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      Qualitative Assessment and Reporting Quality of Intracranial Vessel Wall MR Imaging Studies: A Systematic Review

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          Abstract

          BACKGROUND:

          Over the last quarter-century, the number of publications using vessel wall MR imaging has increased. Although many narrative reviews offer insight into technique and diagnostic applications, a systematic review of publication trends and reporting quality has not been conducted to identify unmet needs and future directions.

          PURPOSE:

          We aimed to identify which intracranial vasculopathies need more data and to highlight areas of strengths and weaknesses in reporting.

          DATA SOURCES:

          PubMed, EMBASE, and MEDLINE databases were searched up to September 2018 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

          DATA ANALYSIS:

          Two independent reviewers screened and extracted data from 128 articles. The Strengthening the Reporting of Observational Studies in Epidemiology guidelines were used to assess the reporting quality of analytic observational studies.

          DATA SYNTHESIS:

          There has been an exponentially increasing trend in the number of vessel wall MR imaging publications during the past 24 years ( P < .0001). Intracranial atherosclerosis is the most commonly studied intracranial vasculopathy (49%), followed by dissections (13%), aneurysms (8%), and vasculitis (5%). Analytic observational study designs composed 48% of the studies. Transcontinental collaborations showed nonsignificantly higher reporting quality compared with work originating from single continents ( P = .20).

          LIMITATIONS:

          A limitation is the heterogeneity in study designs.

          CONCLUSIONS:

          Investigations on the diagnostic utility of vessel wall MR imaging in less commonly studied intracranial vasculopathies such as dissections, aneurysms, and vasculitis are warranted. More consistent adherence to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines should improve transparency and maximize effective synthesis for clinical translation. Diverse collaborative teams are encouraged to advance the understanding of intracranial vasculopathies using vessel wall MR imaging.

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          Most cited references62

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          Observational studies: cohort and case-control studies.

          Observational studies constitute an important category of study designs. To address some investigative questions in plastic surgery, randomized controlled trials are not always indicated or ethical to conduct. Instead, observational studies may be the next best method of addressing these types of questions. Well-designed observational studies have been shown to provide results similar to those of randomized controlled trials, challenging the belief that observational studies are second rate. Cohort studies and case-control studies are two primary types of observational studies that aid in evaluating associations between diseases and exposures. In this review article, the authors describe these study designs and methodologic issues, and provide examples from the plastic surgery literature.
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            Intracranial Vessel Wall MRI: Principles and Expert Consensus Recommendations of the American Society of Neuroradiology.

            Intracranial vessel wall MR imaging is an adjunct to conventional angiographic imaging with CTA, MRA, or DSA. The technique has multiple potential uses in the context of ischemic stroke and intracranial hemorrhage. There remain gaps in our understanding of intracranial vessel wall MR imaging findings and research is ongoing, but the technique is already used on a clinical basis at many centers. This article, on behalf of the Vessel Wall Imaging Study Group of the American Society of Neuroradiology, provides expert consensus recommendations for current clinical practice.
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              Case-control and two-gate designs in diagnostic accuracy studies.

              In some diagnostic accuracy studies, the test results of a series of patients with an established diagnosis are compared with those of a control group. Such case-control designs are intuitively appealing, but they have also been criticized for leading to inflated estimates of accuracy. We discuss similarities and differences between diagnostic and etiologic case-control studies, as well as the mechanisms that can lead to variation in estimates of diagnostic accuracy in studies with separate sampling schemes ("gates") for diseased (cases) and nondiseased individuals (controls). Diagnostic accuracy studies are cross-sectional and descriptive in nature. Etiologic case-control studies aim to quantify the effect of potential causal exposures on disease occurrence, which inherently involves a time window between exposure and disease occurrence. Researchers and readers should be aware of spectrum effects in diagnostic case-control studies as a result of the restricted sampling of cases and/or controls, which can lead to changes in estimates of diagnostic accuracy. These spectrum effects may be advantageous in the early investigation of a new diagnostic test, but for an overall evaluation of the clinical performance of a test, case-control studies should closely mimic cross-sectional diagnostic studies. As the accuracy of a test is likely to vary across subgroups of patients, researchers and clinicians might carefully consider the potential for spectrum effects in all designs and analyses, particularly in diagnostic accuracy studies with differential sampling schemes for diseased (cases) and nondiseased individuals (controls).
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                Author and article information

                Journal
                AJNR Am J Neuroradiol
                AJNR Am J Neuroradiol
                ajnr
                ajnr
                AJNR
                AJNR: American Journal of Neuroradiology
                American Society of Neuroradiology
                0195-6108
                1936-959X
                December 2019
                : 40
                : 12
                : 2025-2032
                Affiliations
                [1] aFrom the Departments of Radiology (J.W.S., S.C.G., S.W., W.R.W., L.A.L.)
                [2] bNeurology (S.R.M., S.E.K.)
                [3] cOtolaryngology (L.A.L.)
                [4] dNeurosurgery (L.A.L.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
                [5] eDepartment of Biostatistics, Epidemiology and Informatics (H.S.), University of Pennsylvania, Philadelphia, Pennsylvania.
                Author notes
                Please address correspondence to Jae W. Song, MD, MS, Department of Radiology, Division of Neuroradiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104; e-mail: jae.song@ 123456pennmedicine.upenn.edu ; @jsongmd
                Author information
                https://orcid.org/0000-0002-3127-6427
                https://orcid.org/0000-0002-4696-7458
                https://orcid.org/0000-0002-3043-047X
                https://orcid.org/0000-0002-8931-1213
                https://orcid.org/0000-0003-1669-2120
                https://orcid.org/0000-0003-3108-5441
                https://orcid.org/0000-0003-0418-6917
                https://orcid.org/0000-0001-9004-0089
                Article
                19-00748
                10.3174/ajnr.A6317
                6911630
                31727743
                cef761b2-992b-433e-b04a-0284a9d98ba5
                © 2019 by American Journal of Neuroradiology

                Indicates open access to non-subscribers at www.ajnr.org

                History
                : 15 July 2019
                : 24 September 2019
                Funding
                Funded by: Institute for Translational Medicine and Therapeutics https://doi.org/10.13039/100007929
                Funded by: Radiological Society of North America https://doi.org/10.13039/100006098
                Funded by: National Heart, Lung, and Blood Institute https://doi.org/10.13039/100000050
                Award ID: R01 HL137984
                Categories
                Adult Brain

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