Michielsen 2017.

Study characteristics
Patient sampling	Aim of the study: to evaluate whole body DW‐MRI for diagnosis, staging, and operability assessment of patients suspected for ovarian cancer compared to abdominal CT Type of study: prospective study Enrolled/eligible: 167/94 Inclusion period: 2010 to 2013
Patient characteristics and setting	Inclusion criteria: ‐ suspicion of ovarian cancer by clinical assessment, serum CA‐125, carcinoembryonic antigen (CEA) and gynaecological ultrasound, and ‐ staging by abdominal CT Exclusion criteria: contraindication for MRI Median age (range): 61 years (14 to 88) Setting: Department of Obstetrics and Gynaecology, University Hospitals, Leuven, Belgium
Index tests	Whole body diffusion‐weighted MRI Criteria to consider primary debulking unfeasible: extra‐abdominal distant metastasis, hepatic metastases, tumour infiltration of duodenum, stomach, pancreas, large vessels of coeliac trunk, hepatoduodenal ligament, metastases behind the portal vein, bowel involvement necessitating multiple bowel resections, deep tumoural involvement of superior mesenteric artery and root, retroperitoneal lymph node metastases above level of renal veins
Target condition and reference standard(s)	Target condition: debulking with no macroscopically visible tumour remaining after surgery Reference standard: explorative laparotomy, diagnostic laparoscopy or image‐guided biopsy of surgical‐critical distant lesions
Flow and timing	No information was provided about the time period between the index test and reference standard. All patients received (primary or interval) debulking surgery except for 4 patients who were medically unfit to undergo surgery. In patients where surgery was considered unfeasible, diagnostic laparoscopy was used as a reference standard to confirm irresectability.
Comparative
Notes
Methodological quality
Item	Authors' judgement	Risk of bias	Applicability concerns
DOMAIN 1: Patient Selection
Was a consecutive or random sample of patients enrolled?	Yes
Did the study avoid inappropriate exclusions?	Yes
Were the patients diagnosed by conventional diagnostic work‐up for advanced stage cancer?	Yes
Were the patients planned for primary debulking surgery after conventional diagnostic work‐up?	Yes
		Low	Low
DOMAIN 2: Index Test MRI
Were the index test results interpreted without knowledge of the results of the reference standard?	Yes
If a threshold was used, was it pre‐specified?	Yes
Did the whole sample, or a random selection of the sample, receive verification using a reference standard of diagnosis?	Yes
Did patients receive the same reference standard regardless of the index test result?	No
Were the same clinical data available when test results were interpreted as would be available when the test is used in clinical practice?	Yes
Did the study provide a clear definition of what was considered to be a ’positive’ result for the index test?	Yes
		Low	Low
DOMAIN 3: Reference Standard
Is the reference standards likely to correctly classify the target condition?	Yes
Were the reference standard results interpreted without knowledge of the results of the index tests?	Yes
Is the surgeon's expertise adequate to perform the reference standard?	Yes
Did the study provide a clear definition of what was considered to be a ’positive’ result for the reference standard?	Yes
		Low	Low
DOMAIN 4: Flow and Timing
Was there an appropriate interval between index test and reference standard?	Unclear
Did all patients receive the same reference standard?	No
Were all patients included in the analysis?	Yes
Were withdrawals from the study reported?	Yes
		Unclear