Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Systematic Review and Meta-Analysis of Studies Evaluating Diagnostic Test Accuracy: A Practical Review for Clinical Researchers-Part I. General Guidance and Tips

  • Kim, Kyung Won (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Lee, Juneyoung (Department of Biostatistics, Korea University College of Medicine) ;
  • Choi, Sang Hyun (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Huh, Jimi (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Park, Seong Ho (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center)
  • Received : 2015.07.07
  • Accepted : 2015.08.28
  • Published : 2015.11.01
⟨ Previous Next ⟩

Abstract

In the field of diagnostic test accuracy (DTA), the use of systematic review and meta-analyses is steadily increasing. By means of objective evaluation of all available primary studies, these two processes generate an evidence-based systematic summary regarding a specific research topic. The methodology for systematic review and meta-analysis in DTA studies differs from that in therapeutic/interventional studies, and its content is still evolving. Here we review the overall process from a practical standpoint, which may serve as a reference for those who implement these methods.

Keywords

References

  1. Macaskill P, Gatsonis C, Deeks JJ, Harbord RM, Takwoingi Y. Chapter 10: Analysing and Presenting Results. In: Deeks JJ, Bossuyt PM, Gatsonis C, eds. Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy Version 1.0. The Cochrane Collaboration, 2010. Available from: http://srdta.cochrane.org/
  2. Tunis AS, McInnes MD, Hanna R, Esmail K. 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? Radiology 2013;269:413-426 https://doi.org/10.1148/radiol.13130273
  3. Irwig L, Tosteson AN, Gatsonis C, Lau J, Colditz G, Chalmers TC, et al. Guidelines for meta-analyses evaluating diagnostic tests. Ann Intern Med 1994;120:667-676 https://doi.org/10.7326/0003-4819-120-8-199404150-00008
  4. Trikalinos TA, Balion CM, Coleman CI, Griffith L, Santaguida PL, Vandermeer B, et al. Chapter 8: meta-analysis of test performance when there is a "gold standard". J Gen Intern Med 2012;27 Suppl 1:S56-S66 https://doi.org/10.1007/s11606-012-2029-1
  5. Lee J, Kim KW, Choi SH, Huh J, Park SH. Systematic review and meta-analysis of studies evaluating diagnostic test accuracy: a practical review for clinical researchers--part ii. statistical methods of meta-analysis. Korean J Radiol 2015;16:1188-1196 https://doi.org/10.3348/kjr.2015.16.6.1188
  6. Jaeschke R, Guyatt GH, Sackett DL. Users' guides to the medical literature. III. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? The Evidence-Based Medicine Working Group. JAMA 1994;271:703-707 https://doi.org/10.1001/jama.1994.03510330081039
  7. Lee YJ, Lee JM, Lee JS, Lee HY, Park BH, Kim YH, et al. Hepatocellular carcinoma: diagnostic performance of multidetector CT and MR imaging-a systematic review and meta-analysis. Radiology 2015;275:97-109 https://doi.org/10.1148/radiol.14140690
  8. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015;4:1 https://doi.org/10.1186/2046-4053-4-1
  9. Shea BJ, Grimshaw JM, Wells GA, Boers M, Andersson N, Hamel C, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol 2007;7:10 https://doi.org/10.1186/1471-2288-7-10
  10. Sampson M, Barrowman NJ, Moher D, Klassen TP, Pham B, Platt R, et al. Should meta-analysts search Embase in addition to Medline? J Clin Epidemiol 2003;56:943-955 https://doi.org/10.1016/S0895-4356(03)00110-0
  11. Staunton M. Evidence-based radiology: steps 1 and 2--asking answerable questions and searching for evidence. Radiology 2007;242:23-31 https://doi.org/10.1148/radiol.2421052135
  12. Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009;151:264-269, W64 https://doi.org/10.7326/0003-4819-151-4-200908180-00135
  13. Jones CM, Ashrafian H, Darzi A, Athanasiou T. Guidelines for diagnostic tests and diagnostic accuracy in surgical research. J Invest Surg 2010;23:57-65 https://doi.org/10.3109/08941930903469508
  14. Whiting P, Rutjes AW, Reitsma JB, Glas AS, Bossuyt PM, Kleijnen J. Sources of variation and bias in studies of diagnostic accuracy: a systematic review. Ann Intern Med 2004;140:189-202 https://doi.org/10.7326/0003-4819-140-3-200402030-00010
  15. Dodd JD. Evidence-based practice in radiology: steps 3 and 4--appraise and apply diagnostic radiology literature. Radiology 2007;242:342-354 https://doi.org/10.1148/radiol.2422051679
  16. Obuchowski NA. Special Topics III: bias. Radiology 2003;229:617-621 https://doi.org/10.1148/radiol.2293010899
  17. Sica GT. Bias in research studies. Radiology 2006;238:780-789 https://doi.org/10.1148/radiol.2383041109
  18. Whiting P, Rutjes AW, Reitsma JB, Bossuyt PM, Kleijnen J. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol 2003;3:25 https://doi.org/10.1186/1471-2288-3-25
  19. Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 2011;155:529-536 https://doi.org/10.7326/0003-4819-155-8-201110180-00009
  20. Wade R, Corbett M, Eastwood A. Quality assessment of comparative diagnostic accuracy studies: our experience using a modified version of the QUADAS-2 tool. Res Synth Methods 2013;4:280-286
  21. Leeflang MM, Deeks JJ, Gatsonis C, Bossuyt PM; Cochrane Diagnostic Test Accuracy Working Group. Systematic reviews of diagnostic test accuracy. Ann Intern Med 2008;149:889-897 https://doi.org/10.7326/0003-4819-149-12-200812160-00008
  22. Reitsma JB, Glas AS, Rutjes AW, Scholten RJ, Bossuyt PM, Zwinderman AH. Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. J Clin Epidemiol 2005;58:982-990 https://doi.org/10.1016/j.jclinepi.2005.02.022
  23. Halligan S, Altman DG. Evidence-based practice in radiology: steps 3 and 4--appraise and apply systematic reviews and meta-analyses. Radiology 2007;243:13-27 https://doi.org/10.1148/radiol.2431051823
  24. Deeks JJ. Systematic reviews in health care: systematic reviews of evaluations of diagnostic and screening tests. BMJ 2001;323:157-162
  25. Devillé WL, Buntinx F, Bouter LM, Montori VM, de Vet HC, van der Windt DA, et al. Conducting systematic reviews of diagnostic studies: didactic guidelines. BMC Med Res Methodol 2002;2:9 https://doi.org/10.1186/1471-2288-2-9
  26. Chappell FM, Raab GM, Wardlaw JM. When are summary ROC curves appropriate for diagnostic meta-analyses? Stat Med 2009;28:2653-2668 https://doi.org/10.1002/sim.3631
  27. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003;327:557-560 https://doi.org/10.1136/bmj.327.7414.557
  28. Song F, Eastwood AJ, Gilbody S, Duley L, Sutton AJ. Publication and related biases. Health Technol Assess 2000;4:1-115
  29. Tatsioni A, Zarin DA, Aronson N, Samson DJ, Flamm CR, Schmid C, et al. Challenges in systematic reviews of diagnostic technologies. Ann Intern Med 2005;142(12 Pt 2):1048-1055 https://doi.org/10.7326/0003-4819-142-12_Part_2-200506211-00004
  30. Mulherin SA, Miller WC. Spectrum bias or spectrum effect? Subgroup variation in diagnostic test evaluation. Ann Intern Med 2002;137:598-602 https://doi.org/10.7326/0003-4819-137-7-200210010-00011
  31. de Groot JA, Dendukuri N, Janssen KJ, Reitsma JB, Brophy J, Joseph L, et al. Adjusting for partial verification or workup bias in meta-analyses of diagnostic accuracy studies. Am J Epidemiol 2012;175:847-853 https://doi.org/10.1093/aje/kwr383
  32. Leeflang MM, Moons KG, Reitsma JB, Zwinderman AH. Bias in sensitivity and specificity caused by data-driven selection of optimal cutoff values: mechanisms, magnitude, and solutions. Clin Chem 2008;54:729-737 https://doi.org/10.1373/clinchem.2007.096032
  33. Ewald B. Post hoc choice of cut points introduced bias to diagnostic research. J Clin Epidemiol 2006;59:798-801 https://doi.org/10.1016/j.jclinepi.2005.11.025
  34. Song F, Khan KS, Dinnes J, Sutton AJ. Asymmetric funnel plots and publication bias in meta-analyses of diagnostic accuracy. Int J Epidemiol 2002;31:88-95 https://doi.org/10.1093/ije/31.1.88
  35. Deeks JJ, Macaskill P, Irwig L. The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. J Clin Epidemiol 2005;58:882-893 https://doi.org/10.1016/j.jclinepi.2005.01.016

Cited by

  1. Systematic Review and Meta-Analysis of Studies Evaluating Diagnostic Test Accuracy: A Practical Review for Clinical Researchers-Part II. Statistical Methods of Meta-Analysis vol.16, pp.6, 2015, https://doi.org/10.3348/kjr.2015.16.6.1188
  2. The detectability of brain metastases using contrast-enhanced spin-echo or gradient-echo images: a systematic review and meta-analysis vol.129, pp.2, 2015, https://doi.org/10.1007/s11060-016-2185-y
  3. The role of core-needle biopsy in the diagnosis of thyroid malignancy in 4580 patients with 4746 thyroid nodules: a systematic review and meta-analysis vol.54, pp.2, 2016, https://doi.org/10.1007/s12020-016-0991-9
  4. Efficacy and Safety of Radiofrequency and Ethanol Ablation for Treating Locally Recurrent Thyroid Cancer: A Systematic Review and Meta-Analysis vol.26, pp.3, 2015, https://doi.org/10.1089/thy.2015.0545
  5. Successful Publication of Systematic Review and Meta-Analysis of Studies Evaluating Diagnostic Test Accuracy vol.17, pp.1, 2015, https://doi.org/10.3348/kjr.2016.17.1.5
  6. Diagnostic Performance of Sonographic Features in Patients With Biliary Atresia: A Systematic Review and Meta-analysis : Sonographic Features in Patients With Biliary Atresia vol.36, pp.10, 2015, https://doi.org/10.1002/jum.14234
  7. The diagnostic performance of shear wave elastography for malignant cervical lymph nodes: A systematic review and meta-analysis vol.27, pp.1, 2015, https://doi.org/10.1007/s00330-016-4378-3
  8. Diagnostic Accuracy of Memory Measures in Alzheimer’s Dementia and Mild Cognitive Impairment: a Systematic Review and Meta-Analysis vol.27, pp.4, 2017, https://doi.org/10.1007/s11065-017-9360-6
  9. Diagnostic Accuracy of Blood-Based Tests and Histopathology for Cytomegalovirus Reactivation in Inflammatory Bowel Disease : A Systematic Review and Meta-Analysis vol.23, pp.4, 2015, https://doi.org/10.1097/mib.0000000000001073
  10. Hypervascular Transformation of Hypovascular Hypointense Nodules in the Hepatobiliary Phase of Gadoxetic Acid–Enhanced MRI: A Systematic Review and Meta-Analysis vol.209, pp.4, 2015, https://doi.org/10.2214/ajr.16.17711
  11. Shear-Wave Elastography for Detection of Prostate Cancer: A Systematic Review and Diagnostic Meta-Analysis vol.209, pp.4, 2015, https://doi.org/10.2214/ajr.17.18056
  12. Diagnostic Performance of CT for Diagnosis of Fat-Poor Angiomyolipoma in Patients With Renal Masses: A Systematic Review and Meta-Analysis vol.209, pp.5, 2015, https://doi.org/10.2214/ajr.17.18184
  13. Diagnostic Performance of DWI for Differentiating High- From Low-Grade Clear Cell Renal Cell Carcinoma: A Systematic Review and Meta-Analysis vol.209, pp.6, 2017, https://doi.org/10.2214/ajr.17.18283
  14. Circulating Tumor DNA is Effective for Detection of KRAS Mutation in Colorectal Cancer: A Meta-Analysis vol.32, pp.4, 2017, https://doi.org/10.5301/ijbm.5000295
  15. Performance of CT in the Preoperative Diagnosis of Cervical Lymph Node Metastasis in Patients with Papillary Thyroid Cancer: A Systematic Review and Meta-Analysis vol.38, pp.1, 2017, https://doi.org/10.3174/ajnr.a4967
  16. The Role of Core Needle Biopsy for Thyroid Nodules with Initially Indeterminate Results on Previous Fine-Needle Aspiration: A Systematic Review and Meta-Analysis vol.38, pp.7, 2015, https://doi.org/10.3174/ajnr.a5182
  17. The Indirect Efficacy Comparison of DNA Methylation in Sputum for Early Screening and Auxiliary Detection of Lung Cancer: A Meta-Analysis vol.14, pp.7, 2015, https://doi.org/10.3390/ijerph14070679
  18. Pheochromocytoma as a frequent false-positive in adrenal washout CT: A systematic review and meta-analysis vol.28, pp.3, 2015, https://doi.org/10.1007/s00330-017-5076-5
  19. The diagnostic performance of shear-wave elastography for liver fibrosis in children and adolescents: A systematic review and diagnostic meta-analysis vol.28, pp.3, 2015, https://doi.org/10.1007/s00330-017-5078-3
  20. Comparison of gradient-recalled echo and spin-echo echo-planar imaging MR elastography in staging liver fibrosis: a meta-analysis vol.28, pp.4, 2015, https://doi.org/10.1007/s00330-017-5149-5
  21. The diagnostic performance of reduced-dose CT for suspected appendicitis in paediatric and adult patients: A systematic review and diagnostic meta-analysis vol.28, pp.6, 2015, https://doi.org/10.1007/s00330-017-5231-z
  22. Multiparametric MRI as a potential surrogate endpoint for decision-making in early treatment response following concurrent chemoradiotherapy in patients with newly diagnosed glioblastoma: a systematic vol.28, pp.6, 2018, https://doi.org/10.1007/s00330-017-5262-5
  23. ADC as a useful diagnostic tool for differentiating benign and malignant vertebral bone marrow lesions and compression fractures: a systematic review and meta-analysis vol.28, pp.7, 2015, https://doi.org/10.1007/s00330-018-5330-5
  24. Complications following ultrasound-guided core needle biopsy of thyroid nodules: a systematic review and meta-analysis vol.28, pp.9, 2018, https://doi.org/10.1007/s00330-018-5367-5
  25. Diagnostic performance of dual-energy CT for the detection of bone marrow oedema: a systematic review and meta-analysis vol.28, pp.10, 2018, https://doi.org/10.1007/s00330-018-5411-5
  26. The role of core needle biopsy in the diagnosis of initially detected thyroid nodules: a systematic review and meta-analysis vol.28, pp.11, 2018, https://doi.org/10.1007/s00330-018-5494-z
  27. Systematic Review and Meta-Analysis of CT Features for Differentiating Complicated and Uncomplicated Appendicitis vol.287, pp.1, 2015, https://doi.org/10.1148/radiol.2017171260
  28. Shear Wave Elastography as a Quantitative Biomarker of Clinically Significant Portal Hypertension: A Systematic Review and Meta-Analysis vol.210, pp.5, 2015, https://doi.org/10.2214/ajr.17.18367
  29. The Diagnostic Performance of MRI for Detection of Lymph Node Metastasis in Bladder and Prostate Cancer: An Updated Systematic Review and Diagnostic Meta-Analysis vol.210, pp.3, 2018, https://doi.org/10.2214/ajr.17.18481
  30. Diagnostic Performance of In-Phase and Opposed-Phase Chemical-Shift Imaging for Differentiating Benign and Malignant Vertebral Marrow Lesions: A Meta-Analysis vol.211, pp.4, 2015, https://doi.org/10.2214/ajr.17.19306
  31. Diagnostic Performance of Transient Elastography for Liver Fibrosis in Children: A Systematic Review and Meta-Analysis vol.211, pp.5, 2015, https://doi.org/10.2214/ajr.18.19535
  32. Head-to-Head Comparison Between Biparametric and Multiparametric MRI for the Diagnosis of Prostate Cancer: A Systematic Review and Meta-Analysis vol.211, pp.5, 2018, https://doi.org/10.2214/ajr.18.19880
  33. Blood Lactate or Lactate Clearance: Which Is Robust to Predict the Neurological Outcomes after Cardiac Arrest? A Systematic Review and Meta-Analysis vol.2018, pp.None, 2015, https://doi.org/10.1155/2018/8014213
  34. Systematic review and meta-analysis of cancer studies evaluating diagnostic test accuracy and prognostic values: approaches to improve clinical interpretation of results vol.10, pp.None, 2015, https://doi.org/10.2147/cmar.s183181
  35. Performance of MRI for suspected appendicitis in pediatric patients and negative appendectomy rate: A systematic review and meta‐analysis vol.47, pp.3, 2015, https://doi.org/10.1002/jmri.25825
  36. Diffusion-Weighted Imaging and Diffusion Tensor Imaging for Differentiating High-Grade Glioma from Solitary Brain Metastasis: A Systematic Review and Meta-Analysis vol.39, pp.7, 2018, https://doi.org/10.3174/ajnr.a5650
  37. MRI Findings in Tumefactive Demyelinating Lesions: A Systematic Review and Meta-Analysis vol.39, pp.9, 2015, https://doi.org/10.3174/ajnr.a5775
  38. Comparison between 3D isotropic and 2D conventional MR arthrography for diagnosing rotator cuff tear and labral lesions: A meta‐analysis vol.48, pp.4, 2015, https://doi.org/10.1002/jmri.26024
  39. The Diagnostic Value of Diffusion-Weighted Imaging in Differentiating Metastatic Lymph Nodes of Head and Neck Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis vol.39, pp.10, 2015, https://doi.org/10.3174/ajnr.a5813
  40. Diagnostic performance of diffusion‐weighted imaging for differentiating benign and malignant gallbladder lesions: A systematic review and meta‐analysis vol.48, pp.5, 2015, https://doi.org/10.1002/jmri.26035
  41. 2-Hydroxyglutarate MR spectroscopy for prediction of isocitrate dehydrogenase mutant glioma: a systemic review and meta-analysis using individual patient data vol.20, pp.12, 2018, https://doi.org/10.1093/neuonc/noy113
  42. The clock drawing test: A systematic review and meta‐analysis of diagnostic accuracy vol.74, pp.12, 2015, https://doi.org/10.1111/jan.13810
  43. Comparison of MRI and PET as Potential Surrogate Endpoints for Treatment Response After Stereotactic Radiosurgery in Patients With Brain Metastasis vol.211, pp.6, 2018, https://doi.org/10.2214/ajr.18.19674
  44. Characteristics, trend, and methodological quality of systematic reviews and meta-analyses in nuclear medicine : A bibliometric analysis of studies published between 2005 and 2016 vol.98, pp.21, 2015, https://doi.org/10.1097/md.0000000000015785
  45. Comparison of 2-point and 3-point point-of-care ultrasound techniques for deep vein thrombosis at the emergency department : A meta-analysis vol.98, pp.22, 2015, https://doi.org/10.1097/md.0000000000015791
  46. Diagnostic accuracy of cervical elastography in predicting preterm delivery : A systematic review and meta-analysis vol.98, pp.29, 2015, https://doi.org/10.1097/md.0000000000016449
  47. A Glimpse on Trends and Characteristics of Recent Articles Published in the Korean Journal of Radiology vol.20, pp.12, 2019, https://doi.org/10.3348/kjr.2019.0928
  48. High performance of critical shoulder angle for diagnosing rotator cuff tears on radiographs vol.27, pp.1, 2019, https://doi.org/10.1007/s00167-018-5247-1
  49. Efficacy and safety of radiofrequency, microwave and laser ablation for treating papillary thyroid microcarcinoma: a systematic review and meta-analysis vol.36, pp.1, 2015, https://doi.org/10.1080/02656736.2019.1700559
  50. Imaging prediction of isocitrate dehydrogenase (IDH) mutation in patients with glioma: a systemic review and meta-analysis vol.29, pp.2, 2015, https://doi.org/10.1007/s00330-018-5608-7
  51. Postmortem computed tomography angiography (PMCTA) and traditional autopsy in cases of sudden cardiac death due to coronary artery disease: a systematic review and meta-analysis vol.124, pp.2, 2015, https://doi.org/10.1007/s11547-018-0943-y
  52. Systematic review and meta-analysis of prognostic microRNA biomarkers for survival outcome in nasopharyngeal carcinoma vol.14, pp.2, 2019, https://doi.org/10.1371/journal.pone.0209760
  53. Diagnostic Performance of Ultrasound Elastography for Evaluating Portal Hypertension in Children: A Systematic Review and Meta-analysis : Ultrasound Elastography for Portal Hypertension vol.38, pp.3, 2015, https://doi.org/10.1002/jum.14764
  54. Cold pulp testing is the simplest and most accurate of all dental pulp sensibility tests vol.20, pp.1, 2019, https://doi.org/10.1038/s41432-019-0004-y
  55. Diagnostic Outcome of Image-Guided Percutaneous Core Needle Biopsy of Sclerotic Bone Lesions: A Meta-Analysis vol.212, pp.3, 2019, https://doi.org/10.2214/ajr.18.20243
  56. Accuracy of presepsin in neonatal sepsis: systematic review and meta-analysis vol.17, pp.4, 2015, https://doi.org/10.1080/14787210.2019.1584037
  57. Amide proton transfer-weighted MRI in distinguishing high- and low-grade gliomas: a systematic review and meta-analysis vol.61, pp.5, 2015, https://doi.org/10.1007/s00234-018-02152-2
  58. Technical performance of shear wave elastography for measuring liver stiffness in pediatric and adolescent patients: a systematic review and meta-analysis vol.29, pp.5, 2015, https://doi.org/10.1007/s00330-018-5900-6
  59. Differentiating between hepatocellular carcinoma and intrahepatic cholangiocarcinoma using contrast-enhanced MRI features: a systematic review and meta-analysis vol.74, pp.5, 2015, https://doi.org/10.1016/j.crad.2018.12.016
  60. Technical Performance of Two-Dimensional Shear Wave Elastography for Measuring Liver Stiffness: A Systematic Review and Meta-Analysis vol.20, pp.6, 2015, https://doi.org/10.3348/kjr.2018.0812
  61. Cognitive screening instruments to identify vascular cognitive impairment: A systematic review vol.34, pp.8, 2015, https://doi.org/10.1002/gps.5136
  62. MRI as a diagnostic biomarker for differentiating primary central nervous system lymphoma from glioblastoma: A systematic review and meta‐analysis vol.50, pp.2, 2015, https://doi.org/10.1002/jmri.26602
  63. Perfusion CT for prediction of hemorrhagic transformation in acute ischemic stroke: a systematic review and meta-analysis vol.29, pp.8, 2015, https://doi.org/10.1007/s00330-018-5936-7
  64. Diagnostic performance of CT in detection of metastatic cervical lymph nodes in patients with thyroid cancer: a systematic review and meta-analysis vol.29, pp.9, 2015, https://doi.org/10.1007/s00330-019-06036-8
  65. The Diagnostic Performance of MRI for Detection of Extramural Venous Invasion in Colorectal Cancer: A Systematic Review and Meta-Analysis of the Literature vol.213, pp.3, 2015, https://doi.org/10.2214/ajr.19.21112
  66. Efficiency of knee ultrasound for diagnosing anterior cruciate ligament and posterior cruciate ligament injuries: a systematic review and meta-analysis vol.48, pp.10, 2015, https://doi.org/10.1007/s00256-019-03225-w
  67. Diagnostic performance of computed tomography for bowel endometriosis: A systematic review and meta-analysis vol.119, pp.None, 2015, https://doi.org/10.1016/j.ejrad.2019.08.007
  68. The “Central Vein Sign” on T2*-weighted Images as a Diagnostic Tool in Multiple Sclerosis: A Systematic Review and Meta-analysis using Individual Patient Data vol.9, pp.1, 2015, https://doi.org/10.1038/s41598-019-54583-3
  69. Accuracy of single molecular biomarkers in gingival crevicular fluid for the diagnosis of periodontitis: A systematic review and meta‐analysis vol.46, pp.12, 2015, https://doi.org/10.1111/jcpe.13188
  70. Imaging modality for measuring the presence and extent of the labral lesions of the shoulder: a systematic review and meta-analysis vol.20, pp.1, 2015, https://doi.org/10.1186/s12891-019-2876-6
  71. Radiological Recurrence Patterns after Bevacizumab Treatment of Recurrent High-Grade Glioma: A Systematic Review and Meta-Analysis vol.21, pp.7, 2015, https://doi.org/10.3348/kjr.2019.0898
  72. MRI Assessment of Complete Response to Preoperative Chemoradiation Therapy for Rectal Cancer: 2020 Guide for Practice from the Korean Society of Abdominal Radiology vol.21, pp.7, 2015, https://doi.org/10.3348/kjr.2020.0483
  73. Accuracy of single molecular biomarkers in saliva for the diagnosis of periodontitis: A systematic review and meta‐analysis vol.47, pp.1, 2015, https://doi.org/10.1111/jcpe.13202
  74. Meta-analysis of diagnostic performance of serology tests for COVID-19: impact of assay design and post-symptom-onset intervals vol.9, pp.1, 2015, https://doi.org/10.1080/22221751.2020.1826362
  75. Diagnostic and clinical significance of antigen-specific pancreatic antibodies in inflammatory bowel diseases: A meta-analysis vol.26, pp.2, 2015, https://doi.org/10.3748/wjg.v26.i2.246
  76. Comparison of technical failure of MR elastography for measuring liver stiffness between gradient‐recalled echo and spin‐echo echo‐planar imaging: A systematic review and meta‐ vol.51, pp.4, 2015, https://doi.org/10.1002/jmri.26918
  77. Predictive value of cystatin C and neutrophil gelatinase-associated lipocalin in contrast-induced nephropathy: A meta-analysis vol.15, pp.4, 2020, https://doi.org/10.1371/journal.pone.0230934
  78. Efficacy and Safety of Thermal Ablation Techniques for the Treatment of Primary Papillary Thyroid Microcarcinoma: A Systematic Review and Meta-Analysis vol.30, pp.5, 2015, https://doi.org/10.1089/thy.2019.0707
  79. Diagnostic performance of ankle ultrasound for diagnosing anterior talofibular and calcaneofibular ligament injuries: a meta-analysis vol.61, pp.5, 2020, https://doi.org/10.1177/0284185119873119
  80. Long-Term Results of Thermal Ablation of Benign Thyroid Nodules: A Systematic Review and Meta-Analysis vol.35, pp.2, 2015, https://doi.org/10.3803/enm.2020.35.2.339
  81. Comparison of diagnostic performance between CT and MRI for detection of cartilage invasion for primary tumor staging in patients with laryngo-hypopharyngeal cancer: a systematic review and meta-analy vol.30, pp.7, 2015, https://doi.org/10.1007/s00330-020-06718-8
  82. Diagnostic performance of MRI to detect metastatic cervical lymph nodes in patients with thyroid cancer: a systematic review and meta-analysis vol.75, pp.7, 2020, https://doi.org/10.1016/j.crad.2020.03.025
  83. Diagnostic Performance of Magnetic Resonance Imaging for Detecting Meniscal Ramp Lesions in Patients With Anterior Cruciate Ligament Tears: A Systematic Review and Meta-analysis vol.48, pp.8, 2015, https://doi.org/10.1177/0363546519880528
  84. MRI for prediction of hemorrhagic transformation in acute ischemic stroke: a systematic review and meta-analysis vol.61, pp.7, 2020, https://doi.org/10.1177/0284185119887593
  85. Diagnostic Performance of Four Ultrasound Risk Stratification Systems: A Systematic Review and Meta-Analysis vol.30, pp.8, 2015, https://doi.org/10.1089/thy.2019.0812
  86. Diagnostic test accuracy of the Nursing Delirium Screening Scale: A systematic review and meta‐analysis vol.76, pp.10, 2015, https://doi.org/10.1111/jan.14482
  87. DECAF score as a mortality predictor for acute exacerbation of chronic obstructive pulmonary disease: a systematic review and meta-analysis vol.10, pp.10, 2015, https://doi.org/10.1136/bmjopen-2020-037923
  88. Incidence of Pseudoprogression during Immune Checkpoint Inhibitor Therapy for Solid Tumors: A Systematic Review and Meta-Analysis vol.297, pp.1, 2015, https://doi.org/10.1148/radiol.2020200443
  89. Diagnostic Test Accuracy of the 4AT for Delirium Detection: A Systematic Review and Meta-Analysis vol.17, pp.20, 2015, https://doi.org/10.3390/ijerph17207515
  90. Accuracy of contrast-enhanced ultrasound liver imaging reporting and data system: a systematic review and meta-analysis vol.14, pp.6, 2015, https://doi.org/10.1007/s12072-020-10102-5
  91. Immune Checkpoint Inhibitors with or without Radiotherapy in Non-Small Cell Lung Cancer Patients with Brain Metastases: A Systematic Review and Meta-Analysis vol.10, pp.12, 2015, https://doi.org/10.3390/diagnostics10121098
  92. Neuroprognostic Accuracy of Quantitative Versus Standard Pupillary Light Reflex for Adult Postcardiac Arrest Patients: A Systematic Review and Meta-Analysis* vol.49, pp.10, 2015, https://doi.org/10.1097/ccm.0000000000005045
  93. Immune Checkpoint Inhibitor with or without Radiotherapy in Melanoma Patients with Brain Metastases: A Systematic Review and Meta-Analysis vol.22, pp.4, 2021, https://doi.org/10.3348/kjr.2020.0728
  94. Neuroimaging Findings in Patients with COVID-19: A Systematic Review and Meta-Analysis vol.22, pp.None, 2015, https://doi.org/10.3348/kjr.2021.0127
  95. Classification of true progression after radiotherapy of brain metastasis on MRI using artificial intelligence: a systematic review and meta-analysis vol.3, pp.1, 2015, https://doi.org/10.1093/noajnl/vdab080
  96. The Accuracy of Visceral Adiposity Index for the Screening of Metabolic Syndrome: A Systematic Review and Meta-Analysis vol.2021, pp.None, 2015, https://doi.org/10.1155/2021/6684627
  97. Diagnostic Value of Perfusion-Weighted Magnetic Resonance Imaging as an Adjunct to Routine Magnetic Resonance Protocols for Adults Presenting with Acute Ischemic Stroke vol.14, pp.None, 2021, https://doi.org/10.2147/rmi.s331876
  98. Diagnostic Accuracy of PET for Differentiating True Glioma Progression From Post Treatment-Related Changes: A Systematic Review and Meta-Analysis vol.12, pp.None, 2021, https://doi.org/10.3389/fneur.2021.671867
  99. Diagnosis of Alzheimer’s Disease in Developed and Developing Countries: Systematic Review and Meta-Analysis of Diagnostic Test Accuracy vol.5, pp.1, 2015, https://doi.org/10.3233/adr-200263
  100. Diagnostic performance of neuromelanin-sensitive magnetic resonance imaging for patients with Parkinson’s disease and factor analysis for its heterogeneity: a systematic review and meta-analysis vol.31, pp.3, 2015, https://doi.org/10.1007/s00330-020-07240-7
  101. Cardiac natriuretic peptides for diagnosis of covert atrial fibrillation after acute ischaemic stroke: a meta-analysis of diagnostic accuracy studies vol.6, pp.1, 2015, https://doi.org/10.1136/svn-2020-000440
  102. Definition, Incidence, and Challenges for Assessment of Hyperprogressive Disease During Cancer Treatment With Immune Checkpoint Inhibitors : A Systematic Review and Meta-analysis vol.4, pp.3, 2015, https://doi.org/10.1001/jamanetworkopen.2021.1136
  103. Diagnostic roles of HOX transcript antisense intergenic RNA in cancer vol.17, pp.2, 2015, https://doi.org/10.1111/ajco.13300
  104. Diagnostic value of anti‐citrullinated α‐enolase peptide 1 antibody in patients with rheumatoid arthritis: A systematic review and meta‐analysis vol.24, pp.5, 2021, https://doi.org/10.1111/1756-185x.14093
  105. Incidence of Immune-Mediated Pseudoprogression of Lymphoma Treated with Immune Checkpoint Inhibitors: Systematic Review and Meta-Analysis vol.10, pp.11, 2015, https://doi.org/10.3390/jcm10112257
  106. The T2-FLAIR mismatch sign as a predictor of IDH-mutant, 1p/19q-noncodeleted lower-grade gliomas: a systematic review and diagnostic meta-analysis vol.31, pp.7, 2015, https://doi.org/10.1007/s00330-020-07467-4
  107. Machine Learning for the Prediction of Molecular Markers in Glioma on Magnetic Resonance Imaging : A Systematic Review and Meta-Analysis vol.89, pp.1, 2015, https://doi.org/10.1093/neuros/nyab103
  108. Comparison of diffusion-weighted imaging and MR elastography in staging liver fibrosis: a meta-analysis vol.46, pp.8, 2021, https://doi.org/10.1007/s00261-021-03055-2
  109. Diagnostic accuracy and complication rate of image-guided percutaneous transthoracic needle lung biopsy for subsolid pulmonary nodules: a systematic review and meta-analysis vol.94, pp.1127, 2015, https://doi.org/10.1259/bjr.20210065
  110. Machine learning with neuroimaging data to identify autism spectrum disorder: a systematic review and meta-analysis vol.63, pp.12, 2015, https://doi.org/10.1007/s00234-021-02774-z
  111. Transient Severe Motion Artifact on Arterial Phase in Gadoxetic Acid-Enhanced Liver Magnetic Resonance Imaging : A Systematic Review and Meta-analysis vol.57, pp.1, 2015, https://doi.org/10.1097/rli.0000000000000806
  112. The value of contrast‐enhanced ultrasound for the diagnosis of metastatic cervical lymph nodes of papillary thyroid carcinoma: A systematic review and meta‐analysis vol.50, pp.1, 2022, https://doi.org/10.1002/jcu.23073
  113. Ultrasonography and Fine‐Needle Aspiration in Indeterminate Thyroid Nodules: A Systematic Review of Diagnostic Test Accuracy vol.132, pp.1, 2015, https://doi.org/10.1002/lary.29778
  114. Diagnostic Performance of the Magnetic Resonance Parkinsonism Index in Differentiating Progressive Supranuclear Palsy from Parkinson’s Disease: An Updated Systematic Review and Meta-Analysis vol.12, pp.1, 2022, https://doi.org/10.3390/diagnostics12010012