AJR:215, November 2020 1257 and cerebral mycotic aneurysms are intraop- erative fndings and catheter angiography, re- spectively [3, 4, 10]. There remains a paucity of literature regarding the accuracy of imag- ing techniques for mycotic aneurysms and whether the fndings have changed over time. The aim of this meta-analysis was to review the diagnostic performance of CT and MRI for mycotic aneurysms involving either the aorta or cerebral vessels. Materials and Methods We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guide- lines in the methods of this meta-analysis. The following search terms were used: (mycotic OR infective) AND (aneurysm OR artery OR aortitis) AND (CT OR MRI). The PubMed, Cochrane, and Embase databases were searched from January 1, 1980, through June 30, 2019, with flters of adult older than 18 years, English language, and human study. Mycotic aneurysms were defned as infect- ed and dilated blood vessels anywhere in the body; the aortic root and both aneurysms and pseudoan- eurysms were included. Inclusion criteria were in- vestigation of mycotic aneurysms, separate use of Diagnostic Utility of CT and MRI for Mycotic Aneurysms: A Meta- Analysis Tom Kai Ming Wang 1 Brian Grif fn 1 Paul Cremer 1 Nabin Shrestha 2 Steve Gordon 2 Gosta Pettersson 3 Milind Desai 1 Wang TKM, Griffn B, Cremer P, et al. 1 Department of Cardiovascular Medicine, Cardiovascular Imaging Section, Cleveland Clinic, Main Campus J1-5, 9500 Euclid Ave, Cleveland, OH 44195. Address correspondence to M. Desai (desaim2@ccf.org). 2 Department of Infectious Disease, Cleveland Clinic, Cleveland, OH. 3 Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH. Vascular and Interventional Radiology • Original Research AJR 2020; 215:1257–1266 ISSN-L 0361–803X/20/2155–1257 © American Roentgen Ray Society M ycotic aneurysm results from di- lation and degeneration of the ar - terial wall as a result of blood- stream infection or septic embolization commonly due to infective en- docarditis [1–4]. It can affect different arteries throughout the body, including the aorta and visceral, peripheral, and cerebral arteries in descending order of frequency, and has high rates of mortality and morbidity [2–4]. The exact incidence is diffcult to ascertain, but these aneurysms are certainly rare. Mycotic aneurysms make up approximately 1–5% of all aortic [5, 6] and intracranial aneurysms [7, 8] and are seen in 2% of cases of infective en- docarditis [9]. Management involves antibiot- ic therapy and selection of patients for surgical débridement, revascularization, or endovascu- lar procedures [3, 4, 10]. Although clinical factors and biomarkers may raise suspicion in patients with persistent bloodstream infec- tions or confrmed infective endocarditis, these conditions are not specifc to the diagno- sis of mycotic aneurysm [2–4]. CT and MRI are often used to screen for mycotic aneu- rysms, but the reference standards for aortic Keywords: CT, meta-analysis, MRI, mycotic aneurysm doi.org/10.2214/AJR.19.22722 Received December 17, 2019; accepted after revision March 7, 2020. Supported by the National Heart Foundation of New Zealand Overseas Clinical and Research Fellowship (grant no. 1775) (T. K. M. Wang) and the Haslam Family Endowed Chair in Cardiovascular Medicine at the Cleveland Clinic (M. Desai). 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 specifcity 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 ( fve studies) for aortic and cerebral mycotic aneurysms were included. The studies evaluated 622 imaging examinations for 249 mycotic aneurysms. The pooled sensitivities and specifcities 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 specifcities 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 my- cotic aneurysms. Heterogeneity and publication bias were observed in some pooled analyses. CONCLUSION. CT and MRI had moderately high sensitivities and specifcities for my- cotic aneurysms. Study heterogeneity, publication bias, and modest sample size were impor - tant limitations, warranting larger and higher-quality studies. Wang et al. CT and MRI of Mycotic Aneurysms Vascular and Interventional Radiology Original Research Downloaded from www.ajronline.org by 18.207.175.254 on 01/09/22 from IP address 18.207.175.254. Copyright ARRS. For personal use only; all rights reserved