MRI for prediction of hemorrhagic transformation in acute ischemic stroke: a systematic review and meta-analysis

Background Hemorrhagic transformation increases mortality and morbidity in patients with acute ischemic stroke. Purpose The purpose of this study is to evaluate the diagnostic performance of magnetic resonance imaging (MRI) for prediction of hemorrhagic transformation in acute ischemic stroke. Material and Methods A systematic literature search of MEDLINE and EMBASE was performed up to 27 July 2018, including the search terms “acute ischemic stroke,” “hemorrhagic transformation,” and “MRI.” Studies evaluating the diagnostic performance of MRI for prediction of hemorrhagic transformation in acute ischemic stroke were included. Diagnostic meta-analysis was conducted with a bivariate random-effects model to calculate the pooled sensitivity and specificity. Subgroup analysis was performed including studies using advanced MRI techniques including perfusion-weighted imaging, diffusion-weighted imaging, and susceptibility-weighted imaging. Results Nine original articles with 665 patients were included. Hemorrhagic transformation is associated with high permeability, hypoperfusion, low apparent diffusion coefficient (ADC), and FLAIR hyperintensity. The pooled sensitivity was 82% (95% confidence interval [CI] 61–93) and the pooled specificity was 79% (95% CI 71–85). The area under the hierarchical summary receiver operating characteristic curve was 0.85 (95% CI 0.82–0.88). Although study heterogeneity was present in both sensitivity (I2=67.96%) and specificity (I2=78.93%), a threshold effect was confirmed. Studies using advanced MRI showed sensitivity of 92% (95% CI 70–98) and specificity of 78% (95% CI 65–87) to conventional MRI. Conclusion MRI may show moderate diagnostic performance for predicting hemorrhage in acute ischemic stroke although the clinical significance of this hemorrhage is somewhat uncertain.

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Association of Matrix Metalloproteinase 9 and Cellular Fibronectin and Outcome in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Frontiers in Neurology ◽

10.3389/fneur.2020.523506 ◽

2020 ◽

Vol 11 ◽

Author(s):

Lu Wang ◽

Linghui Deng ◽

Ruozhen Yuan ◽

Junfeng Liu ◽

Yuxiao Li ◽

...

Keyword(s):

Ischemic Stroke ◽

Matrix Metalloproteinase ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Brain Edema ◽

Meta Analysis ◽

Hemorrhagic Transformation ◽

Poor Outcome ◽

Metalloproteinase 9 ◽

Cellular Fibronectin

Introduction: The role of matrix metalloproteinase 9 (MMP-9) and cellular fibronectin (c-Fn) in acute ischemic stroke is controversial. We systematically reviewed the literature to investigate the association of circulating MMP-9 and c-Fn levels and MMP-9 rs3918242 polymorphism with the risk of three outcome measures after stroke.Methods: We searched English and Chinese databases to identify eligible studies. Outcomes included severe brain edema, hemorrhagic transformation, and poor outcome (modified Rankin scale score ≥3). We estimated standardized mean differences (SMDs) and pooled odds ratios (ORs) with 95% confidence intervals (CIs).Results: Totally, 28 studies involving 7,239 patients were included in the analysis of circulating MMP-9 and c-Fn levels. Meta-analysis indicated higher levels of MMP-9 in patients with severe brain edema (SMD, 0.76; 95% CI, 0.18–1.35; four studies, 419 patients) and hemorrhagic transformation (SMD, 1.00; 95% CI, 0.41–1.59; 11 studies, 1,709 patients) but not poor outcome (SMD, 0.30; 95% CI, −0.12 to 0.72; four studies, 759 patients). Circulating c-Fn levels were also significantly higher in patients with severe brain edema (SMD, 1.55; 95% CI, 1.18–1.93; four studies, 419 patients), hemorrhagic transformation (SMD, 1.75; 95% CI, 0.72–2.78; four studies, 458 patients), and poor outcome (SMD, 0.46; 95% CI, 0.16–0.76; two studies, 210 patients). Meta-analysis of three studies indicated that the MMP-9 rs3918242 polymorphism may be associated with hemorrhagic transformation susceptibility under the dominant model (TT + CT vs. CC: OR, 0.621; 95% CI, 0.424–0.908; P = 0.014). No studies reported the association between MMP-9 rs3918242 polymorphism and brain edema or functional outcome after acute stroke.Conclusion: Our meta-analysis showed that higher MMP-9 levels were seen in stroke patients with severe brain edema and hemorrhagic transformation but not poor outcome. Circulating c-Fn levels appear to be associated with all three outcomes including severe brain edema, hemorrhagic transformation, and poor functional outcome. The C-to-T transition at the MMP-9 rs3918242 gene appears to reduce the risk of hemorrhagic transformation.

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Perfusion CT for prediction of hemorrhagic transformation in acute ischemic stroke: a systematic review and meta-analysis

European Radiology ◽

10.1007/s00330-018-5936-7 ◽

2019 ◽

Vol 29 (8) ◽

pp. 4077-4087 ◽

Cited By ~ 2

Author(s):

Chong Hyun Suh ◽

Seung Chai Jung ◽

Se Jin Cho ◽

Donghyun Kim ◽

Jung Bin Lee ◽

...

Keyword(s):

Systematic Review ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Meta Analysis ◽

Hemorrhagic Transformation ◽

Perfusion Ct

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Diagnostic performance of lung ultrasound for transient tachypnea of the newborn: A meta-analysis

PLoS ONE ◽

10.1371/journal.pone.0248827 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0248827

Author(s):

Lili He ◽

Yinghua Sun ◽

Wei Sheng ◽

Qiong Yao

Keyword(s):

Sensitivity And Specificity ◽

Diagnostic Performance ◽

Large Scale ◽

Lung Ultrasound ◽

Meta Analysis ◽

Characteristic Curve ◽

Relevant Literature ◽

Cochrane Library ◽

Lower Sensitivity ◽

Summary Receiver Operating Characteristic

Several recent studies demonstrated that lung ultrasound could achieve desired diagnostic accuracy for transient tachypnea of the neonate (TTN). However, the diagnostic performance of lung ultrasound for TTN has not been systematically studied to date. This meta-analysis aimed to investigate the performance of lung ultrasound in diagnosing TTN. The relevant literature was searched in PubMed, Medline, the Cochrane Library, and Embase databases without any restriction in terms of language and time until January 31, 2021. Studies that assessed the diagnostic performance of lung ultrasound for TTN were included. Seven studies with 1514 participants were summarized. The lung ultrasound provided more accurate performance for diagnosing TTN with pooled sensitivity and specificity of 0.67 [95% confidence interval (CI) = 0.63–0.71] and 0.97 (95% CI = 0.95–0.98), respectively. A higher summarized area under the summary receiver operating characteristic curve was observed as 0.9906. Lower sensitivity and area under the curve (AUC) of B-lines for TTN were observed as 0.330 (95% CI = 0.27–0.38) and 0.5000, respectively. Lung ultrasound provided highly accurate AUC, sensitivity, and specificity in detecting TTN. Large-scale studies are warranted in the future to confirm these results.

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Neuroimaging Markers of Cerebral Small Vessel Disease on Hemorrhagic Transformation and Functional Outcome After Intravenous Thrombolysis in Patients With Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Frontiers in Aging Neuroscience ◽

10.3389/fnagi.2021.692942 ◽

2021 ◽

Vol 13 ◽

Author(s):

Yiqiao Wang ◽

Xiaoting Yan ◽

Jie Zhan ◽

Peiming Zhang ◽

Guangming Zhang ◽

...

Keyword(s):

Systematic Review ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Small Vessel Disease ◽

Meta Analysis ◽

Intravenous Thrombolysis ◽

Hemorrhagic Transformation ◽

Cerebral Small Vessel Disease ◽

Vessel Disease ◽

Increased Risk

Objective: The aim of this study was to perform a systematic review and meta-analysis to assess whether cerebral small vessel disease (CSVD) on neuroimaging of patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT) is associated with an increased risk of hemorrhagic transformation (HT), symptomatic intracranial hemorrhage (sICH), and poor functional outcome (PFO).Methods: A thorough search of several databases was carried out to identify relevant studies up to December 2020. We included studies of patients with AIS and neuroimaging markers of CSVD treated with IVT. The primary outcome was HT, and the secondary outcomes were sICH and 3-month PFO. The quality of the studies involved was evaluated using the Newcastle–Ottawa Scale (NOS). The meta-analysis with the fixed effects model was performed.Results: Twenty-four eligible studies (n = 9,419) were pooled in the meta-analysis. All included studies were regarded as high quality with the NOS scores of at least 6 points. The meta-analysis revealed associations between the presence of CSVD and HT, sICH, and the 3-month PFO after IVT. Compared with no CSVD, the presence of CSVD was associated with an increased risk of HT (OR: 1.81, 95% CI: 1.52–2.16), sICH (OR: 2.42, 95% CI: 1.76–3.33), and 3-month PFO (OR: 2.15, 95% CI: 1.89–2.44). For patients with AIS complicated with CSVD, compared with a CSVD score of 0–1, a CSVD score of 2–4 was associated with an increased risk of HT (OR: 3.10, 95% CI: 1.67–5.77), sICH (OR: 2.86, 95% CI: 1.26–6.49), and 3-month PFO (OR: 4.58, 95% CI: 2.97–7.06).Conclusion: Patients with AIS complicated with neuroimaging markers of CSVD are at increased risk of HT and 3-month PFO after IVT. However, it is still necessary to clarify the exact role of CSVD in the occurrence, development, and prognosis of AIS.Systematic Review Registration:www.ClinicalTrials.gov, identifier CRD4202123 3900.

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Blood–Brain Barrier Disruption and Hemorrhagic Transformation in Acute Ischemic Stroke: Systematic Review and Meta-Analysis

Frontiers in Neurology ◽

10.3389/fneur.2020.594613 ◽

2021 ◽

Vol 11 ◽

Author(s):

Francesco Arba ◽

Chiara Rinaldi ◽

Danilo Caimano ◽

Federica Vit ◽

Giorgio Busto ◽

...

Keyword(s):

Systematic Review ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Blood Brain Barrier ◽

Meta Analysis ◽

Hemorrhagic Transformation ◽

Mr Studies ◽

Brain Barrier ◽

Blood Brain ◽

Ct Studies

Introduction: Hemorrhagic transformation (HT) is a complication of reperfusion therapy for acute ischemic stroke. Blood–brain barrier (BBB) disruption is a crucial step toward HT; however, in clinical studies, there is still uncertainty about this relation. Hence, we conducted a systematic review and meta-analysis to summarize the current evidence.Methods: We performed systematic review and meta-analysis of observational studies from January 1990 to March 2020 about the relation between BBB disruption and HT in patients with acute ischemic stroke with both computed tomography (CT) and magnetic resonance (MR) assessment of BBB. The outcome of interest was HT at follow-up imaging evaluation (within 48 h from symptom onset). We pooled data from available univariate odds ratios (ORs) in random-effects models with DerSimonian–Laird weights and extracted cumulative ORs.Results: We included 30 eligible studies (14 with CT and 16 with MR), N = 2,609 patients, with 88% and 70% of patients included in CT and MR studies treated with acute stroke therapy, respectively. The majority of studies were retrospective and had high or unclear risk of bias. BBB disruption was measured with consistent methodology in CT studies, whereas in MR studies, there was more variability. All CT studies provided a BBB disruption cutoff predictive of HT. Four CT and 10 MR studies were included in the quantitative analysis. We found that BBB disruption was associated with HT with both CT (OR = 3.42; 95%CI = 1.62–7.23) and MR (OR = 9.34; 95%CI = 3.16–27.59). There was a likely publication bias particularly for MR studies.Conclusion: Our results confirm that BBB disruption is associated with HT in both CT and MR studies. Compared with MR, CT has been more uniformly applied in the literature and has resulted in more consistent results. However, more efforts are needed for harmonization of protocols and methodology for implementation of BBB disruption as a neuroradiological marker in clinical practice.

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Intra-arterial treatment for acute ischemic stroke: a meta-analysis

International Archives of Medicine ◽

10.3823/2291 ◽

2017 ◽

Vol 10 ◽

Author(s):

Shaheen E Lakhan ◽

McClellan M Walther ◽

David R Morganstein ◽

Truc Nguyen

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Meta Analysis ◽

Significant Benefit ◽

Large Vessel ◽

Randomized Controlled ◽

Intravenous Tissue Plasminogen Activator ◽

Improved Outcomes ◽

Tissue Plasminogen ◽

Study Heterogeneity

Objective: To assess the potential benefit of treating patients with acute ischemic stroke using intra-arterial methods. Methods: A meta-analysis of published randomized controlled trials that compared standard therapy with intravenous tissue plasminogen activator (IVtPA) for thrombolysis to intra-arterial therapies in patients with acute stroke was performed. All studies reported were analyzed as one group and studies documenting patients with large vessel obstruction were analyzed as a second group. The standardized mean difference (SMD) and the odds ratio (OR) of the dichotomized outcomes of Modified Rankin Scale (mRS) of these trials was calculated. Results: Nine trials were identified with 2,711 patients treated. Meta-analysis of all studies, with and without large vessel obstruction documented, showed a significant benefit with intra-arterial therapy (SMD: 0.22 + 0.041; P=0.003). The dichotomized outcomes of mRS of these trials showed significant improvement (OR: 1.66 -2.43 in four of the five treatment arm groups examined). Meta-analysis of all publications with large vessel obstruction documented as an entry criteria showed a greater significant benefit with intra-arterial therapy (SMD: 0.35 + 0.05; P<0.001). The dichotomized outcomes of mRS of these trials showed significant improvement (OR: 1.36 -2.38 in all five treatment arm groups examined). Some heterogeneity was observed between studies. Conclusion: Treatment of patients with acute ischemic stroke was associated with improved outcomes as measured by mRS. Patient selection, standard treatment, and study treatment factors contributed to the statistical evaluation of inter study heterogeneity and may have contributed to different study outcomes.

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The meta-analysis for ideal cytokines to distinguish the latent and active TB infection

BMC Pulmonary Medicine ◽

10.1186/s12890-020-01280-x ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Zhenhong Wei ◽

Yuanting Li ◽

Chaojun Wei ◽

Yonghong Li ◽

Hui Xu ◽

...

Keyword(s):

Sensitivity And Specificity ◽

Diagnostic Performance ◽

Meta Analysis ◽

Characteristic Curve ◽

Cochrane Library ◽

World Population ◽

Summary Receiver Operating Characteristic ◽

Discriminative Ability ◽

Cytokine Detection ◽

Ifn Γ

Abstract Background One forth whole-world population is infected with Mycobacterium tuberculosis (Mtb), but 90% of them are asymptotic latent infection without any symptoms but positive result in IFN-γ release assay. There is lack of ideal strategy to distinguish active tuberculosis (TB) and latent tuberculosis infection (LTBI). Some scientist had focused on a set of cytokines as biomarkers besides interferon- gamma (IFN-γ) to distinguish active TB and LTBI, but with considerable variance of results. This meta-analysis aimed to evaluate the overall discriminative ability of potential immune molecules to distinguish active TB and LTBI. Methods PubMed, the Cochrane Library, and Web of Science databases were searched to identify studies assessing diagnostic roles of cytokines for distinguishing active TB and LTBI published up to August 2018. The quality of enrolled studies was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). The pooled diagnostic sensitivity and specificity of each cytokine was calculated by using Meta-DiSc software. Area under the summary receiver operating characteristic curve (AUC) was used to summarize the overall diagnostic performance of each biomarker. Results Fourteen studies with 982 subjects met the inclusion criteria, including 526 active TB and 456 LTBI patients. Pooled sensitivity, specificity and AUC for discriminating between active TB and LTBI were analyzed for IL-2 (0.87, 0.61 and 0.9093), IP-10 (0.77, 0.73 and 0.8609), IL-5 (0.64, 0.75 and 0.8533), IL-13 (0.75, 0.71 and 0.8491), IFN-γ (0.67, 0.75 and 0.8031), IL-10 (0.68, 0.74 and 0.7957) and TNF-α (0.67, 0.64 and 0.7783). The heterogeneous subgroup analysis showed that cytokine detection assays, TB incidence, and stimulator with Mtb antigens are main influence factors for their diagnostic performance. Conclusions The meta-analysis showed cytokine production could assist the distinction between active TB and LTBI, IL-2 with the highest overall accuracy. No single biomarker is likely to show sufficiently diagnostic performance due to limited sensitivity and specificity. Further prospective studies are needed to identify the optimal combination of biomarkers to enhanced diagnostic capacity in clinical practice.

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Utility of Routine Frozen Section of Thyroid Nodules Classified as Follicular Neoplasm

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqz152 ◽

2019 ◽

Cited By ~ 1

Author(s):

Jhorman Grisales ◽

Alvaro Sanabria

Keyword(s):

Quality Assessment ◽

Methodological Quality ◽

Diagnostic Performance ◽

Thyroid Nodules ◽

Frozen Section ◽

Meta Analysis ◽

Characteristic Curve ◽

Area Under The Curve ◽

Follicular Neoplasm ◽

Summary Receiver Operating Characteristic

Abstract Objectives To evaluate the diagnostic performance of frozen section in thyroid nodules classified as follicular neoplasm. Methods A diagnostic test meta-analysis was designed. Studies that assessed frozen section in patients with thyroid nodules and a fine-needle aspiration biopsy result of Bethesda IV were selected. The outcomes measured were the number of false- and true-positive and -negative results. We used the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) instrument for methodological quality assessment and a bivariate mixed-effects regression framework and a likelihood-based estimation of the exact binomial approach. Results Forty-six studies from 1991 to 2018 were included. Most studies had moderate methodological quality. The overall sensitivity and specificity were 43% (95% confidence internal [CI], 0.34-0.53) and 100% (95% CI, 0.99-1.00), respectively. The hierarchic summary receiver operating characteristic curve showed an area under the curve of 0.91 (95% CI, 0.80-0.97). Conclusions Frozen section demonstrates moderate diagnostic performance in patients with follicular neoplasm, and its utility for making intraoperative decisions is limited. Its routine use should be discouraged.

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