With the advanced technology of multi-slice CT scans, we explored the effectiveness of CT angiography (CTA) in place of digital subtraction angiography (DSA) in patients with acute spontaneous intracerebral hemorrhage (ICH). We performed a computerized PubMed search of the literature from inception to 27 July 2011 to find reports of similar comparative studies and performed a meta-analysis of diagnostic accuracy. The pooled sensitivity was 97.0% (95% confidence interval [CI]: 93.2-99.1%), specificity was 98.9% (95% CI: 97.0-99.7%), accuracy was 98.2% (95% CI: 96.6-99.2%), positive predictive value was 97.8% (95% CI: 94.2-99.5%) and negative predictive value was 98.5% (95% CI: 96.6-99.5%). The false negative rate was 1% (95% CI: 0.4-2.6%). We concluded that CTA with venography could replace DSA as the initial vascular investigation in patients presenting with spontaneous ICH during the acute phase. Future studies should focus on whether refinement of the techniques could preclude the false negative results.
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