Robert A. Frank

This article provides a practical guide for clinicians and radiologists to critically evaluate diagnostic accuracy systematic reviews when using them to inform clinical decisions. Systematic reviews of diagnostic accuracy studies can provide the best available evidence to inform decisions regarding the use of a diagnostic test. In this guide, the authors provide a practical ...

Background: Biparametric (bp)‐MRI and multiparametric (mp)‐MRI may improve the diagnostic accuracy of renal mass histology.Purpose: To evaluate the available evidence on the diagnostic accuracy of bp‐MRI and mp‐MRI for solid renal masses in differentiating malignant from benign, aggressive from indolent, and clear cell renal cell carcinoma (ccRCC) from other histology.Study Type: Systematic review.Population: MEDLINE, EMBASE, and CENTRAL up to January 11, 2022 were searched.Field Strength/Sequence: 1.5 or 3 Tesla.Assessment: Eligible studies evaluated the accuracy of MRI (with at least two sequences: T2, T1, dynamic contrast and diffusion‐weighted imaging) for diagnosis of solid renal masses in adult patients, using histology as reference standard. Risk of bias and applicability were assessed using QUADAS‐2.Statistical Tests: Meta‐analysis using a bivariate logitnormal random effects model.Results: We included 10 studies (1239 masses from approximately 1200 patients). The risk of bias was high in three studies, unclear in five studies and low in two studies. The diagnostic accuracy of malignant (vs. benign) masses was assessed in five studies (64% [179/281] malignant). The summary estimate of sensitivity was 95% (95% confidence interval [CI]: 77%–99%), and specificity was 63% (95% CI: 46%–77%). No study assessed aggressive (vs. indolent) masses. The diagnostic accuracy of ccRCC (vs. other subtypes) was evaluated in six studies (47% [455/971] ccRCC): the summary estimate of sensitivity was 85% (95% CI: 77%–90%) and specificity was 77% (95% CI: 73%–81%).Data Conclusion: Our study reveals deficits in the available evidence on MRI for diagnosis of renal mass histology. The number of studies was limited, at unclear/high risk of bias, with heterogeneous definitions of solid masses, imaging techniques, diagnostic criteria, and outcome measures.Evidence Level: 3Technical Efficacy: Stage 2

Background: Despite the nearly ubiquitous reported use of peer review among reputable medical journals, there is limited evidence to support the use of peer review to improve the quality of biomedical research and in particular, imaging diagnostic test accuracy (DTA) research.Purpose: To evaluate whether peer review of DTA studies published by imaging journals is associated with changes in completeness of reporting, transparency for risk of bias assessment, and spin.Study Type: Retrospective cross‐sectional study.Study Sample: Cross‐sectional study of articles published in Journal of Magnetic Resonance Imaging (JMRI), Canadian Association of Radiologists Journal (CARJ), and European Radiology (EuRad) before March 31, 2020.Assessment: Initial submitted and final versions of manuscripts were evaluated for completeness of reporting using the Standards for Reporting Diagnostic Accuracy Studies (STARD) 2015 and STARD for Abstracts guidelines, transparency of reporting for risk of bias assessment based on Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS‐2), and actual and potential spin using modified published criteria.Statistical Tests: Two‐tailed paired t‐tests and paired Wilcoxon signed‐rank tests were used for comparisons. A P value P = 0.74), QUADAS‐2 (6.08 vs. 6.11, change of 0.03 [−1.00 to 0.50], P = 0.92), actual “spin” (2.36 vs. 2.40, change of 0.04 [0.00 to 1.00], P = 0.39) or potential “spin” (2.93 vs. 2.81, change of −0.12 [−1.00 to 0.00], P = 0.23) practices.Conclusion: Peer review is associated with a marginal improvement in completeness of reporting in published imaging DTA studies, but not with improvement in transparency for risk of bias assessment or reduction in spin.Level of Evidence: 3Technical Efficacy Stage: 1

Background: Preferential publication of studies with positive findings can lead to overestimation of diagnostic test accuracy (i.e. publication bias). Understanding the contribution of the editorial process to publication bias could inform interventions to optimize the evidence guiding clinical decisions.Purpose/Hypothesis: To evaluate whether accuracy estimates, abstract conclusion positivity, and completeness of abstract reporting are associated with acceptance to radiology conferences and journals.Study Type: Meta‐research.Population: Abstracts submitted to radiology conferences (European Society of Gastrointestinal and Abdominal Radiology (ESGAR) and International Society for Magnetic Resonance in Medicine (ISMRM)) from 2008 to 2018 and manuscripts submitted to radiology journals (Radiology, Journal of Magnetic Resonance Imaging [JMRI]) from 2017 to 2018. Primary clinical studies evaluating sensitivity and specificity of a diagnostic imaging test in humans with available editorial decisions were included.Assessment: Primary variables (Youden's index [YI > 0.8 vs. P‐values were obtained; the threshold for statistical significance was P < 0.05.Results: A total of 1000 conference abstracts (500 ESGAR and 500 ISMRM) and 1000 journal manuscripts (505 Radiology and 495 JMRI) were included. Conference abstract acceptance was not significantly associated with YI (adjusted OR = 0.97 for YI > 0.8; CI = 0.70–1.35), conclusion positivity (OR = 1.21 for positive conclusions; CI = 0.75–1.90) or STARD for Abstracts adherence (OR = 0.96 per unit increase in reported items; CI = 0.82–1.18). Manuscripts with positive abstract conclusions were less likely to be accepted by radiology journals (OR = 0.45; CI = 0.24–0.86), while YI (OR = 0.85; CI = 0.56–1.29) and STARD for Abstracts adherence (OR = 1.06; CI = 0.87–1.30) showed no significant association. Positive conclusions were present in 86.7% of submitted conference abstracts and 90.2% of journal manuscripts.Data Conclusion: Diagnostic test accuracy studies with positive findings were not preferentially accepted by the evaluated radiology conferences or journals.Evidence Level: 3Technical Efficacy: Stage 2.

Toute guerre a un coût et le prix de la guerre est toujours trop lourd. En termes humains, bien entendu, mais aussi en termes financiers. Le constat est évident, même en cas de victoire. Alors, que dire d’une guerre perdue, comme la guerre d’Indochine qui aboutit à la catastrophe française de Dien Bien Phu ? Au prix de la guerre ne voit-on pas s’ajouter celui de la défaite ? C’est René Girault qui eut l’idée première de suggérer une recherche sur le coût de ce conflit. Il aimait favoriser tou...