Diagnostic value of 3D time-of-flight magnetic resonance angiography for detecting intracranial aneurysm: a meta-analysis

This meta-analysis is to comprehensively evaluate the diagnostic performance of three-dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA) for detecting intracranial aneurysm (IA).

PubMed, Embase, Web of Science, and the Cochrane library were systematically searched for retrieving eligible studies. Study inclusion, data extraction, and risk of bias assessment were performed by two researchers independently. Pooled sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the curve (AUC) were calculated to assess the diagnostic value. In addition, heterogeneity and subgroup analysis were carried out.

In total, 18 studies comprising 3463 patients were selected. The results of 3D-TOF-MRA for diagnosing IA were SEN 0.89 (95% CI 0.82–0.94), SPE 0.94 (0.86–0.97), PLR 13.79 (5.92–32.12), NLR 0.11 (0.07–0.19), DOR 121.90 (38.81–382.94), and AUC 0.96 (0.94-0.98), respectively. In the subgroup analysis, studies without subarachnoid hemorrhage (SAH) tend to perform statistical significantly better (P < 0.05) in detecting IAs than studies with SAH 0.99 (0.98–1.00) vs. 0.89 (0.86–0.91). The diagnostic value of studies with a two-image reconstruction method was higher than studies with only one image reconstruction method: 0.99 (0.98–1.00) vs. 0.91 (0.89–0.94) with P < 0.05. The 3D-TOF-MRA had better SEN in aneurysms > 3 mm than the aneurysms ≤ 3 mm in diameter: 0.89 (0.87–0.92) vs. 0.78 (0.71–0.84) with P < 0.05.

This study demonstrated that 3D-TOF-MRA has an excellent diagnostic performance for the overall assessment of IA and may serve as an alternative for further patient management with IA.