Document Detail

MR contrast media in neuroimaging: a critical review of the literature.
MedLine Citation:
PMID:  10319979     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND PURPOSE: MR contrast media are commonly used but do not have evidence-based guidelines for their application. This investigation seeks to define specific methodological problems in the MR contrast media literature and to suggest guidelines for an improved study design. METHODS: To evaluate the reported clinical efficacy of MR contrast media in neuroimaging, we performed a critical review of the literature. From 728 clinical studies retrieved via MEDLINE, we identified 108 articles that evaluated contrast media efficacy for a minimum of 20 patients per study. The articles were randomly assigned to four readers (a fifth reader reviewed all of the articles) who were blinded to article titles, authors, institutions, and journals of publication. The readers applied objective, well-established methodological criteria to assign each article a rating of A, B, C, or D. RESULTS: One hundred one of 108 articles received a D rating, six received a C rating, and one received a B rating. In general, the Methods sections of the evaluated articles did not contain details that would allow the reader to calculate reliable measures of diagnostic accuracy, such as sensitivity and specificity. Specifically, a common problem was failure to establish and uniformly apply an acceptable standard of reference. In addition, images were not always interpreted independently from the reference standard. Radiologists and clinicians need to determine the applicability of any published study to their own practices. Unfortunately, the studies we reviewed commonly lacked clear descriptions of patient demographics, the spectrum of symptomatology, and the procedure for assembling the study cohort. Finally, small sample sizes with inadequate controls were presented in almost all of the articles. CONCLUSION: Although MR contrast media are widely used and play an essential role in lesion detection and confidence of interpretation, no rigorous studies exist to establish valid sensitivity and specificity estimates for their application. On the basis of this review, we herein describe basic methods to document improvements in technology. Such studies are essential to devise measures of diagnostic accuracy, which can form the basis for further studies that will assess diagnostic and therapeutic impact and, ultimately, patient outcomes.
J Breslau; J G Jarvik; D R Haynor; W T Longstreth; D L Kent; K R Maravilla
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Publication Detail:
Type:  Journal Article; Meta-Analysis    
Journal Detail:
Title:  AJNR. American journal of neuroradiology     Volume:  20     ISSN:  0195-6108     ISO Abbreviation:  AJNR Am J Neuroradiol     Publication Date:  1999 Apr 
Date Detail:
Created Date:  1999-06-18     Completed Date:  1999-06-18     Revised Date:  2008-02-14    
Medline Journal Info:
Nlm Unique ID:  8003708     Medline TA:  AJNR Am J Neuroradiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  670-5     Citation Subset:  IM    
Radiological Associates of Sacramento Medical Group, CA 95816, USA.
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MeSH Terms
Cohort Studies
Contrast Media*
Evidence-Based Medicine
Image Enhancement / methods
Magnetic Resonance Imaging* / methods,  standards
Nervous System Diseases / diagnosis*
Practice Guidelines as Topic
Reproducibility of Results
Research Design
Sample Size
Sensitivity and Specificity
Reg. No./Substance:
0/Contrast Media

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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