Comparative accuracy of CT perfusion in diagnosing acute ischemic stroke: A systematic review of 27 trials

<div><p>Objective</p><p>To systematically evaluate and compare the diagnostic accuracy of CT perfusion (CTP), non-enhanced computed tomography (NCCT) and computed tomography angiography (CTA) in detecting acute ischemic stroke.</p><p>Methods</p><p>We searched seven databases and screened the reference lists of the included studies. The risk of bias in the study quality was assessed using QUADASII. We produced paired forest plots in RevMan to show the variation of the sensitivity and specificity estimates together with their 95% CI. We used a hierarchical summary ROC model to summarize the sensitivity and specificity of CTP in detecting ischemic stroke.</p><p>Results</p><p>We identified 27 studies with a total of 2168 patients. The pooled sensitivity of CTP for acute ischemic stroke was 82% (95% CI 75–88%), and the specificity was 96% (95% CI 89–99%). CTP was more sensitive than NCCT and had a similar accuracy with CTA. There were no statistically significant differences in the sensitivity and specificity between patients who underwent CTP within 6 hours of symptom onset and beyond 6 hours after symptom onset. No adverse events were reported in the included studies.</p><p>Conclusions</p><p>CTP is more accurate than NCCT and has similar accuracy to CTA in detecting acute ischemic stroke. However, the evidence is not strong. There is potential benefit of using CTP to select stroke patients for treatment, but more high-quality evidence is needed to confirm this result.</p></div

Risk of bias and applicability concerns summary.

<p>Risk of bias and applicability concerns summary.</p

Forest plot showing the meta-analysis of pyridoxine versus placebo in the incidence of Hand-foot syndrome.

<p>This forest plot is created by the software of RevMan 5.1.0. Horizontal lines indicate 95% CIs. Solid boxes indicate the response rate in each study. Test of heterogeneity (I² = 0%) indicates the absence of substantial heterogeneity. The bottom of diamond indicates the pooled response rate (RR0.96, <i>P</i> = 0.99).</p

Forest plot of CTP and NCCT for detection of ischemic stroke.

<p>Forest plot of CTP and NCCT for detection of ischemic stroke.</p

Pyridoxine for Prevention of Hand-Foot Syndrome Caused by Chemotherapy: A Systematic Review

<div><p>Background</p><p>Hand-foot syndrome (HFS) is a relatively frequent dermatologic toxic reaction to certain anti-cancer chemotherapies. The syndrome can evolve into a distressing condition that limits function and affects quality of life. Pyridoxine (vitamin B6) has been used empirically for the prevention of HFS caused by anti-cancer therapy. However, evidence of its efficacy remains controversial.</p><p>Methodology//Principal Findings</p><p>Systematic literature searches were conducted on the Cochrane Library, PUBMED, EMBASE, LILACS, CBM, CNKI, VIP, WANFANG and the U.S. ClinicalTrials.gov website. We included all related randomized controlled trials (RCTs) irrespective of language. Reviewers from different professions independently assessed all potential studies and extracted data. Subgroup analysis was planned according to dose of pyridoxine. 5 RCTs involving 607 patients were contributed to the meta-analysis. No significant differences were found between patients receiving pyridoxine and placebo for prevention of incidence of HFS and grade 2 or worse HFS (relative risk (RR) 0.96, 95%confidence interval (CI) 0.86–1.06; RR0.95, 95%CI 0.73–1.24, respectively). Similarly, no significant improvement in quality of life was detected among patients. However, significant difference was found for prevention of grade 2 or worse HFS with pyridoxine 400 mg daily compared to 200 mg (RR0.55, 95%CI 0.33–0.92).</p><p>Conclusions/Significance</p><p>There is inadequate evidence to make any recommendation about using pyridoxine for prevention of HFS caused by chemotherapy. However, pyridoxine 400 mg may have some efficacy. Further studies of large sample sizes are needed to evaluate the efficacy and safety of pyridoxine, especially at high dose, in comparison with placebo.</p></div

Risk of bias and applicability concerns graph: Review authors’ judgments about each domain presented as percentages across included studies.

<p>Risk of bias and applicability concerns graph: Review authors’ judgments about each domain presented as percentages across included studies.</p

Forest plot showing the meta-analysis of pyridoxine 400 mg versus 200 mg in the incidence of grade 2 or worse Hand-foot syndrome.

<p>This forest plot is created by the software of RevMan 5.1.0. The diamond indicates the response rate (RR0.55, <i>P</i> = 0.02).</p

Characteristics of the included studies.

<p>Abbreviation: T, treatment group; C, control group; –, no treatment; po. per os.</p><p>Outcomes reported:(1)Incidence of all grades HFS; (2)Incidence of grade 2 or worse HFS; (3)Time to development of grade 2 or worse HFS; (4)Factors affecting development of HFS;(5)Tumor response;(6)Quality of life;(7)Chemotherapy drug dose modification;(8)Progression-free survival;(9)Incidence of Adverse Events excluding HFS.</p

Flow diagram of study selection process.

<p>This PRISMA 2009 flow diagram illustrates the results of search and the process of screening and selecting studies for inclusion, and the reasons for exclusions in this review.</p

Summary ROC Plot of CTP and NCCT for detecting ischemic stroke.

<p>Each ellipse on the plot represents the study estimate of CTP. Each diamond represents the study estimate of NCCT. Red and black solid circles represent the summary sensitivity and specificity for NCCT and CTP respectively, and this summary point is surrounded by a 95% confidence region (dotted line). Red and black solid lines represent HSROC curve of NCCT and CTP respectively.</p