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Research ArticleWhite Paper
Open Access

Imaging Evidence and Recommendations for Traumatic Brain Injury: Advanced Neuro- and Neurovascular Imaging Techniques

M. Wintermark, P.C. Sanelli, Y. Anzai, A.J. Tsiouris and C.T. Whitlow on behalf of the American College of Radiology Head Injury Institute
American Journal of Neuroradiology February 2015, 36 (2) E1-E11; DOI: https://doi.org/10.3174/ajnr.A4181
M. Wintermark
aFrom the Division of Neuroradiology (M.W.), Stanford University, Palo Alto, California
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P.C. Sanelli
bDepartment of Radiology (P.C.S.), North Shore–LIJ Health System, Manhasset, New York
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Y. Anzai
cDepartment of Radiology (Y.A.), University of Washington, Seattle, Washington
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A.J. Tsiouris
dDepartment of Radiology (A.J.T.), Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
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C.T. Whitlow
eDepartment of Radiology and Translational Science Institute (C.T.W.), Wake Forest School of Medicine, Winston-Salem, North Carolina.
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    Table 1:

    Levels of evidence for studies of the accuracy of diagnostic testsa

    Levels of EvidenceType of Evidence
    IaSystematic review (with homogeneity)b of level-1 studiesc
    IbLevel-1 studiesc
    IILevel-2 studiesd
    Systematic reviews of level-2 studies
    IIILevel-3 studiese
    Systematic reviews of level-3 studies
    IVConsensus, expert committee reports or opinions and/or clinical experience without explicit critical appraisal; or based on physiology, bench research, or “first principles”
    • ↵a Adapted from The Oxford Centre for Evidence-Based Medicine Levels of Evidence (2001) and the Centre for Reviews and Dissemination Report Number 4 (2001). Copyright National Institute for Health and Care Excellence February 2004.

    • ↵b Homogeneity means there are no or minor variations in the directions and degrees of results between individual studies that are included in the systematic review.

    • ↵c Level-1 studies are studies:

      • •  that use a blind comparison of the test with a validated reference standard.

      • •  in a sample of patients that reflects the population to whom the test would apply.

    • ↵d Level-2 studies are studies that have only 1 of the following:

      • •  narrow population (the sample does not reflect the population to whom the test would apply).

      • •  use a poor reference standard (defined as that where the “test” is included in the “reference,” or where the “testing” affects the “reference”).

      • •  the comparison between the test and reference standard is not blind.

      • •  case-control studies.

    • ↵e Level-3 studies are studies that have at least 2 or 3 of the features listed above.

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    Table 2:

    Classification of recommendationsa

    Class IConditions for which there is evidence for and/or general agreement that a procedure or treatment is beneficial, useful, and effective
    Class IIConditions for which there is conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of a procedure or treatment
        Class IIaWeight of evidence/opinion is in favor of usefulness/efficacy
        Class IIbUsefulness/efficacy is less well-established
    Class IIIConditions for which there is evidence and/or general agreement that a procedure/treatment is not useful/effective and in some cases may be harmful
    • ↵a From the American Heart Association Evidence-Based Scoring System.

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American Journal of Neuroradiology: 36 (2)
American Journal of Neuroradiology
Vol. 36, Issue 2
1 Feb 2015
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Cite this article
M. Wintermark, P.C. Sanelli, Y. Anzai, A.J. Tsiouris, C.T. Whitlow
Imaging Evidence and Recommendations for Traumatic Brain Injury: Advanced Neuro- and Neurovascular Imaging Techniques
American Journal of Neuroradiology Feb 2015, 36 (2) E1-E11; DOI: 10.3174/ajnr.A4181

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Imaging Evidence and Recommendations for Traumatic Brain Injury: Advanced Neuro- and Neurovascular Imaging Techniques
M. Wintermark, P.C. Sanelli, Y. Anzai, A.J. Tsiouris, C.T. Whitlow
American Journal of Neuroradiology Feb 2015, 36 (2) E1-E11; DOI: 10.3174/ajnr.A4181
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