Use of follow-up imaging in isolated perimesencephalic subarachnoid hemorrhage: a meta-analysis.

Abstract:

BACKGROUND AND PURPOSE:Multiple studies have shown that negative computed tomographic angiograms (CTAs) are reliable in excluding aneurysms in patients with isolated perimesencephalic subarachnoid hemorrhage (pSAH). We evaluate the use of digital subtraction angiography versus CTA for initial diagnosis and of angiographic follow-ups in patients with pSAH by performing an institutional analysis and a meta-analysis of literature. METHODS:Retrospective institutional analysis of patients with pSAH was performed from 2008 to 2014. The number and types of follow-up imaging studies were tabulated. Initial and follow-up studies were evaluated by an experienced neuroradiologist for intracranial aneurysm. Meta-analysis of literature was performed to assess the use of initial digital subtraction angiography and of follow-up imaging. RESULTS:Our institutional review revealed no additional use of initial digital subtraction angiography or of any angiographic follow-up after initial negative CTA in patients with pSAH on noncontrast CT. Meta-analysis of 40 studies yielded a total of 1031 patients. Only 8 aneurysms were first diagnosed on follow-ups (0.78%). Careful review showed that some of these aneurysms reported on follow-up are of questionable validity. Initial digital subtraction angiography and follow-up imaging after a negative initial CTA showed no statistically significant benefits. CONCLUSIONS:In patients meeting the strict imaging criteria of pSAH, initial negative CTA is reliable in excluding aneurysms. A critical review of the literature through meta-analysis shows no foundation for multiple follow-up studies in patients with pSAH.

journal_name

Stroke

journal_title

Stroke

authors

Kalra VB,Wu X,Matouk CC,Malhotra A

doi

10.1161/STROKEAHA.114.007370

subject

Has Abstract

pub_date

2015-02-01 00:00:00

pages

401-6

issue

2

eissn

0039-2499

issn

1524-4628

pii

STROKEAHA.114.007370

journal_volume

46

pub_type

杂志文章,meta分析

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