Forty-three studies (n=1,877) were included in the review.
CTA for detection of atherosclerosis (n=30).
The quality score ranged from 0.12 to 0.74. Fifteen of the 19 high-quality studies, reporting 22 comparisons between CTA and DSA, provided data at the relevant diagnostic thresholds and were included in the meta-analysis. There was little correlation between sensitivity and specificity (P=0.29), while a visual inspection of forest plots suggested no other important source of inter-study heterogeneity. The sensitivity of CTA was greater than 85% in all studies and the median sensitivity was 97%. Pooled sensitivity was 95% (95% confidence interval, CI: 91, 97). Specificity was greater than 90% for severe stenosis and occlusion. The median specificity was 97%. The pooled specificity was 98% (95% CI: 96, 99).
CTA following blunt cervical trauma (n=2).
One study reported a sensitivity of 47% (95% CI: 23, 72) to detect carotid artery injuries and 53% (95% CI: 34, 72) to detect vertebral artery injuries. Specificity was high (greater than 99%). The second study reported a sensitivity of 68% (95% CI: 45, 86), but specificity was poorer at 67% (95% CI: 45, 84).
CTA for penetrating neck trauma (n=2).
Both studies suggested high sensitivity for this type of injury, with both reporting 100% specificity.
CTA for other aetiologies (n=8).
The results for these studies were not reported in detail.