CT & MRI for renal artery stenosis - metanalysis - A story of how rubbish articles get published
A meta-analysis of articles published between 1998 and 2001 on the accuracy of CT and MRI in diagnosing renal artery stenosis, has been published recently in the Annals of Internal Medicine.
It concludes that these two modalities are not good enough to replace DSA.
And also reinforces my oft-repeated claim that journals need to publish articles in perspective. With the advent of 64-slice CT scanners and newer MRI scanners, there is no question that the accuracy of CT and MRI angiography has improved by leaps and bounds as far as renal angiography is concerned. And in practice, they have replaced DSA. Period.
This must be one of the worst articles that could have been published on this subject.
5 Comments:
Interesting.........
There is an article in "EBM Online" of 2002, - the title is - "Review: CT angiography and magnetic resonance imaging are the best less invasive tests for renal artery stenosis". The author is Vasbinder GB and I find a Vasbinder GBC who figures in the "author contributors" in the meta-analysis published in the Annals article. (Have not figured out if it is the same person)
11:53 AM
Sorry - forgot to add the url for the EBM online article - it is http://ebm.bmjjournals.com/cgi/content/full/7/2/58
11:57 AM
The articles of Vasbinder et al as published in the Annals in 2001 and 2004 are well designed. First, they publish a meta-analysis concluding that Gd MRA and CTA are the best non-invasive tests for the detection of RAS (based on all literature published till 2000). Next, they publish the largest prospective study to date that shows that CTA and MRA are not sensitive enough to rule out RAS (with DSA as reference test).
Finally a well-designed study that shows small studies with 100% sens/spec are not realistic, and discuss the shortcomings of DSA as reference test.
Besides, the authors (I have met at many (MRA) meetings) are leading researchers in the field of new (renal) MR and CT angiography techniques.
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