Quality of Evidence and Clinical Impact in Recent Neuroradiology Research: A Systematic Assessment of American Journal of Neuroradiology (AJNR) Articles

BACKGROUND AND PURPOSE: Evidence-based medicine frameworks in radiology emphasize rigorous study design and clinical applicability, yet the extent to which neuroradiology research aligns with these standards remains unclear. This study aimed to evaluate the methodological quality and clinical relevance of recent AJNR publications by assessing their evidence level (EL) and clinical efficacy (CE). MATERIALS AND METHODS: We systematically reviewed all original articles published in the AJNR in 2018-19 and 2021-22. Articles were classified by EL (scale 1-5) and by CE (scale 1-6). Study type (diagnostic, prognostic, therapeutic, economic), design (prospective vs. retrospective), cohort selection (consecutive vs. non-consecutive), and citation count were analyzed for associations with EL and CE and trends were assessed by comparing articles between 2018-19 and 2021-22. RESULTS: A total of 1085 articles (592 between 2018-19 and 493 between 2021-22) were included. The average EL was 2.67 (SD 0.85); over half were EL-3 (54.5%). Between 2018-19, majority of articles were Diagnostic (84%) and among them accuracy/monitoring studies had markedly stronger EL (2.10 ± 1.0) than clinical-utility studies (2.91 ± 0.7; P < 0.001). Stronger EL correlated with greater citation frequency (P < 0.001). Then in 2021-22, diagnostic monitoring/accuracy studies again had the strongest evidence (1.73 ± 0.8). In addition, AI- or software-based diagnostic studies demonstrated significantly stronger EL (2.02 ± 0.8) than those introducing new sequences or techniques (2.72 ± 0.9; P < 0.001) or refining current frameworks (2.52 ± 1.0; P = 0.002). Average EL improved from 2.75 ± 0.81 to 2.58 ± 0.87 (P < 0.001), driven by more diagnostic-accuracy and AI/software-based papers, categories linked to stronger evidence. According to CE, average score was 2.64 (SD: 1.17); 62% (670/1085) studies were CE-2, evaluating diagnostic accuracy. Few studies addressed patient outcomes (11.4%), or societal impact (<1%), and the proportion remained stable during the study period. CONCLUSIONS: Most recent AJNR publications demonstrate moderate evidence levels and are concentrated at lower clinical efficacy tiers, primarily focused on diagnostic accuracy. High-level study designs and research evaluating impact on management, outcomes, or cost-effectiveness remain limited. These findings underscore the need for methodologically rigorous and clinically impactful neuroradiology research that aligns more closely with evidence-based practice and effectiveness/value analysis.