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

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

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 of CTP and NCCT for detection of ischemic stroke.

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

Characteristics of included studies.

<p>Characteristics of included studies.</p

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

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

Forest plot of CTP for detection of ischemic stroke.

<p>The plot shows study-specific estimates of sensitivity and specificity (with 95% confidence intervals). The studies are ordered according to whether recruitment was prospective or not, and sensitivity. FN: false negative; FP: false positive; TN: true negative; TP: true positive.</p

Radiofrequency Ablation versus Hepatic Resection for Small Hepatocellular Carcinomas: A Meta-Analysis of Randomized and Nonrandomized Controlled Trials

<div><p>Objectives</p><p>To evaluate the efficacy and safety of radiofrequency ablation (RFA) versus hepatic resection (HR) for early hepatocellular carcinoma (HCC) meeting the Milan criteria.</p><p>Methods</p><p>A meta-analysis was conducted, and PubMed, Web of Science, the Cochrane Library, CBM, CNKI and VIP databases were systematically searched through November 2012 for randomized and nonrandomized controlled trials (RCTs and NRCTs). The Cochrane Collaboration's tool and modified MINORS score were applied to assess the quality of RCTs and NRCTs, respectively. The GRADE approach was employed to evaluate the strength of evidence.</p><p>Results</p><p>Three RCTs and twenty-five NRCTs were included. Among 11,873 patients involved, 6,094 patients were treated with RFA, and 5,779 with HR. The pooled results of RCTs demonstrated no significant difference between groups for 1- and 3-year overall survival (OS), recurrence-free survival (RFS) and disease-free survival (DFS) (p>0.05). The 5-year OS (Relative Risk, RR 0.72, 95% CI 0.60 to 0.88) and RFS (RR 0.56, 95% CI 0.40 to 0.78) were lower with RFA than with HR. The 3- and 5-year recurrences with RFA were higher than with HR (RR 1.48, 95% CI 1.14 to 1.94, and RR 1.52, 95% CI 1.18 to 1.97, respectively), but 1-year recurrence and in-hospital mortality showed no significant differences between groups (p>0.05). The complication rate (RR 0.18, 95% CI 0.06 to 0.53) was lower and hospital stays (Mean difference -8.77, 95% CI −10.36 to −7.18) were shorter with RFA than with HR. The pooled results of NRCTs showed that the RFA group had lower 1-, 3- and 5-year OS, RFS and DFS, and higher recurrence than the HR group (p<0.05). But for patients with very early stage HCC, RFA was comparable to HR for OS and recurrence.</p><p>Conclusion</p><p>The effectiveness of RFA is comparable to HR, with fewer complications but higher recurrence, especially for very early HCC patients.</p></div

Summary of finding table for HCC patients with tumor size ≤3cm in NRCTs.

<p>Summary of finding table for HCC patients with tumor size ≤3cm in NRCTs.</p