Prostate Cancer: Can Multiparametric MR Imaging Help Identify Patients Who Are Candidates for Active Surveillance?

Retrospective study of 133 patients who underwent multiparametric MRI before radical prostatectomy.  The MRI results were compared to clinical scoring systems, with pathology (tumour<0.5cc) as the reference standard for assessing eligibility for Active Surveillance. 14/133 would have been eligible for AS based on pathologic results, and the MRI was highly accurate for predicting eligibility for AS.

D'Amico system:  sensitivity 93%, PPV 25%, and accuracy 70%.

Epstein criteria: sensitivity 64%, PPV 45%, and accuracy 88%. 

CAPRA system: sensitivity 93%, PPV 20%, and accuracy 59%.
Multiparametric MR: sensitivity 93%, PPV 57%, and accuracy of 92% (P < .005). 

This is limited by its retrospective nature, but provides further evidence of the utility of multiparametric MRI in the evaluation of prostate cancer.

PICO Analysis:
Population:

• 133 patients (mean age, 59.3 years) 
• Mean PSA 6.73 ng/mL (median, 4.39 ng/mL) 

Intervention: Multiparametric MR imaging at 3.0 T before radical prostatectomy.
Comparison: Conventional clinical assessment scores (the D'Amico, Epstein, and CAPRA scoring systems)
Outcome: Radical prostatectomy pathology specimen (gross tumour <0.5cc) as Active Surveillance eligible.

Reference: Turkbey et al., Radiology, July 2013, 268(1): 144-152.
Links: Pubmed Full Text

Comparison of Imaging Strategies with Conditional Contrast-enhanced CT and Unenhanced MR Imaging in Patients Suspected of Having Appendicitis: A Multicenter Diagnostic Performance Study.

Prospective study of 230 patients with suspected appendicitis. All underwent MRI, and remainder followed clinical pathway with US +/- CT. the results of immediate MRI, conditional MRI after US and conditional CT after US were analyzed. 

Conditonal CT missed appendicitis in 3%, with 8% (10 of 125; 95% CI: 4%, 14%) false-positives.
Conditional MR missed appendicitis in 2% with 10% (13 of 129; 95% CI: 6%, 16%) false-positives.
Immediate MR missed appendicitis in 3% with 6% (seven of 120; 95% CI: 3%, 12%) false-positives.

While no consistent gold standard was applied in this study, the similar results of conditional or staged MRI and CT after inconclusive or negative US are impressive, and support the possibility of using MRI in suspected appendicitis when ionizing radiation from CT is a concern. No information on bmi or detailed demographics were provided to assess for applicability or correlate with results from the paediatric radiology literature.

PICO Analysis:
Population: adult patients with suspected appendicitis
Intervention: unenhanced MRI
Comparison: unenhanced MRI after ultrasound and CT after ultrasound
Outcome: expert consensus (surgeons and radiologists)

Reference: Leeuwenburgh MM et al., Radiology, July 2013, 268(1):135-143.
Links:  Pubmed Full Text

QUADAS-2 tool for review of diagnostic accuracy studies

A good resource for those doing reviews of diagnostic accuracy studies is the QUADAS-2 tool.  This is an update of the QUADAS tool that allows flexibility and modification based on relevant parameters from the included studies in your review.  More information and user's guide can be found here:

http://www.bris.ac.uk/quadas/quadas-2/

Association of Study Quality with Completeness of Reporting: Have Completeness of Reporting and Quality of Systematic Reviews and Meta-Analyses in Major Radiology Journals Changed Since Publication of the PRISMA Statement?

This study provides an assessment of the reporting and quality of systematic reviews and meta analyses in the radiology literature. The study reviewed 130 studies from 11 journals, and assessed them for compliance with the PRISMA (reporting) and AMSTAR (methodology/quality) guidelines.

The results are comparable to similar studies in other fields of medicine, with higher scores post publication of PRISMA in 2009. There was strong positive correlation between the PRISMA and AMSTAR results.  There was high variability between journals, 'Radiology' had the highest PRISMA reported items and AJNR had the lowest at 19.6/27.  Specific items that are consistently weak (and should be paid attention to by authors of SR/MA) are registration of study protocol and assessment for bias. 

Reference: Tunis et al., Radiology, 2013 Jul 3. (epub).

Links: Pubmed Full Text