title: Methodological quality of diagnostic accuracy studies on non-invasive coronary CT angiography: influence of QUADAS (Quality Assessment of Diagnostic Accuracy Studies included in systematic reviews) items on sensitivity and specificity.
abstract: OBJECTIVE
  To evaluate the methodological quality of diagnostic accuracy studies on coronary computed tomography (CT) angiography using the QUADAS (Quality Assessment of Diagnostic Accuracy Studies included in systematic reviews) tool.
  
  
  METHODS
  Each QUADAS item was individually defined to adapt it to the special requirements of studies on coronary CT angiography. Two independent investigators analysed 118 studies using 12 QUADAS items. Meta-regression and pooled analyses were performed to identify possible effects of methodological quality items on estimates of diagnostic accuracy.
  
  
  RESULTS
  The overall methodological quality of coronary CT studies was merely moderate. They fulfilled a median of 7.5 out of 12 items. Only 9 of the 118 studies fulfilled more than 75 % of possible QUADAS items. One QUADAS item ("Uninterpretable Results") showed a significant influence (P = 0.02) on estimates of diagnostic accuracy with "no fulfilment" increasing specificity from 86 to 90 %. Furthermore, pooled analysis revealed that each QUADAS item that is not fulfilled has the potential to change estimates of diagnostic accuracy.
  
  
  CONCLUSIONS
  The methodological quality of studies investigating the diagnostic accuracy of non-invasive coronary CT is only moderate and was found to affect the sensitivity and specificity. An improvement is highly desirable because good methodology is crucial for adequately assessing imaging technologies.
  
  
  CONCLUSIONS
  • Good methodological quality is a basic requirement in diagnostic accuracy studies. • Most coronary CT angiography studies have only been of moderate design quality. • Weak methodological quality will affect the sensitivity and specificity. • No improvement in methodological quality was observed over time. • Authors should consider the QUADAS checklist when undertaking accuracy studies.
authors: Charité Medical School, Department of Radiology, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany.
authors: Sabine
authors: S
authors: Schueler
authors: Stefan
authors: S
authors: Walther
authors: Georg M
authors: GM
authors: Schuetz
authors: Peter
authors: P
authors: Schlattmann
authors: Marc
authors: M
authors: Dewey
mesh_terms: D000465:Algorithms; D017023:Coronary Angiography / Q000379:methods*; D003955:Diagnostic Tests, Routine / Q000592:standards; D006801:Humans; D011857:Radiographic Image Interpretation, Computer-Assisted; D012044:Regression Analysis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*