Diagnostic value of transcranial doppler ultrasonography for middle cerebral artery stenosis: a Meta-analysis

Objective To evaluate the diagnostic value of transcranial doppler ultrasonography (TCD) for middle cerebral artery stenosis. Methods A comprehensive electronic search was performed in PubMed, EMBase, The Cochrane Library, CNKI, Wanfang Database and VIP Database to retrieve relevant studies on TCD in diagnosis of middle cerebral artery stenosis from initiation of the databases to January 2017. The general information and diagnostic parameters were documented from the retrieved studies. The quality of the prepared studies was evaluated by QUADAS-2 and the risk assessment maps brought by RevMan 5.3 statistical software. Pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR) and the heterogeneity of the included studies were analyzed using the Stata 13.0 software. Summary receiver operating characteristic curve (SROC) was drawn and the area under the curve (AUC) was calculated. The publication bias was assessed with funnel plotting. Results A total of 11 studies were included for this Meta analysis, involving 2 550 patients. Heterogeneity test showed that the heterogeneity was established between studies in sensitivity, specificity, NLR and diagnostic odds ratio (DOR), resulting from disparity in study design and TCD test criteria (P<0.05). Meta analysis revealed a pooled sensitivity of 0.88 (95% CI: 0.84~0.91), a specificity of 0.93 (95% CI: 0.91~0.95), a PLR of 12.93 (95% CI: 9.90~16.90), a NLR of 0.13 (95% CI: 0.09~0.17), a diagnostic score (SCORE) of 4.63 (95% CI: 4.32~4.94), a diagnostic odds ratio (DOR) of102.64 (95% CI: 75.44~139.65), and an AUC of SROC of 0.96 (95% CI: 0.94~0.98). The sensitivity analysis after removing studies with sample capacity <100 showed that the confidence interval of the diagnostic parameters mostly overlapped with that of the original data. Conclusion As TCD shows good accuracy in diagnosing middle cerebral artery stenosis, it can be used in diagnostic screening of the disease. Key words: Transcranial doppler ultrasonography (TCD); Middle cerebral artery stenosis; Diagnosis; Meta-analysis