitivity and specificity, together with 95% CIs, were estimated using the bivariate random-effects model. Summary receiver operating characteristic (SROC) curves were estimated using the same model. Forest plots were constructed to display individual study and summary estimates of sensitivity and specificity, together with 95% CIs. Heterogeneity was assessed using the I<sup>2</sup> and Q statistics. Publication bias was assessed using a funnel plot. Subgroup analyses were used to investigate the effects of study design, study quality, reference standard and prevalence of ruptured aneurysms.</p></div><div id="d12011000878.results"><h2 id="_d12011000878_results_">Results of the review</h2><p>Fifty studies (n=4,097 participants, range 21 to 336) were included. QUADAS scores ranged from 7 to 14 out of 14. Forty-two studies reported data on both sensitivity and specificity and were included in the analysis.</p><p>Sensitivity ranged from 88% to 100% with moderate heterogeneity (I<sup>2</sup>=54%). Summary sensitivity was 98% (95% CI 97% to 99%). Specificity ranged from 50% to 100% with low heterogeneity (I<sup>2</sup>=19%). </p><p>Summary specificity was 100% (95% CI 97% to 100%). When the analysis was restricted to studies that used a 16- or 64-detector row CT scanner, heterogeneity was reduced to 15% and the summary estimate of sensitivity remained the same. </p><p>Summary estimates of sensitivity and specificity did not differ according to study design (non-consecutive versus consecutive patients), quality score, reference standard or prevalence of ruptured aneurysms; heterogeneity was reduced for some of these analyses.</p></div><div id="d12011000878.conclusions"><h2 id="_d12011000878_conclusions_">Authors' conclusions</h2><p>CT angiography had a very high diagnostic value for the detection of ruptured intracranial aneurysms.</p></div><div id="d12011000878.commentary"><h2 id="_d12011000878_commentary_">CRD commentary</h2><p>The review addressed a clear question. Inclusion criteria were defined. The literature search was restricted to two databases, used a diagnostic filter and only published studies with abstracts were eligible, so relevant studies may have been missed. Publication bias was assessed in the review, but the methods used were not appropriate for diagnostic data. Appropriate steps were taken to minimise bias and errors during study selection and quality assessment; it was unclear whether such steps were also taken when extracting data. </p><p>Study quality was assessed using appropriate criteria, but results were presented only as summary quality scores with no discussion of individual items fulfilled; therefore, the quality of the included studies was unclear. Only limited study details were presented in tables and this made it difficult to determine the generalisability of the review findings. Statistically robust models were used to pool results. Heterogeneity was investigated. It would have been informative to investigate the one or two studies that showed much lower estimates of specificity than the other studies. </p><p>The authors' conclusions are supported by the data, but should be interpreted with some caution due to the possibility of missing studies, lack of details on study quality and unclear generalisability of the review findings.</p></div><div id="d12011000878.implications"><h2 id="_d12011000878_implications_">Implications of the review for practice and research</h2><p><u>Practice</u>: The authors stated that multidetector CT angiography can be used as a primary examination tool in the diagnostic work-up of patients with subarachnoid haemorrhage. They suggested that selective cerebral angiography can be omitted where CT angiography results were positive and that negative CT angiography results should be confirmed with a second re-evaluation by a radiologist; at that point a negative CT angiography result should be accepted as the final diagnosis.</p><p><u>Research</u>: The authors stated that this meta-analysis should be updated when further data become available and that further research was required into whether these methods and information improved decision making. They stated that their recommendations for clinical practice should be assessed using further prospective data collection.</p></div><div id="d12011000878.funding"><h2 id="_d12011000878_funding_">Funding</h2><p>None stated.</p></div><div id="d12011000878.citation"><h2 id="_d12011000878_citation_">Bibliographic details</h2><p>Westerlaan HE, van Dijk MJ, Jansen-van der Weide MC, de Groot JC, Groen RJ, Mooij JJ, Oudkerk M. Intracranial aneurysms in patients with subarachnoid hemorrhage: CT angiography as a primary examination tool for diagnosis; systematic review and meta-analysis. Radiology 2010; 258(1): 134-145. [<a href="https://pubmed.ncbi.nlm.nih.gov/20935079" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20935079</span></a>]</p></div><div id="d12011000878.paper-url"><h2 id="_d12011000878_paper-url_">Original Paper URL</h2><p><a href="http://radiology.rsna.org/content/258/1/134.abstract" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">http://radiology.rsna.org/content/258/1/134.abstract</a></p></div><div id="d12011000878.indexing"><h2 id="_d12011000878_indexing_">Indexing Status</h2><p>Subject indexing assigned by NLM</p></div><div id="d12011000878.mesh"><h2 id="_d12011000878_mesh_">MeSH</h2><p>Algorithms; Aneurysm, Ruptured /radiography /therapy; Angiography, Digital Subtraction; Cerebral Angiography /methods; Humans; Intracranial Aneurysm /complications /radiography /therapy; Radiation Dosage; Sensitivity and Specificity; Tomography, X-Ray Computed /methods</p></div><div id="d12011000878.accession"><h2 id="_d12011000878_accession_">AccessionNumber</h2><p><a href="http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?AccessionNumber=12011000878" ref="pagearea=body&targetsite=external&targetcat=link&targettype=dare">12011000878</a></p></div><div id="d12011000878.db-entry-date"><h2 id="_d12011000878_db-entry-date_">Database entry date</h2><p>21/09/2011</p></div><div id="d12011000878.status"><h2 id="_d12011000878_status_">Record Status</h2><p>This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.</p></div></div></div>
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<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK78889/?report=reader">PubReader</a></li><li><a href="/books/NBK78889/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK78889" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK78889" style="display:none" title="Cite this Page"><div class="bk_tt">Westerlaan HE, van Dijk MJ, Jansen-van der Weide MC, et al. Intracranial aneurysms in patients with subarachnoid hemorrhage: CT angiography as a primary examination tool for diagnosis; systematic review and meta-analysis. 2010. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-. <span class="bk_cite_avail"></span></div></div></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>In this Page</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="page-toc" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="#d12011000878.summary" ref="log$=inpage&link_id=inpage">CRD summary</a></li><li><a href="#d12011000878.objectives" ref="log$=inpage&link_id=inpage">Authors' objectives</a></li><li><a href="#d12011000878.searching" ref="log$=inpage&link_id=inpage">Searching</a></li><li><a href="#d12011000878.selection" ref="log$=inpage&link_id=inpage">Study selection</a></li><li><a href="#d12011000878.quality-assessment" ref="log$=inpage&link_id=inpage">Assessment of study quality</a></li><li><a href="#d12011000878.data-extraction" ref="log$=inpage&link_id=inpage">Data extraction</a></li><li><a href="#d12011000878.synthesis-methods" ref="log$=inpage&link_id=inpage">Methods of synthesis</a></li><li><a href="#d12011000878.results" ref="log$=inpage&link_id=inpage">Results of the review</a></li><li><a href="#d12011000878.conclusions" ref="log$=inpage&link_id=inpage">Authors' conclusions</a></li><li><a href="#d12011000878.commentary" ref="log$=inpage&link_id=inpage">CRD commentary</a></li><li><a href="#d12011000878.implications" ref="log$=inpage&link_id=inpage">Implications of the review for practice and research</a></li><li><a href="#d12011000878.funding" ref="log$=inpage&link_id=inpage">Funding</a></li><li><a href="#d12011000878.citation" ref="log$=inpage&link_id=inpage">Bibliographic details</a></li><li><a href="#d12011000878.paper-url" ref="log$=inpage&link_id=inpage">Original Paper URL</a></li><li><a href="#d12011000878.indexing" ref="log$=inpage&link_id=inpage">Indexing Status</a></li><li><a href="#d12011000878.mesh" ref="log$=inpage&link_id=inpage">MeSH</a></li><li><a href="#d12011000878.accession" ref="log$=inpage&link_id=inpage">AccessionNumber</a></li><li><a href="#d12011000878.db-entry-date" ref="log$=inpage&link_id=inpage">Database entry date</a></li><li><a href="#d12011000878.status" ref="log$=inpage&link_id=inpage">Record Status</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Similar articles in PubMed</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PBooksDiscovery_RA" id="Shutter"></a></div><div class="portlet_content"><ul><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/17641372" ref="ordinalpos=1&linkpos=1&log$=relatedarticles&logdbfrom=pubmed">Intracranial aneurysms: role of multidetector CT angiography in diagnosis and endovascular therapy planning.</a><span class="source">[Radiology. 2007]</span><div class="brieflinkpop offscreen_noflow">Intracranial aneurysms: role of multidetector CT angiography in diagnosis and endovascular therapy planning.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Papke K, Kuhl CK, Fruth M, Haupt C, Schlunz-Hendann M, Sauner D, Fiebich M, Bani A, Brassel F. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">Radiology. 2007 Aug; 244(2):532-40. </em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/25293950" ref="ordinalpos=1&linkpos=2&log$=relatedarticles&logdbfrom=pubmed">CT angiography in non-traumatic subarachnoid hemorrhage: the importance of arterial attenuation for the detection of intracranial aneurysms.</a><span class="source">[Acta Radiol. 2015]</span><div class="brieflinkpop offscreen_noflow">CT angiography in non-traumatic subarachnoid hemorrhage: the importance of arterial attenuation for the detection of intracranial aneurysms.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Ramgren B, Siemund R, Nilsson OG, Höglund P, Larsson EM, Abul-Kasim K, Björkman-Burtscher IM. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">Acta Radiol. 2015 Oct; 56(10):1248-55. 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