Diagnostic accuracy of computed tomography perfusion in patients with acute stroke: A meta-analysis

PURPOSE The purpose of this meta-analysis was to evaluate the sensitivity and specificity of computed tomography perfusion (CTP) in diagnosing acute ischemic stroke in patients presenting to the emergency department with stroke-like symptoms. METHODS Medline, Cochrane, EMBASE, and Google Scholar databases were searched until November 5, 2014 using the following terms: magnetic resonance imaging/MRI, computed tomography/CT, and stroke. Randomized controlled trials, retrospective, and case-controlled studies were included which evaluated patients who presented for emergency assessment of stroke-like systems. Diffusion weighted imaging (DWI) was used as reference standard. Only studies published in English or Chinese were included. Quality assessment and sensitivity analysis were performed to evaluate that strength of the data. RESULTS The analysis included six studies with a total of 1429 patients. The pooled overall sensitivity for CTP indicated it had reasonable sensitivity (55.7%) and high specificity (92%). Subgroup analysis indicated that of the different CTP modes, MTT and CBF had higher sensitivities (48.6% and 47.3%, respectively) than CBV (26.3%). CBF and CBV had higher specificity (91.0% and 95.4%, respectively) compared with MTT (86.6%). CONCLUSION All three CTP modes had adequate sensitivity but very high specificity, and among the three CTP modes, CBF had the best diagnostic characteristics.