Diagnostic Utility of CT and MRI for Mycotic Aneurysms: A Meta-Analysis

OBJECTIVE. The purpose of this meta-analysis was to assess the diagnostic performance of CT and MRI in detecting mycotic aneurysm, an infection of high mortality and morbidity. MATERIALS AND METHODS. The PubMed, Cochrane, and Embase databases were searched from January 1, 1980, through June 30, 2019, for diagnostic studies assessing both sensitivity and specificity of CT or MRI for detecting mycotic aneurysms, and studies were pooled by use of random-effects models and freely available meta-analysis software. RESULTS. Among 1507 articles searched, 15 studies of CT (13 studies) or MRI (five studies) for aortic and cerebral mycotic aneurysms were included. The studies evaluated 622 imaging examinations for 249 mycotic aneurysms. The pooled sensitivities and specificities of CT for all mycotic aneurysms were 0.82 (95% CI, 0.77-0.87) and 0.93 (95% CI, 0.89-0.95) and of MRI were 0.79 (95% CI, 0.61-0.91) and 0.89 (95% CI, 0.81-0.95). CT and MRI had pooled sensitivities and specificities of 0.84 (95% CI, 0.78-0.89) and 0.92 (95% CI, 0.89-0.95) for aortic and 0.71 (95% CI, 0.54-0.85) and 0.90 (95% CI, 0.83-0.95) for cerebral mycotic aneurysms. Heterogeneity and publication bias were observed in some pooled analyses. CONCLUSION. CT and MRI had moderately high sensitivities and specificities for mycotic aneurysms. Study heterogeneity, publication bias, and modest sample size were important limitations, warranting larger and higher-quality studies.