Journal of the American College of Radiology最新文献

ACR Appropriateness Criteria® Imaging of Suspected Intracranial Hypotension ACR 适当性标准® 疑似颅内低血压的成像。

IF 4 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of the American College of Radiology

Pub Date : 2024-11-01 DOI: 10.1016/j.jacr.2024.08.020

The clinical syndrome of intracranial hypotension refers to the symptoms caused by cerebrospinal fluid hypovolemia and is primarily characterized by postural headaches, but can be associated with a multitude of other neurological symptoms. Imaging plays a critical role in helping to establish a diagnosis of intracranial hypotension, localize the source of cerebrospinal fluid leak, and assist in directing targeted treatments. Using the best available evidence, this document provides diagnostic imaging recommendations for the workup of intracranial hypotension across various clinical presentations.

The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

颅内低血压临床综合征是指脑脊液容量不足引起的症状，主要表现为姿势性头痛，但也可能伴有其他多种神经系统症状。影像学检查在帮助确定颅内低血压的诊断、定位脑脊液漏的来源以及协助指导针对性治疗方面起着至关重要的作用。本文件利用现有的最佳证据，为不同临床表现的颅内压低症提供了影像学诊断建议。美国放射学会适宜性标准是针对特定临床病症的循证指南，每年由一个多学科专家小组进行审查。指南的制定和修订过程支持对同行评审期刊上的医学文献进行系统分析。既定的方法原则，如 "建议评估、发展和评价分级"（GRADE），被用来评估证据。兰德/加州大学洛杉矶分校《适宜性方法用户手册》提供了确定特定临床情况下成像和治疗程序适宜性的方法。在缺乏同行评议文献或文献不明确的情况下，专家可能是制定建议的主要证据来源。

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引用次数: 0

ACR Appropriateness Criteria® Endometriosis ACR 适宜性标准® 子宫内膜异位症。

IF 4 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of the American College of Radiology

Pub Date : 2024-11-01 DOI: 10.1016/j.jacr.2024.08.017

Endometriosis is a common condition impacting individuals assigned female at birth. Though incompletely understood, the disorder is caused by endometrial-like tissue located outside of the endometrial cavity, associated with inflammation and fibrosis. Clinical presentation is variable, ranging from asymptomatic to severe pelvic pain and infertility. Treatment is determined by the patient’s individualized goals and can include medical therapies to temporize symptoms or definitive surgical excision. Imaging is used to help diagnose endometriosis and for treatment planning.

The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

子宫内膜异位症是一种常见疾病，影响着出生时就被指定为女性的人。尽管人们对这种疾病的认识尚不全面，但它是由位于子宫内膜腔外的子宫内膜样组织引起的，并伴有炎症和纤维化。临床表现多种多样，从无症状到严重盆腔疼痛和不孕不育不等。治疗方法根据患者的个体化目标而定，包括暂时缓解症状的药物疗法或明确的手术切除。影像学检查有助于诊断子宫内膜异位症和制定治疗计划。美国放射学会适当性标准是针对特定临床情况的循证指南，每年由一个多学科专家小组进行审查。指南的制定和修订过程支持对同行评审期刊上的医学文献进行系统分析。既定的方法原则，如 "建议评估、发展和评价分级"（GRADE），被用来评估证据。兰德/加州大学洛杉矶分校《适宜性方法用户手册》提供了确定特定临床情况下成像和治疗程序适宜性的方法。在缺乏同行评议文献或文献不明确的情况下，专家可能是制定建议的主要证据来源。

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引用次数: 0

ACR Appropriateness Criteria® Multiple Gestations: 2024 Update ACR 适当性标准® 多胎妊娠：2024 年更新版。

IF 4 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of the American College of Radiology

Pub Date : 2024-11-01 DOI: 10.1016/j.jacr.2024.08.013

The incidence of twin pregnancies has been rising, largely attributable to increasing use of artificial reproductive techniques. Ultrasound plays a critical role in establishing the chorionicity and amnionicity of multiple gestations, a key predictor of the expected risk and complications, along with guiding future clinical and imaging follow-up examinations and intervals. People carrying multiple gestations will typically undergo more ultrasound examinations (and occasionally fetal MRI) than those carrying singletons, at minimum including a first trimester dating scan, nuchal translucency scan at 11 to 14 weeks, an anatomy scan at 18 to 22 weeks, and other scans in the second and third trimesters for growth and surveillance. This document clarifies the most appropriate imaging guidelines for multiple gestations for seven clinical scenarios/variants, which range from initial imaging, follow-up imaging, growth and surveillance for uncomplicated multiple gestations, and those complicated by a known abnormality or discordance between fetuses.

The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

双胎妊娠的发生率一直在上升，这主要归因于人工生殖技术的使用越来越多。超声检查在确定多胎妊娠的绒毛膜性和羊膜性方面起着至关重要的作用，是预测预期风险和并发症的关键因素，同时还能指导未来的临床和影像学随访检查及间隔时间。与单胎妊娠相比，多胎妊娠患者通常需要接受更多的超声波检查（偶尔也会进行胎儿核磁共振成像），至少包括妊娠头三个月的日期扫描、11 至 14 周的颈部透明层扫描、18 至 22 周的解剖扫描，以及妊娠第二和第三季度的其他扫描，以了解胎儿的生长发育情况并进行监测。本文件阐明了七种临床情况/变异中最合适的多胎妊娠影像学指南，包括无并发症多胎妊娠的初始影像学检查、随访影像学检查、生长发育和监测，以及因已知异常或胎儿间不一致而复杂化的多胎妊娠影像学检查。美国放射学会适宜性标准是针对特定临床情况的循证指南，每年由一个多学科专家小组进行审查。指南的制定和修订过程支持对来自同行评审期刊的医学文献进行系统分析。已确立的方法原则，如 "建议评估、发展和评价分级"（GRADE），被用来评估证据。兰德/加州大学洛杉矶分校《适宜性方法用户手册》提供了确定特定临床情况下成像和治疗程序适宜性的方法。在缺乏同行评议文献或文献模棱两可的情况下，专家可能是制定建议的主要证据来源。

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引用次数: 0

ACR Appropriateness Criteria® Acute Elbow and Forearm Pain ACR Appropriateness Criteria® 急性肘部和前臂疼痛。

IF 4 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of the American College of Radiology

Pub Date : 2024-11-01 DOI: 10.1016/j.jacr.2024.08.012

Acute elbow pain can be the result of traumatic and atraumatic processes. Pathologic processes include osseous, ligamentous, and tendinous etiologies.

The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

急性肘部疼痛可由创伤和非创伤过程引起。病理过程包括骨性、韧带性和肌腱性病因。美国放射学会适宜性标准是针对特定临床情况的循证指南，每年由一个多学科专家小组进行审查。指南的制定和修订过程支持对同行评审期刊上的医学文献进行系统分析。既定的方法原则，如 "建议评估、发展和评价分级"（GRADE），被用来评估证据。兰德/加州大学洛杉矶分校《适宜性方法用户手册》提供了确定特定临床情况下成像和治疗程序适宜性的方法。在缺乏同行评议文献或文献模棱两可的情况下，专家可能是制定建议的主要证据来源。

引用次数: 0

ACR Appropriateness Criteria® Acute Onset of Scrotal Pain-Without Trauma, Without Antecedent Mass: 2024 Update ACR Appropriateness Criteria® 《急性发作性阴囊疼痛--无外伤、无前驱肿块：2024 年更新版》（ACR Appriateness Criteria® Acute Onset of Scrotal Pain-Without Trauma, Without Antecedent Mass: 2024 Update）。

IF 4 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of the American College of Radiology

Pub Date : 2024-11-01 DOI: 10.1016/j.jacr.2024.08.011

Acute scrotum is a medical emergency that requires prompt accurate diagnosis to appropriately triage potentially surgical conditions. Numerous differential diagnoses with overlapping clinical presentations make this a diagnostic challenge. Ultrasound is the established first-line imaging modality for acute scrotal disease and can be used to diagnose most scrotal disorders promptly and with high accuracy.

The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

急性阴囊炎是一种内科急症，需要及时做出准确诊断，以便对潜在的手术病症进行适当分流。众多的鉴别诊断和重叠的临床表现使诊断成为一项挑战。超声波是治疗急性阴囊疾病的公认一线成像方式，可用于及时、准确地诊断大多数阴囊疾病。美国放射学会适当性标准是针对特定临床病症的循证指南，每年由一个多学科专家小组进行审查。指南的制定和修订过程支持对同行评审期刊上的医学文献进行系统分析。既定的方法原则，如 "建议评估、发展和评价分级"（GRADE），被用来评估证据。兰德/加州大学洛杉矶分校《适宜性方法用户手册》提供了确定特定临床情况下成像和治疗程序适宜性的方法。在缺乏同行评议文献或文献模棱两可的情况下，专家可能是制定建议的主要证据来源。

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引用次数: 0

ACR Appropriateness Criteria® Tracheobronchial Disease ACR Appropriateness Criteria® 气管支气管疾病。

IF 4 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of the American College of Radiology

Pub Date : 2024-11-01 DOI: 10.1016/j.jacr.2024.08.015

A variety of thoracic imaging modalities and techniques have been used to evaluate diseases of the trachea and central bronchi. This document evaluates evidence for the use of thoracic imaging in the evaluation of tracheobronchial disease, including clinically suspected tracheal or bronchial stenosis, tracheomalacia or bronchomalacia, and bronchiectasis. Appropriateness guidelines for initial imaging evaluation of tracheobronchial disease and for pretreatment planning or posttreatment evaluation are included.

The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

各种胸部成像模式和技术已被用于评估气管和中央支气管疾病。本文件评估了使用胸部成像评估气管支气管疾病的证据，包括临床上怀疑的气管或支气管狭窄、气管畸形或支气管畸形以及支气管扩张。其中包括气管支气管疾病初始成像评估、预处理计划或治疗后评估的适当性指南。美国放射学会适宜性标准是针对特定临床病症的循证指南，每年由一个多学科专家小组进行审查。指南的制定和修订过程支持对同行评审期刊上的医学文献进行系统分析。已确立的方法原则，如 "建议评估、发展和评价分级"（GRADE），被用来评估证据。兰德/加州大学洛杉矶分校《适宜性方法用户手册》提供了确定特定临床情况下成像和治疗程序适宜性的方法。在缺乏同行评议文献或文献模棱两可的情况下，专家可能是制定建议的主要证据来源。

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引用次数: 0

ACR Appropriateness Criteria® Introduction to the JACR Appropriateness Criteria November 2024 Supplement ACR 适宜性标准® JACR 适宜性标准 2024 年 11 月增补版简介。

IF 4 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of the American College of Radiology

Pub Date : 2024-11-01 DOI: 10.1016/j.jacr.2024.08.023

引用次数: 0

ACR Appropriateness Criteria® Thoracic Back Pain ACR Appropriateness Criteria® 胸背部疼痛。

IF 4 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of the American College of Radiology

Pub Date : 2024-11-01 DOI: 10.1016/j.jacr.2024.08.016

Thoracic back pain is a common site for inflammatory, neoplastic, metabolic, infectious, and degenerative conditions, and may be associated with significant disability and morbidity. Uncomplicated acute thoracic back pain and/or radiculopathy does not typically warrant imaging. Imaging may be considered in those patients who have persistent pain despite 6 weeks of conservative treatment. Early imaging may also be warranted in patients presenting with “red flag” history or symptoms, including those with a known or suspected history of cancer, infection, immunosuppression, or trauma; in myelopathic patients; or in those with a history of prior thoracic spine fusion.

The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

胸背部疼痛是炎症、肿瘤、代谢、感染和退行性病变的常见部位，可能会导致严重的残疾和发病。无并发症的急性胸背部疼痛和/或根性病变通常不需要进行造影检查。在保守治疗 6 周后仍有持续疼痛的患者可考虑进行造影检查。对于有 "危险 "病史或症状的患者，包括已知或怀疑有癌症、感染、免疫抑制或外伤病史的患者；骨髓病患者；或既往有胸椎融合术病史的患者，也应及早进行造影检查。美国放射学会适当性标准是针对特定临床情况的循证指南，每年由一个多学科专家小组进行审查。指南的制定和修订过程支持对同行评审期刊上的医学文献进行系统分析。已确立的方法原则，如 "建议评估、发展和评价分级"（GRADE），被用来评估证据。兰德/加州大学洛杉矶分校《适宜性方法用户手册》提供了确定特定临床情况下成像和治疗程序适宜性的方法。在缺乏同行评议文献或文献模棱两可的情况下，专家可能是制定建议的主要证据来源。

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引用次数: 0

ACR Appropriateness Criteria® Nonvariceal Upper Gastrointestinal Bleeding: 2024 Update ACR 适宜性标准® 非静脉性上消化道出血：2024 年更新。

IF 4 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of the American College of Radiology

Pub Date : 2024-11-01 DOI: 10.1016/j.jacr.2024.08.021

This document summarizes the relevant literature for the selection of the initial imaging in five clinical scenarios in patients with suspected or known nonvariceal upper gastrointestinal bleeding (UGIB). These clinical scenarios include suspected nonvariceal UGIB without endoscopy performed; endoscopically confirmed nonvariceal UGIB with clear source but treatment not possible or continued bleeding after endoscopic treatment; endoscopically confirmed nonvariceal UGIB without a confirmed source; suspected nonvariceal UGIB with negative endoscopy; and postsurgical or post-traumatic nonvariceal UGIB when endoscopy is contraindicated. The appropriateness of imaging modalities as they apply to each clinical scenario is rated as usually appropriate, may be appropriate, and usually not appropriate to assist the selection of the most appropriate imaging modality in the corresponding clinical scenarios of nonvariceal UGIB.

The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

本文件总结了在疑似或已知非静脉性上消化道出血（UGIB）患者的五种临床情况下选择初始影像学检查的相关文献。这些临床情况包括：未进行内镜检查的疑似非静脉性上消化道出血；内镜确诊的非静脉性上消化道出血，出血源明确但无法治疗或内镜治疗后继续出血；内镜确诊的非静脉性上消化道出血，出血源不明确；内镜检查阴性的疑似非静脉性上消化道出血；以及内镜检查禁忌的手术后或创伤后非静脉性上消化道出血。成像方式在每种临床情况下的适宜性分为通常适宜、可能适宜和通常不适宜，以帮助在非静脉性 UGIB 的相应临床情况下选择最适宜的成像方式。美国放射学会适宜性标准是针对特定临床情况的循证指南，每年由一个多学科专家小组进行审查。指南的制定和修订过程支持对同行评审期刊上的医学文献进行系统分析。已确立的方法原则，如 "建议评估、发展和评价分级"（GRADE），被用来评估证据。兰德/加州大学洛杉矶分校《适宜性方法用户手册》提供了确定特定临床情况下成像和治疗程序适宜性的方法。在缺乏同行评议文献或文献模棱两可的情况下，专家可能是制定建议的主要证据来源。

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引用次数: 0

ACR Appropriateness Criteria® Stress (Fatigue-Insufficiency) Fracture Including Sacrum Excluding Other Vertebrae: 2024 Update ACR 适宜性标准®应力（疲劳-不全）骨折（包括骶骨，不包括其他椎骨）：2024 年更新。

IF 4 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of the American College of Radiology

Pub Date : 2024-11-01 DOI: 10.1016/j.jacr.2024.08.019

Stress fractures, including both fatigue and insufficiency types, are frequently encountered in clinical practice as a source of pain in a variety of patients (athletes, older patients, and patients with predisposing conditions). Radiography is the imaging modality of choice for baseline diagnosis. MRI has greatly improved our ability to diagnose radiographically occult stress fractures. Nuclear medicine scintigraphy and CT may also be useful as diagnostic tools. Although fatigue and insufficiency fractures can be self-limited and go on to healing even without diagnosis, there is usually value in initiating prompt therapeutic measures as incomplete stress fractures have the potential to progress to completion, necessitating surgery. This is particularly important in the setting of stress fractures of the femoral neck. Accuracy in the identification of these injuries is also relevant because the differential diagnosis includes entities that would otherwise be treated differently (ie, metastatic disease).

The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

应力性骨折（包括疲劳性和功能不全性骨折）在临床实践中经常出现，是各种患者（运动员、老年患者和有易发疾病的患者）的疼痛来源。放射摄影是基线诊断的首选成像方式。核磁共振成像大大提高了我们诊断影像学隐匿性应力性骨折的能力。核医学闪烁扫描和 CT 也可作为有用的诊断工具。虽然疲劳性骨折和功能不全性骨折可以是自限性的，即使没有确诊也可以继续愈合，但由于不完全应力性骨折有可能发展为完全性骨折，因此必须进行手术治疗，因此及时采取治疗措施通常是有价值的。这一点对于股骨颈应力性骨折尤为重要。准确鉴别这些损伤也很重要，因为鉴别诊断包括本来会以不同方式治疗的实体（即转移性疾病）。美国放射学会适当性标准是针对特定临床情况的循证指南，每年由一个多学科专家小组进行审查。指南的制定和修订过程支持对同行评审期刊上的医学文献进行系统分析。已确立的方法原则，如 "建议评估、发展和评价分级"（GRADE），被用来评估证据。兰德/加州大学洛杉矶分校《适宜性方法用户手册》提供了确定特定临床情况下成像和治疗程序适宜性的方法。在缺乏同行评议文献或文献模棱两可的情况下，专家可能是制定建议的主要证据来源。

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引用次数: 0