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<meta name="DC.Title" content="CTA and CTP for Detecting Distal Medium Vessel Occlusions: A Systematic Review and Meta-analysis" />
<meta name="DC.Identifier" content="10.3174/ajnr.A8080" />
<meta name="DC.Date" content="2024-01-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2024 by American Journal of Neuroradiology" />
<meta name="DC.AccessRights" content="restricted" />
<meta name="DC.Description" content="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 &lt; 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 &lt; .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.

DMVO
:   distal medium vessel occlusion
EVT
:   endovascular treatment
GRADE
:   Grading of Recommendations, Assessment, Development and Evaluation
mpCTA
:   multiphase CT angiography
QUADAS-2
:   Quality Assessment of Diagnostic Accuracy
SCA
:   superior cerebellar artery
spCTA
:   single-phase CTA
Tmax
:   time-to-maximum" />
<meta name="DC.Contributor" content="João André Sousa" />
<meta name="DC.Contributor" content="Anton Sondermann" />
<meta name="DC.Contributor" content="Sara Bernardo-Castro" />
<meta name="DC.Contributor" content="Ricardo Varela" />
<meta name="DC.Contributor" content="Helena Donato" />
<meta name="DC.Contributor" content="João Sargento-Freitas" />
<meta name="article:published_time" content="2024-01-01" />
<meta name="article:section" content="Neurovascular/Stroke Imaging" />
<meta name="citation_title" content="CTA and CTP for Detecting Distal Medium Vessel Occlusions: A Systematic Review and Meta-analysis" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND:&lt;/h3&gt;
&lt;p&gt;The optimal imaging method for detecting distal medium vessel occlusions (DMVOs) remains undefined.&lt;/p&gt;&lt;h3&gt;PURPOSE:&lt;/h3&gt;
&lt;p&gt;The objective of this study is to compare the diagnostic performance of CTA with CTP in detecting DMVOs.&lt;/p&gt;&lt;h3&gt;DATA SOURCES:&lt;/h3&gt;
&lt;p&gt;We searched PubMed, EMBASE, Web of Science Core Collection, and Cochrane Central Register of Controlled Trials up to March 31, 2023 (PROSPERO: CRD42022344006).&lt;/p&gt;&lt;h3&gt;STUDY SELECTION:&lt;/h3&gt;
&lt;p&gt;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.&lt;/p&gt;&lt;h3&gt;DATA ANALYSIS:&lt;/h3&gt;
&lt;p&gt;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.&lt;/p&gt;&lt;h3&gt;DATA SYNTHESIS:&lt;/h3&gt;
&lt;p&gt;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), &lt;i&gt;P&lt;/i&gt; &amp;lt; 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), &lt;i&gt;P&lt;/i&gt; &amp;lt; .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), &lt;i&gt;P&lt;/i&gt; = .02].&lt;/p&gt;&lt;h3&gt;LIMITATIONS:&lt;/h3&gt;
&lt;p&gt;We identified an overall high risk of bias and low quality of evidence, attributable to the design and reference standards of most studies.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Our findings highlight a significantly lower sensitivity of single-phase CTA compared to multi-phase CTA and CTP in diagnosing DMVOs.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
<meta name="citation_publisher" content="American Journal of Neuroradiology" />
<meta name="citation_publication_date" content="2024/01/01" />
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<meta name="citation_issn" content="0195-6108" />
<meta name="citation_issn" content="1936-959X" />
<meta name="citation_doi" content="10.3174/ajnr.A8080" />
<meta name="citation_pmid" content="38164544" />
<meta name="citation_volume" content="45" />
<meta name="citation_issue" content="1" />
<meta name="citation_article_type" content="Research Article" />
<meta name="citation_section" content="Neurovascular/Stroke Imaging" />
<meta name="citation_firstpage" content="51" />
<meta name="citation_lastpage" content="56" />
<meta name="citation_author" content="João André Sousa" />
<meta name="citation_author_institution" content="aFrom the Neurology Department (J.A.S., S.B.-C., J.S.-F.), Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal" />
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<meta name="citation_author" content="Sara Bernardo-Castro" />
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<meta name="twitter:title" content="CTA and CTP for Detecting Distal Medium Vessel Occlusions: A Systematic Review and Meta-analysis" />
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<meta name="twitter:description" content="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 &lt; 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 &lt; .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.

DMVO
:   distal medium vessel occlusion
EVT
:   endovascular treatment
GRADE
:   Grading of Recommendations, Assessment, Development and Evaluation
mpCTA
:   multiphase CT angiography
QUADAS-2
:   Quality Assessment of Diagnostic Accuracy
SCA
:   superior cerebellar artery
spCTA
:   single-phase CTA
Tmax
:   time-to-maximum" />
<meta name="og-title" property="og:title" content="CTA and CTP for Detecting Distal Medium Vessel Occlusions: A Systematic Review and Meta-analysis" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/45/1/51" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="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 &lt; 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 &lt; .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.

DMVO
:   distal medium vessel occlusion
EVT
:   endovascular treatment
GRADE
:   Grading of Recommendations, Assessment, Development and Evaluation
mpCTA
:   multiphase CT angiography
QUADAS-2
:   Quality Assessment of Diagnostic Accuracy
SCA
:   superior cerebellar artery
spCTA
:   single-phase CTA
Tmax
:   time-to-maximum" />
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      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">Neurovascular/Stroke Imaging</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">CTA and CTP for Detecting Distal Medium Vessel Occlusions: A Systematic Review and Meta-analysis</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">João André Sousa</span>, <span class="highwire-citation-author" data-delta="1">Anton Sondermann</span>, <span class="highwire-citation-author" data-delta="2">Sara Bernardo-Castro</span>, <span class="highwire-citation-author" data-delta="3">Ricardo Varela</span>, <span class="highwire-citation-author" data-delta="4">Helena Donato</span> and <span class="highwire-citation-author" data-delta="5">João Sargento-Freitas</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">January 2024,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">45 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(1) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">51-56; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A8080 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-105404--6453194590" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">João André Sousa </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Neurology Department (J.A.S., S.B.-C., J.S.-F.), Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Jo%C3%A3o%2BAndr%C3%A9%2BSousa%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Sousa%20JA&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li 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Hospitalar e Universitário de Coimbra, Coimbra, Portugal</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Faculdade de Medicina da Universidade de Coimbra (S.B.-C., J.S.-F.), Coimbra, Portugal</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Sara%2BBernardo-Castro%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Bernardo-Castro%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3ASara%2BBernardo-Castro%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li 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href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Helena%2BDonato%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Donato%20H&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AHelena%2BDonato%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-1905-1268" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Helena Donato</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">João Sargento-Freitas </div><div class="author-tooltip-affiliation"><span 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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">João André</span> <span class="nlm-surname">Sousa</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">Anton</span> <span class="nlm-surname">Sondermann</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">Sara</span> <span class="nlm-surname">Bernardo-Castro</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">Ricardo</span> <span class="nlm-surname">Varela</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">Helena</span> <span class="nlm-surname">Donato</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">João</span> <span class="nlm-surname">Sargento-Freitas</span></span></span></div>
  
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