Systematic reviews of diagnostic test accuracy (DTA) studies are fundamental to the decision-making process in evidence-based medicine. Although such studies are regarded as high-level evidence, these reviews are not always reported completely and transparently. Sub-optimal reporting of DTA systematic reviews compromises their validity and generalizability, and subsequently their value to key stakeholders. PRISMA-DTA, an extension of the PRISMA statement, was recently developed to improve the quality of reporting of DTA systematic reviews. The PRISMA-DTA statement consists of 27 items, of which 8 are unmodified from the original PRISMA statement. This document provides an explanation for the 19 new and modified items, along with their meaning and rationale. Examples of complete reporting are used for each item to illustrate best practices. The PRISMA-DTA statement, this explanation and elaboration document, and the associated web site (http://www.prisma-statement.org/Extensions/DTA) provide resources to support the complete and transparent reporting of DTA systematic reviews.