Author + information
- Received December 20, 2016
- Accepted December 21, 2016
- Published online March 6, 2017.
- aDuke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- bInstitute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
- cDepartment of Epidemiology and Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands
- dDepartment of Health Policy and Management, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. M.G. Myriam Hunink, Department of Epidemiology and Radiology, Erasmus University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
Cardiovascular diagnostic imaging tests are increasingly used in everyday clinical practice, but are often imperfect, just like any other diagnostic test. The performance of a cardiovascular diagnostic imaging test is usually expressed in terms of sensitivity and specificity compared with the reference standard (gold standard) for diagnosing the disease. However, evidence-based application of a diagnostic test also requires knowledge about the pre-test probability of disease, the benefit of making a correct diagnosis, the harm caused by false-positive imaging test results, and potential adverse effects of performing the test itself. To assist in clinical decision making regarding appropriate use of cardiovascular diagnostic imaging tests, we reviewed quantitative concepts related to diagnostic performance (e.g., sensitivity, specificity, predictive values, likelihood ratios), as well as possible biases and solutions in diagnostic performance studies, Bayesian principles, and the threshold approach to decision making.
This work was supported by an American Heart Association Grant #16MCPRP31030016 (Dr. Ferket). Dr. Hunink has received royalties for textbook from Cambridge University Press; grants and nonfinancial support from European Society of Radiology; and nonfinancial support from European Institute for Biomedical Imaging Research, outside the submitted work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Pamela Douglas, MD, served as the Guest Editor for this paper.
- Received December 20, 2016.
- Accepted December 21, 2016.
- American College of Cardiology Foundation