Pitfalls of systematic reviews and meta-analyses in imaging research1

Abstract

Systematic reviews of imaging research represent a tool to better understand test accuracy or the efficacy of interventions. Like any type of research, appropriate methods must be applied to optimize quality. The purpose of this review is to outline common pitfalls in performing systematic reviews of imaging research, with a focus on challenges particular to performing reviews of diagnostic accuracy studies. The following challenges are highlighted: posing relevant review questions, conducting comprehensive literature searches, assessing for bias in included studies, testing for heterogeneity and publication bias, pooling results across studies, and forming appropriate conclusions. By guiding authors on how to overcome these, the hope is that published reviews in imaging research will be of higher quality and have a positive impact on clinical practice. In addition, the review aims to educate readers of reviews so they become aware of crucial elements of systematic reviews that could bias review results.