Methodological problems in clinical radiology research: pituitary microadenoma detection as a paradigm

Forty papers on the radiologic detection of pituitary microadenomas were reviewed and used as the basis for a discussion of the sometimes tentative nature of published results in clinical research. Early articles on the radiologic evaluation of pituitary microadenomas, reporting favorable results with special plain film and polytomographic techniques, altered traditional examination patterns and led to surgical exploration of some patients. Later radiographic and pathologic studies revealed flaws in the specificity of the original proposed criteria, resulting in a decline in the use of the new routines. The authors warn that the methodologic pitfalls that accompanied the rise and subsequent fall in popularity of plain radiography techniques could be repeated when computed tomography comes into more widespread use in the diagnosis of this entity.