Comparative reviews of diagnostic test accuracy in imaging research: evaluation of current practices.

• Few comparative accuracy imaging reviews include only primary studies with optimal comparative study designs. Among the rest, few recognize the risk of bias conferred from inclusion of primary studies with non-comparative designs. • The demand for accurate comparative accuracy data combined with minimal awareness of valid comparative study designs may lead to counter-productive research and inadequately supported clinical decisions for diagnostic tests. • Using comparative accuracy imaging reviews with a high risk of bias to inform guidelines and funding decisions may have detrimental impacts on patient care.