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Abstract：
BACKGROUND: Due to the increasing incidence of ischaemic cerebrovascular diseases, the accurate assessment of internal carotid artery (ICA) stenosis is crucial for the development of treatment plans. This systematic review and meta-analysis aimed to evaluate the diagnostic value of computed tomography angiography (CTA) for severe ICAstenosis, thereby providing support for clinical decision-making and promoting diagnostic updates.
METHODS: The PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Database for Chinese Technical Periodicals (VIP), and Chinese Biomedical Literature (CBM) electronic databases were searched from inception to March 21, 2024, to identify publicly available research literature on the use of CTA to diagnose severe ICA stenosis. Literature screening, data extraction, and quality assessment were conducted based on the inclusion and exclusion criteria as well as the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) standards. Data analysis was performed using Stata 17.0 and Meta-Disc 1.4 software. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of the included studies were calculated using Stata 17.0 software, and forest plots and summary receiver operating characteristic (SROC) curves were generated. The area under the curve (AUC) was calculated, and funnel plots were constructed to assess publication bias.
RESULTS: A total of 16 studies with 2368 vascular segments were included. The meta-analysis revealed that the combined sensitivity and specificity of CTA for severe ICA stenosis were 0.93 (95% CI: 0.88 ~ 0.96) and 0.99 (95% CI: 0.96 ~ 1.00), respectively. The combined positive likelihood ratio and negative likelihood ratio were 92.0 (95% CI: 24.2 ~ 349.6) and 0.07 (95% CI: 0.04 ~ 0.13), respectively. The diagnostic odds ratio was 1302 (95% CI: 257 ~ 6606), and the AUC of the SROC curve was 0.98. The Deeks funnel plot suggested no publication bias among the included studies.
CONCLUSIONS: CTA demonstrated high sensitivity and specificity for diagnosing severe ICA stenosis. Therefore, this study provided important evidence for the accurate diagnosis and treatment of severe ICA stenosis. However, there was considerable heterogeneity among the included studies, thus indicating the need for additional high-quality prospective studies to confirm the clinical applicability of CTA.
METHODS: The PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Database for Chinese Technical Periodicals (VIP), and Chinese Biomedical Literature (CBM) electronic databases were searched from inception to March 21, 2024, to identify publicly available research literature on the use of CTA to diagnose severe ICA stenosis. Literature screening, data extraction, and quality assessment were conducted based on the inclusion and exclusion criteria as well as the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) standards. Data analysis was performed using Stata 17.0 and Meta-Disc 1.4 software. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of the included studies were calculated using Stata 17.0 software, and forest plots and summary receiver operating characteristic (SROC) curves were generated. The area under the curve (AUC) was calculated, and funnel plots were constructed to assess publication bias.
RESULTS: A total of 16 studies with 2368 vascular segments were included. The meta-analysis revealed that the combined sensitivity and specificity of CTA for severe ICA stenosis were 0.93 (95% CI: 0.88 ~ 0.96) and 0.99 (95% CI: 0.96 ~ 1.00), respectively. The combined positive likelihood ratio and negative likelihood ratio were 92.0 (95% CI: 24.2 ~ 349.6) and 0.07 (95% CI: 0.04 ~ 0.13), respectively. The diagnostic odds ratio was 1302 (95% CI: 257 ~ 6606), and the AUC of the SROC curve was 0.98. The Deeks funnel plot suggested no publication bias among the included studies.
CONCLUSIONS: CTA demonstrated high sensitivity and specificity for diagnosing severe ICA stenosis. Therefore, this study provided important evidence for the accurate diagnosis and treatment of severe ICA stenosis. However, there was considerable heterogeneity among the included studies, thus indicating the need for additional high-quality prospective studies to confirm the clinical applicability of CTA.
摘要：
背景：由于缺血性脑血管疾病的发病率不断增加，准确评估颈内动脉(ICA)狭窄对制定治疗方案至关重要.本系统评价和荟萃分析旨在评估CT血管造影（CTA）对重度ICAA狭窄的诊断价值。从而为临床决策提供支持并促进诊断更新。
方法：PubMed，Embase,科克伦图书馆,中国国家知识基础设施(CNKI),万方数据库,中国科技期刊VIP数据库(VIP),从开始到2024年3月21日检索了中国生物医学文献(CBM)电子数据库,以确定使用CTA诊断重度ICA狭窄的公开研究文献.文学筛选,数据提取,根据纳入和排除标准以及诊断准确性研究质量评估(QUADAS)标准进行质量评估.使用Stata17.0和Meta-Disc1.4软件进行数据分析。敏感性,特异性，正似然比，负似然比，使用Stata17.0软件计算纳入研究的诊断比值比，并生成了森林图和综合接受者工作特征(SROC)曲线。计算曲线下面积(AUC),并构建漏斗图评估发表偏倚.
结果：共纳入16项2368个血管段的研究。Meta分析显示CTA对重度ICA狭窄的联合敏感性和特异性分别为0.93(95%CI:0.88~0.96)和0.99(95%CI:0.96~1.00)。分别。合并的正似然比和负似然比分别为92.0（95％CI：24.2〜349.6）和0.07（95％CI：0.04〜0.13），分别。诊断比值比为1302(95%CI:257~6606)，SROC曲线的AUC为0.98。Deeks漏斗图表明在纳入的研究中没有发表偏倚。
结论：CTA对诊断重度ICA狭窄具有较高的敏感性和特异性。因此,本研究为重度ICA狭窄的准确诊断和治疗提供了重要依据。然而,纳入的研究之间存在相当大的异质性，因此,需要更多高质量的前瞻性研究来证实CTA的临床适用性.
方法：PubMed，Embase,科克伦图书馆,中国国家知识基础设施(CNKI),万方数据库,中国科技期刊VIP数据库(VIP),从开始到2024年3月21日检索了中国生物医学文献(CBM)电子数据库,以确定使用CTA诊断重度ICA狭窄的公开研究文献.文学筛选,数据提取,根据纳入和排除标准以及诊断准确性研究质量评估(QUADAS)标准进行质量评估.使用Stata17.0和Meta-Disc1.4软件进行数据分析。敏感性,特异性，正似然比，负似然比，使用Stata17.0软件计算纳入研究的诊断比值比，并生成了森林图和综合接受者工作特征(SROC)曲线。计算曲线下面积(AUC),并构建漏斗图评估发表偏倚.
结果：共纳入16项2368个血管段的研究。Meta分析显示CTA对重度ICA狭窄的联合敏感性和特异性分别为0.93(95%CI:0.88~0.96)和0.99(95%CI:0.96~1.00)。分别。合并的正似然比和负似然比分别为92.0（95％CI：24.2〜349.6）和0.07（95％CI：0.04〜0.13），分别。诊断比值比为1302(95%CI:257~6606)，SROC曲线的AUC为0.98。Deeks漏斗图表明在纳入的研究中没有发表偏倚。
结论：CTA对诊断重度ICA狭窄具有较高的敏感性和特异性。因此,本研究为重度ICA狭窄的准确诊断和治疗提供了重要依据。然而,纳入的研究之间存在相当大的异质性，因此,需要更多高质量的前瞻性研究来证实CTA的临床适用性.
