Is a Systematic Review on Onodi Cell Prevalence on CT Publishable in a Q1 Journal?
A systematic review on Onodi cell prevalence detected on CT scans is a reasonable research idea but faces significant limitations for Q1 journal publication due to the narrow clinical scope, lack of direct impact on major patient outcomes (mortality/morbidity), and the existence of multiple prevalence studies that already demonstrate high detection rates.
Assessment of Publication Potential
Strengths Supporting Publication
Clinical relevance exists: Onodi cells create significant risk for optic nerve injury during endoscopic sinus surgery, and the American College of Radiology emphasizes that prevalence rates are substantially higher than historically reported with frequent underdetection on preoperative imaging 1.
Existing data shows variability: Published studies demonstrate wide prevalence ranges from 19.6% to 65.3%, suggesting potential value in synthesizing this heterogeneous data 2, 3, 4.
Methodological precedent: Recent systematic reviews in radiology focusing on imaging prevalence and anatomical variations have been published in high-impact journals when they address clinically significant questions 5.
Critical Limitations for Q1 Publication
Limited outcome impact: Unlike systematic reviews that directly address mortality, morbidity, or quality of life (such as lung cancer screening studies that demonstrate 20% relative risk reduction in mortality 5), Onodi cell prevalence is an anatomical finding rather than a therapeutic intervention or prognostic marker.
Narrow scope: The topic addresses a single anatomical variant in a specific surgical context, which may limit appeal to broader readership required by Q1 journals 5.
Descriptive rather than actionable: Prevalence data alone does not change clinical management algorithms unless linked to surgical complication rates, which would require a different study design 1.
Recommendations to Enhance Publishability
Expand the Research Question
Include clinical outcomes: Correlate Onodi cell presence with surgical complication rates (optic nerve injury, carotid artery injury) to demonstrate direct clinical impact 1.
Add diagnostic accuracy component: Evaluate CT detection sensitivity/specificity compared to intraoperative findings, as one study showed 8 out of 9 HRCT findings corresponded to intraoperative findings 6.
Incorporate imaging protocols: Analyze which CT protocols (axial, coronal, sagittal oblique views) optimize detection, as sagittal oblique views parallel to the optic canal detected Onodi cells in 49.5% of cases 7.
Methodological Rigor
Follow PRISMA guidelines: Ensure transparent reporting using the PRISMA 2020 checklist for systematic reviews, which is essential for high-quality publication 5.
Address quality assessment: Use appropriate risk of bias tools for prevalence studies, as demonstrated in recent systematic reviews where most studies showed moderate to high risk of bias 5.
Consider meta-analysis: Pool prevalence estimates with subgroup analyses by ethnicity (Asian 83.3%, White 73.1%, African American 57.0%, Hispanic 62.7%) and imaging modality 3.
Alternative Approaches for Higher Impact
Diagnostic test accuracy review: Focus on comparing different imaging modalities (conventional CT vs. cone-beam CT vs. MRI) for Onodi cell detection 2.
Clinical practice guideline synthesis: Develop evidence-based imaging recommendations for preoperative assessment before endoscopic sinus surgery, similar to lung cancer screening guidelines 5.
Prognostic systematic review: Link anatomical variations to surgical outcomes, which would align with higher-impact study designs 5.
Common Pitfalls to Avoid
Insufficient clinical context: Don't present prevalence data in isolation without discussing implications for surgical planning and complication prevention 1.
Heterogeneous definitions: Ensure consistent definition of Onodi cells across included studies (superior vs. superolateral vs. lateral patterns relative to sphenoid sinus) 2, 7.
Publication bias: Acknowledge that studies may preferentially report higher prevalence rates, and assess this systematically 5.
The project would be more suitable for specialty journals (otolaryngology, rhinology, or head and neck radiology) rather than top-tier Q1 general medical journals unless significantly expanded to include clinical outcomes and diagnostic accuracy components 5.