Diagnostic accuracy of flat panel computed tomography for acute stroke: a systematic review and meta-analysis of...

This systematic review and diagnostic test accuracy meta-analysis aimed to evaluate the diagnostic performance of flat-panel computed tomography (FPCT) for acute stroke-related findings, particularly intracranial hemorrhage and ischemic events, in comparison with standard CT or MRI.

A systematic review and meta-analysis were conducted following PRISMA-DTA guidelines. PubMed, Scopus, and Embase were searched through September 2024 for diagnostic accuracy studies comparing FPCT with CT or MRI in acute stroke settings. Pooled sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated using random-effects and bivariate models. Subgroup analyses and sensitivity analyses addressed heterogeneity.

Thirteen studies were included in the meta-analysis. Pooled univariate estimates showed a sensitivity of 82.2% (95% CI: 75.1-87.7), specificity of 93.1% (95% CI: 88.5-96.0), and DOR of 78.6 (95% CI: 40.3-153.4). Bivariate analysis demonstrated improved diagnostic performance with a sensitivity of 86.5%, specificity of 96.7%, and DOR of 187.3. Subgroup analysis revealed higher sensitivity for intracerebral hemorrhage (92.6%) than ischemic stroke (62.3%, p=0.003). Specificity was highest for intraventricular hemorrhage (98.8%). While significant heterogeneity and publication bias were detected, results remained robust after exclusion of outliers.

FPCT demonstrates high specificity and moderate-to-high sensitivity for stroke-related findings, with strongest performance for intracranial hemorrhage. These findings support consideration of FPCT as a complementary in-suite imaging tool in selected direct-to-angiosuite workflows, particularly for rapid hemorrhage exclusion. However, its lower sensitivity for ischemic changes and susceptibility to contrast-related artifacts indicate that FPCT should complement, rather than replace, standard CT/MRI-based evaluation.