Angiorresonancia versus angiografía por sustracción digital en el seguimiento de aneurismas intracraneales embolizados. Comparación del desempeño diagnóstico
| Contribuinte(s) |
Puentes Vargas, Juan Carlos |
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| Data(s) |
20/01/2015
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| Resumo |
Introducción: La DSA es el método de elección para el seguimiento de pacientes con aneurismas intracraneales embolizados; esta se puede asociar a complicaciones incapacitantes o mortales. La MRA se ha propuesto como método alternativo por menor costo y menos morbi-mortalidad, aunque su desempeño diagnóstico permanece en discusión debido al desarrollo de nuevos protocolos, resonadores más potentes y nuevas aplicaciones de la DSA. Metodología: Exploramos la literatura hasta la actualidad y comparamos el desempeño diagnóstico de la MRA con la DSA para detectar flujo residual posterior a la embolización terapéutica de aneurismas intracraneales. Realizamos una revisión sistemática de la literatura y meta-análisis basados en 34 artículos detectados en la búsqueda que incluyó las bases de datos PubMed, Scopus, ScIELO y BVS. Resultados: La TOF-MRA demostró sensibilidad de 86.8% (84.3%-89.1%) y especificidad de 91.2% (89%-93.1%); la SROC para TOF-MRA demostró un AUC de 0.95. El desempeño de la CE-MRA demostró sensibilidad de 88.1% (84.6%-91.1%) y especificidad de 89.1% (85.7%-91.9%); la SROC presentó una AUC de 0.93. El análisis estratificado por potencia del resonador encontró que la TOF-MRA tiene mejor desempeño con el resonador de 3T, aunque no es estadísticamente significativo. La concordancia interobservador con TOF-MRA y CE-MRA fue moderada a muy buena. Discusión: El desempeño diagnóstico de la MRA en el seguimiento de aneurismas intracraneales embolizados demostró ser bueno, con sensibilidad mayor a 84%, siendo ligeramente mejor con TOF-MRA, sin lograr reemplazar la DSA. Sin embargo, los resultados deben ser evaluados con precaución por la heterogeneidad de los resultados de los estudios incluidos. (Abreviaturas: DSA: Angiografía por Sustracción Digital; MRA: Angiografía por Resonancia Magnética; TOF-MRA: Angiorresonancia por Tiempo de Vuelo; CE-MRA: Angiorresonancia contrastada). Introduction: DSA is the method of choice to follow patients with embolized intracranial aneurysms; it may be associated with disabling or fatal complications. The MRA has been proposed as an alternative because has less cost and less morbidity and mortality, although its diagnostic performance remains under discussion due to the development of new protocols, more powerful magnets and new applications for DSA. Methodology: We explored literature up to present and compared the diagnostic performance of the MRA with the DSA to detect residual flow after therapeutic embolization of intracranial aneurysms. We performed a systematic review of the literature and meta-analysis based on 34 articles detected in the search which included PubMed, Scopus, ScIELO and BVS databases. Results: TOF-MRA showed sensitivity of 86.8% (84.3%-89.1%) and specificity of 91.2% (89%-93.1%); the SROC for TOF-MRA showed an AUC of 0.95. The performance of CE-MRA showed sensitivity of 88.1% (84.6%-91.1%) and specificity of 89.1% (85.7%-91.9%); the SROC demonstrated an AUC of 0.93. Stratified analysis according to resonator strength found that TOF-MRA has better performance under 3T magnets, although it is not statistically significant. Interobserver concordance was moderate to very good for TOF-MRA and CE-MRA. Discussion: The diagnostic performance of the MRA in the monitoring of embolized intracranial aneurysms proved to be good, with sensitivity higher than 84%, slightly better with TOF-MRA, without being able to replace the DSA. However, the results should be evaluated with caution because of the heterogeneity of the results from the included studies. (Abbreviations: DSA: Digital Subtraction Angiography; MRA: Magnetic Resonance Angiography; TOF-MRA: Resonance Angiography by Time of Flight; CE-MRA: Resonance Angiography with Contrast). |
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application/pdf |
| Identificador | |
| Idioma(s) |
spa |
| Publicador |
Facultad de Medicina |
| Direitos |
info:eu-repo/semantics/openAccess |
| Fonte |
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| Palavras-Chave | #616.0757 #Aneurisma #Angiografía cerebral #Embolización terapéutica #Radiología #Intracranial Aneurysm #Angiography #Magnetic Resonance Angiography #Therapeutic Embolization #Sensitivity and Specificity #Digital Subtraction Angiography |
| Tipo |
info:eu-repo/semantics/bachelorThesis info:eu-repo/semantics/acceptedVersion |
