Comparative diagnostic efficacy of cranial CT, CTA, and DSA in subarachnoid hemorrhage management: A systematic review and meta-analysis

Subarachnoid hemorrhage (SAH) is a critical medical condition associated with high morbidity and mortality rates. Timely and accurate diagnosis is crucial for optimal patient outcomes. Cranial computed tomography (CT), computed tomography angiography (CTA), and digital subtraction angiography (DSA) are commonly used imaging modalities for diagnosing SAH, but their comparative diagnostic efficacy remains debated. A systematic review and meta-analysis was conducted to evaluate the diagnostic performance of cranial CT, CTA, and DSA in identifying SAH. PubMed, Google scholar, Cochrane Library databases were searched for relevant studies published up to January 2024. Pooled sensitivity, specificity, and the summary receiver operating characteristic (SROC) curve were calculated using Review Manager 5.4. A total of 31 studies involving 10,287 patients were included in the analysis. The pooled sensitivity of cranial CT for detecting SAH was 94.7 % (95 % Confidence Interval, CI) with a specificity of 98.3 % (95 % CI). CTA demonstrated a pooled sensitivity of 94.1 % (95 % CI) and specificity of 93.4 % (95 % CI). DSA showed a pooled sensitivity of 87.7 % (95 % CI) and specificity of 95.8 % (95 % CI). The SROC curve demonstrated discriminatory ability for all modalities. Cranial CT, CTA, and DSA are valuable imaging modalities for diagnosing SAH, with high sensitivity and specificity. Cranial CT serves as an initial screening tool, while CTA offers superior sensitivity in detecting aneurysmal SAH. DSA remains essential in specific clinical scenarios. Further prospective studies are needed to validate these findings and refine diagnostic guidelines for SAH. L'hémorragie sous-arachnoïdienne (HSA) est un état médical critique associé à des taux élevés de morbidité et de mortalité. Un diagnostic rapide et précis est essentiel pour obtenir des résultats optimaux pour le patient. La tomodensitométrie (TDM) crânienne, l'angiographie par tomodensitométrie (angio-TDM) et l'angiographie par soustraction numérique (ASN) sont des modalités d'imagerie couramment utilisées pour diagnostiquer la HSA, mais leur efficacité diagnostique comparée reste débattue. Nous avons réalisé une revue systématique et une méta-analyse pour évaluer les performances diagnostiques de la TDM crânienne, de l'angiographie par soustraction numérique et de l'angiographie par soustraction numérique dans l'identification de la HSA. Les bases de données PubMed, Google scholar et Cochrane Library ont été consu