title: Diagnosing flow residuals in coiled cerebral aneurysms by MR angiography: meta-analysis.
abstract: This meta-analysis summarizes the accuracy of magnetic resonance angiography (MRA) for diagnosing residuals in coiled cerebral aneurysms by using the threefold Roy classification (residuals: none, neck, or sac). Four databases were searched from 2000 to June 2013 for eligible studies that compared MRA to digital subtraction angiography (DSA) and reported 3 × 3 count data of threefold Roy classification, or a reduced scheme of 2 × 2 count data. Bivariate and trivariate Bayesian random-effects models were used for meta-analysis. Among 27 included studies (2,119 coiled aneurysms in 1,809 patients) the average prevalence of DSA-confirmed sac residuals was 18.2 % (range 0-43 %). The pooled sensitivity was 88.0 % (95 % CI 81.4-94.0) and specificity was 97.2 % (94.6-99.0 %) for assessing sac residuals by MRA. In the trivariate meta-analysis, a "sac residual" finding at MRA had a high positive likelihood ratio of 28.2 (14.0-79.0). A "neck residual" finding had a moderate negative likelihood ratio of 0.246 (0.111-0.426), and the MRA finding of "no residual" had a good negative likelihood ratio of 0.044 (0.013-0.096). Subgroup analyses identified no significant influence of covariates on diagnostic accuracy (P > 0.05). In conclusion, in coiled cerebral aneurysms MRA with application of the threefold Roy classification is well suited for detecting or excluding sac residuals that might require retreatment.
authors.affiliation: Department of Diagnostic Radiology, University Hospital, Robert-Koch-Strasse 40, 37075, Goettingen, Germany, Menke-J@T-Online.de.
authors.forename: Jan
authors.initials: J
authors.lastname: Menke
authors.forename: Peter
authors.initials: P
authors.lastname: Schramm
authors.forename: Jan Martin
authors.initials: JM
authors.lastname: Sohns
authors.forename: Kai
authors.initials: K
authors.lastname: Kallenberg
authors.forename: Wieland
authors.initials: W
authors.lastname: Staab
mesh_terms: D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D018810:Magnetic Resonance Angiography / Q000379:methods*; D019635:Neurosurgical Procedures; D011237:Predictive Value of Tests; D013525:Surgical Instruments
references.citation: Eur Radiol. 2009 Sep;19(9):2204-16
references.pmid: 19399505
references.citation: N Engl J Med. 2012 Jun 28;366(26):2474-82
references.pmid: 22738097
references.citation: J Neurol. 2012 Apr;259(4):679-83
references.pmid: 21947244
references.citation: Eur J Epidemiol. 1994 Feb;10(1):29-36
references.pmid: 7957786
references.citation: Stroke. 2008 Jan;39(1):120-5
references.pmid: 18048860
references.citation: Radiology. 2012 Jun;263(3):828-35
references.pmid: 22623696
references.citation: Stroke. 2007 Apr;38(4):1404-10
references.pmid: 17332442
references.citation: BMC Med Res Methodol. 2003 Nov 10;3:25
references.pmid: 14606960
references.citation: Lancet Neurol. 2009 May;8(5):427-33
references.pmid: 19329361
references.citation: Stroke. 2009 Aug;40(8):e523-9
references.pmid: 19520984
references.citation: Acad Radiol. 2007 Aug;14(8):974-84
references.pmid: 17659244
references.citation: J Comput Assist Tomogr. 2011 Sep-Oct;35(5):568-72
references.pmid: 21926851
references.citation: J Clin Epidemiol. 2005 Sep;58(9):882-93
references.pmid: 16085191
references.citation: Biostatistics. 2007 Apr;8(2):239-51
references.pmid: 16698768
references.citation: BMC Med Res Methodol. 2006 Jul 12;6:31
references.pmid: 16836745
references.citation: Stroke. 2007 May;38(5):1538-44
references.pmid: 17395870
references.citation: Ann Intern Med. 2009 Aug 18;151(4):264-9, W64
references.pmid: 19622511
references.citation: Stroke. 2011 May;42(5):1331-7
references.pmid: 21454823
references.citation: J Clin Epidemiol. 2005 Mar;58(3):261-8
references.pmid: 15718115
references.citation: Ann Intern Med. 2008 Dec 16;149(12):889-97
references.pmid: 19075208
references.citation: Med Decis Making. 2013 Jul;33(5):692-701
references.pmid: 23475941
references.citation: Methods Inf Med. 2010;49(1):54-62, 62-4
references.pmid: 19936437
references.citation: J Neurointerv Surg. 2013 Nov;5 Suppl 3:iii62-5
references.pmid: 23000564
references.citation: Radiology. 2012 Dec;265(3):858-63
references.pmid: 23012464
references.citation: J Neurol. 2012 Jul;259(7):1298-302
references.pmid: 22186848
references.citation: Stroke. 2003 Jun;34(6):1398-403
references.pmid: 12775880
references.citation: Lancet. 2003 Jul 12;362(9378):103-10
references.pmid: 12867109
references.citation: Ann Intern Med. 2009 Aug 18;151(4):W65-94
references.pmid: 19622512
references.citation: Interv Neuroradiol. 2008 Mar 30;14(1):85-96
references.pmid: 20557790
references.citation: Stroke. 2001 Sep;32(9):1998-2004
references.pmid: 11546888
references.citation: Ann Neurol. 2011 Apr;69(4):646-54
references.pmid: 21391230
references.citation: Lancet. 2005 Sep 3-9;366(9488):809-17
references.pmid: 16139655
references.citation: N Engl J Med. 2006 Aug 31;355(9):928-39
references.pmid: 16943405
references.citation: Interv Neuroradiol. 2012 Sep;18(3):275-83
references.pmid: 22958765
references.citation: Interv Neuroradiol. 2008 Nov 11;14 Suppl 2:53-63
references.pmid: 20557802
references.citation: Clin Radiol. 2000 Mar;55(3):227-35
references.pmid: 10708618
references.citation: Radiology. 2007 Jun;243(3):812-9
references.pmid: 17517935
references.citation: Stat Med. 2000 Mar 15;19(5):649-63
references.pmid: 10700737
references.citation: J Clin Epidemiol. 2003 Nov;56(11):1129-35
references.pmid: 14615004
references.citation: Ann Intern Med. 2010 Sep 7;153(5):325-34
references.pmid: 20820041
references.citation: Neuroradiology. 2007 Sep;49(9):703-13
references.pmid: 17646977
references.citation: Korean J Radiol. 2011 Nov-Dec;12(6):662-70
references.pmid: 22043147