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acrac_70546_0 | Acute Trauma to the Foot | Introduction/Background Acute injuries to the foot are frequently encountered in the setting of the emergency room and in general practice. The clinical indications for imaging (known as the Ottawa rules) have been developed to minimize unnecessary radiographs, and their utility is well documented by multiple studies.... | Acute Trauma to the Foot. Introduction/Background Acute injuries to the foot are frequently encountered in the setting of the emergency room and in general practice. The clinical indications for imaging (known as the Ottawa rules) have been developed to minimize unnecessary radiographs, and their utility is well docum... | 70546 |
acrac_70546_1 | Acute Trauma to the Foot | Other clinical scenarios of foot trauma not directly addressed by the Ottawa rules include trauma to the metatarsal heads and toes and penetrating trauma with concern for a foreign body in the soft tissues. Also, there is little in the literature on medical decision making of when to order a radiographic study of the t... | Acute Trauma to the Foot. Other clinical scenarios of foot trauma not directly addressed by the Ottawa rules include trauma to the metatarsal heads and toes and penetrating trauma with concern for a foreign body in the soft tissues. Also, there is little in the literature on medical decision making of when to order a r... | 70546 |
acrac_70546_2 | Acute Trauma to the Foot | The more serious potential problems in determining the need for imaging occurs in the patient who does not meet the inclusion criteria for imaging by the Ottawa rules of the foot. These inclusionary criteria are stated in the Introduction/Background section [5,6]; added criterion of swelling increases sensitivity and s... | Acute Trauma to the Foot. The more serious potential problems in determining the need for imaging occurs in the patient who does not meet the inclusion criteria for imaging by the Ottawa rules of the foot. These inclusionary criteria are stated in the Introduction/Background section [5,6]; added criterion of swelling i... | 70546 |
acrac_70546_3 | Acute Trauma to the Foot | Additional views, such as axial calcaneal view, can be useful in patients with suspected calcaneal fracture [15] because addition of this view increases specificity in diagnosing calcaneal fractures and sensitivity in distinguishing intra-articular calcaneal fractures. Radiography Foot with Weightbearing If there are c... | Acute Trauma to the Foot. Additional views, such as axial calcaneal view, can be useful in patients with suspected calcaneal fracture [15] because addition of this view increases specificity in diagnosing calcaneal fractures and sensitivity in distinguishing intra-articular calcaneal fractures. Radiography Foot with We... | 70546 |
acrac_70546_4 | Acute Trauma to the Foot | Initial imaging. Multiple conditions or scenarios preclude the use of the Ottawa rules for determining if imaging is necessary [5,6]. It has been reported that the Ottawa rules for the foot should not be used or should be used with great caution in the following clinical situations: penetrating trauma, pregnancy, any s... | Acute Trauma to the Foot. Initial imaging. Multiple conditions or scenarios preclude the use of the Ottawa rules for determining if imaging is necessary [5,6]. It has been reported that the Ottawa rules for the foot should not be used or should be used with great caution in the following clinical situations: penetratin... | 70546 |
acrac_70546_5 | Acute Trauma to the Foot | Therefore, CT is essential for appropriate treatment planning and determining the true extent of osseous injuries in the polytrauma patient and can be used as primary imaging technique in high-energy polytrauma patients. Initial clinical experience suggests that cone-beam CT of the foot or ankle of pediatric patients i... | Acute Trauma to the Foot. Therefore, CT is essential for appropriate treatment planning and determining the true extent of osseous injuries in the polytrauma patient and can be used as primary imaging technique in high-energy polytrauma patients. Initial clinical experience suggests that cone-beam CT of the foot or ank... | 70546 |
acrac_70546_6 | Acute Trauma to the Foot | Acute Trauma to the Foot Radiography Foot Metatarsal-Phalangeal Joint Injury The best initial imaging study for evaluating hallux plantar plate disruption after metatarsal-phalangeal (MTP) joint injury is weightbearing AP, lateral, and sesamoid axial views, with addition of comparison radiographs of the contralateral f... | Acute Trauma to the Foot. Acute Trauma to the Foot Radiography Foot Metatarsal-Phalangeal Joint Injury The best initial imaging study for evaluating hallux plantar plate disruption after metatarsal-phalangeal (MTP) joint injury is weightbearing AP, lateral, and sesamoid axial views, with addition of comparison radiogra... | 70546 |
acrac_70546_7 | Acute Trauma to the Foot | Fluoroscopy Foot In addition to routine radiographs, fluoroscopy has been suggested in assessment of a hallux MTP joint injury with direct fluoroscopic evaluation of sesamoid tracking distally with great toe extension at the MTP joint on forced dorsiflexion lateral view or fluoroscopy [29]. Variant 5: Adult or child ol... | Acute Trauma to the Foot. Fluoroscopy Foot In addition to routine radiographs, fluoroscopy has been suggested in assessment of a hallux MTP joint injury with direct fluoroscopic evaluation of sesamoid tracking distally with great toe extension at the MTP joint on forced dorsiflexion lateral view or fluoroscopy [29]. Va... | 70546 |
acrac_70546_8 | Acute Trauma to the Foot | Lisfranc Injury MRI has been advocated as a sensitive diagnostic test in evaluation of Lisfranc ligamentous complex (especially if the patient is not able to bear weight), and 3-D volumetric acquisitions have proven superiority over orthogonal proton density fat-suppressed imaging [33,38,41-45]. There is a high correla... | Acute Trauma to the Foot. Lisfranc Injury MRI has been advocated as a sensitive diagnostic test in evaluation of Lisfranc ligamentous complex (especially if the patient is not able to bear weight), and 3-D volumetric acquisitions have proven superiority over orthogonal proton density fat-suppressed imaging [33,38,41-45... | 70546 |
acrac_70546_9 | Acute Trauma to the Foot | Turf Toe and Plantar Plate Injuries US in the sagittal plane best visualizes the plantar plate between the flexor tendon and hyaline cartilage of the metatarsal head [63]. US has shown a 96% sensitivity compared with 87% sensitivity for MRI for the detection of lesser toe plantar plate tears; however, both modalities h... | Acute Trauma to the Foot. Turf Toe and Plantar Plate Injuries US in the sagittal plane best visualizes the plantar plate between the flexor tendon and hyaline cartilage of the metatarsal head [63]. US has shown a 96% sensitivity compared with 87% sensitivity for MRI for the detection of lesser toe plantar plate tears; ... | 70546 |
acrac_3158175_0 | Osteomyelitis or Septic Arthritis Child Excluding Axial Skeleton PCAs | Introduction/Background Pediatric musculoskeletal infections can result in significant morbidity, particularly given ongoing skeletal maturation, and delayed diagnosis may result in premature physeal arrest or joint damage. Among osteoarticular infections, osteomyelitis occurs twice as frequently as septic arthritis [... | Osteomyelitis or Septic Arthritis Child Excluding Axial Skeleton PCAs. Introduction/Background Pediatric musculoskeletal infections can result in significant morbidity, particularly given ongoing skeletal maturation, and delayed diagnosis may result in premature physeal arrest or joint damage. Among osteoarticular inf... | 3158175 |
acrac_3158175_1 | Osteomyelitis or Septic Arthritis Child Excluding Axial Skeleton PCAs | The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual... | Osteomyelitis or Septic Arthritis Child Excluding Axial Skeleton PCAs. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel doe... | 3158175 |
acrac_3158175_2 | Osteomyelitis or Septic Arthritis Child Excluding Axial Skeleton PCAs | On MRI, susceptibility artifact limits regional visualization and directly correlates with magnetic field strength. Basic metal artifact reduction can be performed by increasing bandwidth, decreasing slice thickness, increasing echo train length, and increasing matrix size [20]. Advanced MR software packages and sequen... | Osteomyelitis or Septic Arthritis Child Excluding Axial Skeleton PCAs. On MRI, susceptibility artifact limits regional visualization and directly correlates with magnetic field strength. Basic metal artifact reduction can be performed by increasing bandwidth, decreasing slice thickness, increasing echo train length, an... | 3158175 |
acrac_3158175_3 | Osteomyelitis or Septic Arthritis Child Excluding Axial Skeleton PCAs | Although some studies have shown no significant difference in sensitivity and specificity in diagnosis of osteomyelitis or septic arthritis with or without the use of gadolinium-based contrast agents, IV contrast has been shown to improve detection of abscesses [32,33]. Decreased femoral head enhancement on early postc... | Osteomyelitis or Septic Arthritis Child Excluding Axial Skeleton PCAs. Although some studies have shown no significant difference in sensitivity and specificity in diagnosis of osteomyelitis or septic arthritis with or without the use of gadolinium-based contrast agents, IV contrast has been shown to improve detection ... | 3158175 |
acrac_3158175_4 | Osteomyelitis or Septic Arthritis Child Excluding Axial Skeleton PCAs | Among patients who did not have osteomyelitis, 20% had contralateral abnormalities; most common diagnoses included stress reaction, soft-tissue edema, myositis, sterile joint effusion, and leukemia. Radiography Area of Interest Features of acute osteomyelitis on radiographs include periosteal reaction, a well-circumscr... | Osteomyelitis or Septic Arthritis Child Excluding Axial Skeleton PCAs. Among patients who did not have osteomyelitis, 20% had contralateral abnormalities; most common diagnoses included stress reaction, soft-tissue edema, myositis, sterile joint effusion, and leukemia. Radiography Area of Interest Features of acute ost... | 3158175 |
acrac_3158175_5 | Osteomyelitis or Septic Arthritis Child Excluding Axial Skeleton PCAs | The absence of hip joint effusion virtually excludes septic arthritis; a false negative rate of 5% has been described, noted in patients with a shorter duration of symptoms (<1 day) [40,43,45-47]. Hip US for the purpose of identifying joint effusion can be performed with high sensitivity and specificity [48]. In one st... | Osteomyelitis or Septic Arthritis Child Excluding Axial Skeleton PCAs. The absence of hip joint effusion virtually excludes septic arthritis; a false negative rate of 5% has been described, noted in patients with a shorter duration of symptoms (<1 day) [40,43,45-47]. Hip US for the purpose of identifying joint effusion... | 3158175 |
acrac_3158175_6 | Osteomyelitis or Septic Arthritis Child Excluding Axial Skeleton PCAs | Single-photon emission computed tomography (SPECT)/CT offers improved characterization of osseous pathology compared to planar imaging [53]. MRI is generally considered preferable in detection of early manifestations of osteomyelitis, as well as infection of the surrounding soft tissues, because of the rapid progressio... | Osteomyelitis or Septic Arthritis Child Excluding Axial Skeleton PCAs. Single-photon emission computed tomography (SPECT)/CT offers improved characterization of osseous pathology compared to planar imaging [53]. MRI is generally considered preferable in detection of early manifestations of osteomyelitis, as well as inf... | 3158175 |
acrac_3158175_7 | Osteomyelitis or Septic Arthritis Child Excluding Axial Skeleton PCAs | SPECT/CT offers improved characterization of osseous pathology compared with planar imaging [59]. MRI is generally considered preferable in detection of early manifestations of osteomyelitis, as well as infection of the surrounding soft tissues, because of the rapid progression of the disease [53]. Osteomyelitis or Sep... | Osteomyelitis or Septic Arthritis Child Excluding Axial Skeleton PCAs. SPECT/CT offers improved characterization of osseous pathology compared with planar imaging [59]. MRI is generally considered preferable in detection of early manifestations of osteomyelitis, as well as infection of the surrounding soft tissues, bec... | 3158175 |
acrac_3158175_8 | Osteomyelitis or Septic Arthritis Child Excluding Axial Skeleton PCAs | Although some studies have shown no significant difference in sensitivity and specificity in the diagnosis of osteomyelitis or septic arthritis with or without the use of gadolinium-based contrast agents, IV contrast has been shown to improve detection of abscesses [32,33]. Decreased femoral head enhancement on early p... | Osteomyelitis or Septic Arthritis Child Excluding Axial Skeleton PCAs. Although some studies have shown no significant difference in sensitivity and specificity in the diagnosis of osteomyelitis or septic arthritis with or without the use of gadolinium-based contrast agents, IV contrast has been shown to improve detect... | 3158175 |
acrac_3158175_9 | Osteomyelitis or Septic Arthritis Child Excluding Axial Skeleton PCAs | MRI Extremity Area of Interest In one study, a large field-of-view MRI was performed to encompass both lower extremities rather than the area of concern [38]. In patients who were later found to have osteomyelitis, 11% had contralateral extremity findings, including contralateral osteomyelitis, and 20% had ipsilateral ... | Osteomyelitis or Septic Arthritis Child Excluding Axial Skeleton PCAs. MRI Extremity Area of Interest In one study, a large field-of-view MRI was performed to encompass both lower extremities rather than the area of concern [38]. In patients who were later found to have osteomyelitis, 11% had contralateral extremity fi... | 3158175 |
acrac_3158175_10 | Osteomyelitis or Septic Arthritis Child Excluding Axial Skeleton PCAs | In assessment of septic arthritis, the majority of pediatric patients with septic arthritis were noted on MRI to have infection beyond the joint space, though this may vary based on population factors such as geography [7,46,60,65,66]. Conversely, in metaphyseal osteomyelitis, >50% in one study were noted on MRI to hav... | Osteomyelitis or Septic Arthritis Child Excluding Axial Skeleton PCAs. In assessment of septic arthritis, the majority of pediatric patients with septic arthritis were noted on MRI to have infection beyond the joint space, though this may vary based on population factors such as geography [7,46,60,65,66]. Conversely, i... | 3158175 |
acrac_3158175_11 | Osteomyelitis or Septic Arthritis Child Excluding Axial Skeleton PCAs | Hip US for the purpose of identifying joint effusion can be performed with high sensitivity and specificity [48]. In one study, nearly 80% of pediatric patients with hip septic arthritis required US imaging alone to guide their management [45]. US in evaluation of osteomyelitis is limited in its ability to assess the o... | Osteomyelitis or Septic Arthritis Child Excluding Axial Skeleton PCAs. Hip US for the purpose of identifying joint effusion can be performed with high sensitivity and specificity [48]. In one study, nearly 80% of pediatric patients with hip septic arthritis required US imaging alone to guide their management [45]. US i... | 3158175 |
acrac_3158175_12 | Osteomyelitis or Septic Arthritis Child Excluding Axial Skeleton PCAs | In one study of 213 children referred for skeletal scintigraphy because of a suspicion for acute hematogenous osteomyelitis who underwent a 3-phase bone scan of the area of interest along with whole-body delayed images, accurate diagnosis was made in 84% of cases without the need for MRI, including 92% of those diagnos... | Osteomyelitis or Septic Arthritis Child Excluding Axial Skeleton PCAs. In one study of 213 children referred for skeletal scintigraphy because of a suspicion for acute hematogenous osteomyelitis who underwent a 3-phase bone scan of the area of interest along with whole-body delayed images, accurate diagnosis was made i... | 3158175 |
acrac_3158175_13 | Osteomyelitis or Septic Arthritis Child Excluding Axial Skeleton PCAs | In patients with suspected or confirmed septic arthritis, femoral neck aspiration performed at the time of incision and drainage was noted to improve diagnosis of concurrent osteomyelitis compared with preoperative MRI alone [63]. Although the bulk of literature on image-guided joint aspiration in the pediatric populat... | Osteomyelitis or Septic Arthritis Child Excluding Axial Skeleton PCAs. In patients with suspected or confirmed septic arthritis, femoral neck aspiration performed at the time of incision and drainage was noted to improve diagnosis of concurrent osteomyelitis compared with preoperative MRI alone [63]. Although the bulk ... | 3158175 |
acrac_3158175_14 | Osteomyelitis or Septic Arthritis Child Excluding Axial Skeleton PCAs | In patients who were later found to have osteomyelitis, 11% had contralateral extremity findings, including contralateral osteomyelitis, and 20% had ipsilateral septic arthritis. Among patients who did not have osteomyelitis, 20% had contralateral abnormalities, most commonly stress reaction, soft-tissue edema, myositi... | Osteomyelitis or Septic Arthritis Child Excluding Axial Skeleton PCAs. In patients who were later found to have osteomyelitis, 11% had contralateral extremity findings, including contralateral osteomyelitis, and 20% had ipsilateral septic arthritis. Among patients who did not have osteomyelitis, 20% had contralateral a... | 3158175 |
acrac_3158175_15 | Osteomyelitis or Septic Arthritis Child Excluding Axial Skeleton PCAs | Bone scan findings were correlated with the final diagnosis in 34 sites of septic arthritis and in 62 sites of osteomyelitis. Bone scan accuracy was 81%. Positive predictive value was 82% for those sites with increased activity and 100% for those sites with decreased activity. Negative predictive value was 63%. Bone Sc... | Osteomyelitis or Septic Arthritis Child Excluding Axial Skeleton PCAs. Bone scan findings were correlated with the final diagnosis in 34 sites of septic arthritis and in 62 sites of osteomyelitis. Bone scan accuracy was 81%. Positive predictive value was 82% for those sites with increased activity and 100% for those si... | 3158175 |
acrac_69482_0 | Headache PCAs | Initial Imaging Definition Initial imaging is defined as imaging at the beginning of the care episode for the medical condition defined by the variant. More than one procedure can be considered usually appropriate in the initial imaging evaluation when: aColumbia University Medical Center, New York, New York. bPanel C... | Headache PCAs. Initial Imaging Definition Initial imaging is defined as imaging at the beginning of the care episode for the medical condition defined by the variant. More than one procedure can be considered usually appropriate in the initial imaging evaluation when: aColumbia University Medical Center, New York, New... | 69482 |
acrac_69482_1 | Headache PCAs | The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual... | Headache PCAs. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final documen... | 69482 |
acrac_69482_2 | Headache PCAs | Less common causes of TCH include cerebral venous thrombosis (CVT), cervical arterial dissection, posterior reversible encephalopathy syndrome (PRES), spontaneous intracranial hypotension (SIH), pituitary apoplexy, perimesencephalic hemorrhage, arteriovenous malformations (AVM), dural arteriovenous fistulas, and intrav... | Headache PCAs. Less common causes of TCH include cerebral venous thrombosis (CVT), cervical arterial dissection, posterior reversible encephalopathy syndrome (PRES), spontaneous intracranial hypotension (SIH), pituitary apoplexy, perimesencephalic hemorrhage, arteriovenous malformations (AVM), dural arteriovenous fistu... | 69482 |
acrac_69482_3 | Headache PCAs | CT Head Without IV Contrast CT head without IV contrast is useful in the setting of TCH because of its high sensitivity for detecting intracranial hemorrhage. Several studies have demonstrated a high negative predictive value of a noncontrast head CT performed within 6 hours of headache onset in detecting aneurysmal SA... | Headache PCAs. CT Head Without IV Contrast CT head without IV contrast is useful in the setting of TCH because of its high sensitivity for detecting intracranial hemorrhage. Several studies have demonstrated a high negative predictive value of a noncontrast head CT performed within 6 hours of headache onset in detectin... | 69482 |
acrac_69482_4 | Headache PCAs | For example, a concurrent or follow-up CTA is useful in suspected cases of intracranial aneurysm (ruptured or unruptured), arterial dissection, and RCVS [10-12,18]. CTV Head With IV Contrast There is no relevant literature to support the use of CT venography (CTV) head with IV contrast in the initial imaging evaluation... | Headache PCAs. For example, a concurrent or follow-up CTA is useful in suspected cases of intracranial aneurysm (ruptured or unruptured), arterial dissection, and RCVS [10-12,18]. CTV Head With IV Contrast There is no relevant literature to support the use of CT venography (CTV) head with IV contrast in the initial ima... | 69482 |
acrac_69482_5 | Headache PCAs | For example, recent studies have demonstrated concentric thickening of the vessel wall with minimal or no enhancement in RCVS, compared with more eccentric wall thickening and significant wall enhancement in cases of vasculitis [12]. In addition, vessel wall imaging can be used to help identify the ruptured lesion when... | Headache PCAs. For example, recent studies have demonstrated concentric thickening of the vessel wall with minimal or no enhancement in RCVS, compared with more eccentric wall thickening and significant wall enhancement in cases of vasculitis [12]. In addition, vessel wall imaging can be used to help identify the ruptu... | 69482 |
acrac_69482_6 | Headache PCAs | Brain MRV can be used as a follow-up imaging study in cases of suspected CVT [11]. Variant 2: Primary migraine or tension-type headache. Normal neurologic examination. Initial imaging. In a single year, more than half of the adult population suffers from a headache, most often a primary headache such as TTH and migrain... | Headache PCAs. Brain MRV can be used as a follow-up imaging study in cases of suspected CVT [11]. Variant 2: Primary migraine or tension-type headache. Normal neurologic examination. Initial imaging. In a single year, more than half of the adult population suffers from a headache, most often a primary headache such as ... | 69482 |
acrac_69482_7 | Headache PCAs | It was found that patients with migraine with aura were imaged more frequently and demonstrated an increased incidence of minor intracranial abnormalities such as lacunar infarcts and microvascular ischemic changes. No abnormalities were detected that were of major clinical significance [24]. A study performed in China... | Headache PCAs. It was found that patients with migraine with aura were imaged more frequently and demonstrated an increased incidence of minor intracranial abnormalities such as lacunar infarcts and microvascular ischemic changes. No abnormalities were detected that were of major clinical significance [24]. A study per... | 69482 |
acrac_69482_8 | Headache PCAs | CTV Head With IV Contrast There is no relevant literature to support the use of CTV head with IV contrast in the initial imaging evaluation of primary migraine or TTH with a normal neurologic examination. MRA Head With IV Contrast There is no relevant literature to support the use of MRA head with IV contrast in the in... | Headache PCAs. CTV Head With IV Contrast There is no relevant literature to support the use of CTV head with IV contrast in the initial imaging evaluation of primary migraine or TTH with a normal neurologic examination. MRA Head With IV Contrast There is no relevant literature to support the use of MRA head with IV con... | 69482 |
acrac_69482_9 | Headache PCAs | Imaging techniques continue to evolve and improve, and recent developments in advanced MRI techniques are allowing the clinical community to better understand the underlying pathophysiology of migraines, which remains less well characterized than the clinical phenotype. Early research with novel structural imaging tech... | Headache PCAs. Imaging techniques continue to evolve and improve, and recent developments in advanced MRI techniques are allowing the clinical community to better understand the underlying pathophysiology of migraines, which remains less well characterized than the clinical phenotype. Early research with novel structur... | 69482 |
acrac_69482_10 | Headache PCAs | MRV Head Without and With IV Contrast There is no relevant literature to support the use of MRV head without and with IV contrast in the initial imaging evaluation of primary migraine or TTH with a normal neurologic examination. MRV Head Without IV Contrast There is no relevant literature to support the use of MRV head... | Headache PCAs. MRV Head Without and With IV Contrast There is no relevant literature to support the use of MRV head without and with IV contrast in the initial imaging evaluation of primary migraine or TTH with a normal neurologic examination. MRV Head Without IV Contrast There is no relevant literature to support the ... | 69482 |
acrac_69482_11 | Headache PCAs | The exact pathophysiology of TACs is not well understood; current investigations suggest the involvement of the trigeminovascular system, the autonomic nervous system, and the hypothalamus. Recent functional and anatomic neuroimaging studies have demonstrated changes in the pain neuromatrix including the trigeminal ner... | Headache PCAs. The exact pathophysiology of TACs is not well understood; current investigations suggest the involvement of the trigeminovascular system, the autonomic nervous system, and the hypothalamus. Recent functional and anatomic neuroimaging studies have demonstrated changes in the pain neuromatrix including the... | 69482 |
acrac_69482_12 | Headache PCAs | The European Headache Federation recommends vascular imaging especially when 3 consecutive preventative treatments fail [34]. CTV Head With IV Contrast There is no relevant literature to support the use of CTV head with IV contrast in the initial imaging evaluation of TACs. Brain CTV can be used as a follow-up imaging ... | Headache PCAs. The European Headache Federation recommends vascular imaging especially when 3 consecutive preventative treatments fail [34]. CTV Head With IV Contrast There is no relevant literature to support the use of CTV head with IV contrast in the initial imaging evaluation of TACs. Brain CTV can be used as a fol... | 69482 |
acrac_69482_13 | Headache PCAs | Headache MRV Head With IV Contrast There is no relevant literature to support the use of MRV head with IV contrast in the initial imaging evaluation of TACs. Brain MRV can be used as a follow-up imaging study in cases of suspected CVT, which is in the differential diagnosis for TACs, especially hemicrania continua [30,... | Headache PCAs. Headache MRV Head With IV Contrast There is no relevant literature to support the use of MRV head with IV contrast in the initial imaging evaluation of TACs. Brain MRV can be used as a follow-up imaging study in cases of suspected CVT, which is in the differential diagnosis for TACs, especially hemicrani... | 69482 |
acrac_69482_14 | Headache PCAs | Headache is present in 90% of patients with IIH and is commonly the presenting symptom. The diagnostic criteria as per the ICHD-3 includes a documentation of intracranial pressure exceeding 250 mm H2O (or 280 mm H2O in obese children). A lumbar puncture to document opening pressure remains a required diagnostic tool fo... | Headache PCAs. Headache is present in 90% of patients with IIH and is commonly the presenting symptom. The diagnostic criteria as per the ICHD-3 includes a documentation of intracranial pressure exceeding 250 mm H2O (or 280 mm H2O in obese children). A lumbar puncture to document opening pressure remains a required dia... | 69482 |
acrac_69482_15 | Headache PCAs | Headache of venous sinus stenosis or thrombosis in patients with suspected IIH and patients with chronic headaches, which reinforces the value of venous imaging for unexplained headaches, especially when there are features of intracranial hypertension [38-40]. Several studies have also demonstrated the increased utilit... | Headache PCAs. Headache of venous sinus stenosis or thrombosis in patients with suspected IIH and patients with chronic headaches, which reinforces the value of venous imaging for unexplained headaches, especially when there are features of intracranial hypertension [38-40]. Several studies have also demonstrated the i... | 69482 |
acrac_69482_16 | Headache PCAs | Based on a 2011 study including patients with elevated intracranial pressure, 6 signs were more prevalent in patients with IIH: partially empty sella, posterior displacement of the pituitary stalk, flattening of the posterior globe, optic nerve head protrusion, optic nerve sheath distension, and optic nerve sheath tort... | Headache PCAs. Based on a 2011 study including patients with elevated intracranial pressure, 6 signs were more prevalent in patients with IIH: partially empty sella, posterior displacement of the pituitary stalk, flattening of the posterior globe, optic nerve head protrusion, optic nerve sheath distension, and optic ne... | 69482 |
acrac_69482_17 | Headache PCAs | The decision to use noncontrast (eg, time-of-flight or phase-contrast) versus contrast techniques may depend on the preferences of different institutions. The use of IV contrast helps clearly delineate the venous sinus lumen and avoids some of the flow- related artifacts encountered in noncontrast MRV techniques, which... | Headache PCAs. The decision to use noncontrast (eg, time-of-flight or phase-contrast) versus contrast techniques may depend on the preferences of different institutions. The use of IV contrast helps clearly delineate the venous sinus lumen and avoids some of the flow- related artifacts encountered in noncontrast MRV te... | 69482 |
acrac_69482_18 | Headache PCAs | CT Head Without and With IV Contrast There is no relevant literature to support the use of CT head without and with IV contrast in the initial imaging evaluation of headache with features of intracranial hypotension. CT Head Without IV Contrast There is no relevant literature to support the use of CT head without IV co... | Headache PCAs. CT Head Without and With IV Contrast There is no relevant literature to support the use of CT head without and with IV contrast in the initial imaging evaluation of headache with features of intracranial hypotension. CT Head Without IV Contrast There is no relevant literature to support the use of CT hea... | 69482 |
acrac_69482_19 | Headache PCAs | It should be noted that the venous sinus, pituitary gland, and optic nerve sheath findings are opposite of what is seen in IIH or intracranial hypertension, as expected. It should also be noted that these need to be interpreted in the appropriate clinical context of orthostatic headaches, because there are other diseas... | Headache PCAs. It should be noted that the venous sinus, pituitary gland, and optic nerve sheath findings are opposite of what is seen in IIH or intracranial hypertension, as expected. It should also be noted that these need to be interpreted in the appropriate clinical context of orthostatic headaches, because there a... | 69482 |
acrac_69482_20 | Headache PCAs | MRI Thoracic Spine Without IV Contrast MRI spine without IV contrast is useful in the initial imaging evaluation of headache with features of intracranial hypotension. The primary purpose is to look for an extradural fluid collection in the spinal canal, usually at the level of the thoracic spine, that would be consist... | Headache PCAs. MRI Thoracic Spine Without IV Contrast MRI spine without IV contrast is useful in the initial imaging evaluation of headache with features of intracranial hypotension. The primary purpose is to look for an extradural fluid collection in the spinal canal, usually at the level of the thoracic spine, that w... | 69482 |
acrac_69482_21 | Headache PCAs | These techniques are, therefore, useful in the follow-up imaging evaluation of headache with features of intracranial hypotension, when refractory to nontargeted therapy. The choice between spinal CSF leak localization techniques may depend on the suspected CSF leak type (dural tear versus distal nerve root sleeve) and... | Headache PCAs. These techniques are, therefore, useful in the follow-up imaging evaluation of headache with features of intracranial hypotension, when refractory to nontargeted therapy. The choice between spinal CSF leak localization techniques may depend on the suspected CSF leak type (dural tear versus distal nerve r... | 69482 |
acrac_69482_22 | Headache PCAs | Within this group, hypertensive disorder of pregnancy was most common, predominated by preeclampsia [47]. Various secondary headaches are more likely to occur during pregnancy, which may be related to hypercoagulability, hormonal factors, and anesthesia for labor. Pregnancy-induced hypercoagulability is an adaptive phy... | Headache PCAs. Within this group, hypertensive disorder of pregnancy was most common, predominated by preeclampsia [47]. Various secondary headaches are more likely to occur during pregnancy, which may be related to hypercoagulability, hormonal factors, and anesthesia for labor. Pregnancy-induced hypercoagulability is ... | 69482 |
acrac_69482_23 | Headache PCAs | Lymphocytic hypophysitis is a rare inflammatory autoimmune disorder of the pituitary gland/stalk that can occur in the postpartum period or in the third trimester. Typically, these lesions can present with visual symptoms due to impingement of the optic chiasm in addition to symptoms of headache and hypopituitarism. Pi... | Headache PCAs. Lymphocytic hypophysitis is a rare inflammatory autoimmune disorder of the pituitary gland/stalk that can occur in the postpartum period or in the third trimester. Typically, these lesions can present with visual symptoms due to impingement of the optic chiasm in addition to symptoms of headache and hypo... | 69482 |
acrac_69482_24 | Headache PCAs | CTV Head With IV Contrast CTV head with IV contrast can be useful in the initial imaging evaluation of new headache during pregnancy or peripartum period, as this patient demographic is at a higher risk for thromboembolic complications such as CVT, especially in the postpartum period [12,49]. In pregnant patients requi... | Headache PCAs. CTV Head With IV Contrast CTV head with IV contrast can be useful in the initial imaging evaluation of new headache during pregnancy or peripartum period, as this patient demographic is at a higher risk for thromboembolic complications such as CVT, especially in the postpartum period [12,49]. In pregnant... | 69482 |
acrac_69482_25 | Headache PCAs | MRI Head Without and With IV Contrast There is no relevant literature to support the use of MRI head without and with IV contrast in the initial imaging evaluation of new headache during pregnancy or peripartum period; the recommendation is to avoid administering IV GBCA during pregnancy. MRI Head Without IV Contrast M... | Headache PCAs. MRI Head Without and With IV Contrast There is no relevant literature to support the use of MRI head without and with IV contrast in the initial imaging evaluation of new headache during pregnancy or peripartum period; the recommendation is to avoid administering IV GBCA during pregnancy. MRI Head Withou... | 69482 |
acrac_69482_26 | Headache PCAs | MRV Head Without and With IV Contrast There is no relevant literature to support the use of MRV head without and with IV contrast in the initial imaging evaluation of new headache during pregnancy or peripartum period; the recommendation is to avoid administering IV GBCA during pregnancy. MRV Head Without IV Contrast M... | Headache PCAs. MRV Head Without and With IV Contrast There is no relevant literature to support the use of MRV head without and with IV contrast in the initial imaging evaluation of new headache during pregnancy or peripartum period; the recommendation is to avoid administering IV GBCA during pregnancy. MRV Head Withou... | 69482 |
acrac_69503_0 | Acute Pelvic Pain in the Reproductive Age Group | Introduction/Background Premenopausal patients with acute pelvic pain often pose a diagnostic dilemma. They may exhibit additional nonspecific signs and symptoms, the most common being nausea, vomiting, and leukocytosis. The differential considerations encompass gynecological and obstetrical causes (eg, hemorrhagic ov... | Acute Pelvic Pain in the Reproductive Age Group. Introduction/Background Premenopausal patients with acute pelvic pain often pose a diagnostic dilemma. They may exhibit additional nonspecific signs and symptoms, the most common being nausea, vomiting, and leukocytosis. The differential considerations encompass gynecol... | 69503 |
acrac_69503_1 | Acute Pelvic Pain in the Reproductive Age Group | Gadolinium is considered a pregnancy category C drug (it should be administered only if the potential benefit outweighs the risk) because animal studies have revealed adverse effects. Among 26 patients who had exposure to gadopentetate-dimeglumine in the periconceptional and first trimester period, only one congenital ... | Acute Pelvic Pain in the Reproductive Age Group. Gadolinium is considered a pregnancy category C drug (it should be administered only if the potential benefit outweighs the risk) because animal studies have revealed adverse effects. Among 26 patients who had exposure to gadopentetate-dimeglumine in the periconceptional... | 69503 |
acrac_69503_2 | Acute Pelvic Pain in the Reproductive Age Group | This suggests that contrast-enhanced MRI could be used as a reliable adjunct for diagnosing cesarean scar pregnancy in select cases or if US is inconclusive or nondiagnostic. The typical findings of a gestational sac embedded in the anterior lower part of the uterus in the sagittal T2-weighted views were identified in ... | Acute Pelvic Pain in the Reproductive Age Group. This suggests that contrast-enhanced MRI could be used as a reliable adjunct for diagnosing cesarean scar pregnancy in select cases or if US is inconclusive or nondiagnostic. The typical findings of a gestational sac embedded in the anterior lower part of the uterus in t... | 69503 |
acrac_69503_3 | Acute Pelvic Pain in the Reproductive Age Group | TVUS is currently considered the single best diagnostic modality to assess for ectopic pregnancy [15]. In a retrospective study of 1,880 patients presenting to the emergency department with first trimester pain or vaginal bleeding, an overall accuracy of TVUS diagnosis was 78%, with a specificity above 90% but a low se... | Acute Pelvic Pain in the Reproductive Age Group. TVUS is currently considered the single best diagnostic modality to assess for ectopic pregnancy [15]. In a retrospective study of 1,880 patients presenting to the emergency department with first trimester pain or vaginal bleeding, an overall accuracy of TVUS diagnosis w... | 69503 |
acrac_69503_4 | Acute Pelvic Pain in the Reproductive Age Group | Findings of irregular peripherally enhancing adnexal cyst usually accompanied by hemorrhagic pelvic free fluid might also indicate a ruptured hemorrhagic cyst. Acute Pelvic Pain in the Reproductive Age Group MRI Pelvis Without and With IV Contrast There is no relevant literature to support the use of pelvic MRI without... | Acute Pelvic Pain in the Reproductive Age Group. Findings of irregular peripherally enhancing adnexal cyst usually accompanied by hemorrhagic pelvic free fluid might also indicate a ruptured hemorrhagic cyst. Acute Pelvic Pain in the Reproductive Age Group MRI Pelvis Without and With IV Contrast There is no relevant li... | 69503 |
acrac_69503_5 | Acute Pelvic Pain in the Reproductive Age Group | MRI with DWI and contrast-enhanced sequences showed a sensitivity of 83.3% for ovarian torsion, 100% for endometriotic cysts, 100% for hemorrhagic cysts, 83.3% for TOA, and 87.5% for dermoid cysts in a prospective study on 74 patients evaluated with TVUS and MRI. Overall sensitivity of MRI in these pathological entitie... | Acute Pelvic Pain in the Reproductive Age Group. MRI with DWI and contrast-enhanced sequences showed a sensitivity of 83.3% for ovarian torsion, 100% for endometriotic cysts, 100% for hemorrhagic cysts, 83.3% for TOA, and 87.5% for dermoid cysts in a prospective study on 74 patients evaluated with TVUS and MRI. Overall... | 69503 |
acrac_69503_6 | Acute Pelvic Pain in the Reproductive Age Group | A meta-analysis reported a similar pooled sensitivity and specificity in diagnosing adnexal torsion using Doppler US (7 studies, 845 patients, sensitivity 80% and specificity 88%) compared with the grayscale US only (12 studies, 1,187 patients, sensitivity 79% and specificity 76%) [22]. Ovarian torsion may lead to adne... | Acute Pelvic Pain in the Reproductive Age Group. A meta-analysis reported a similar pooled sensitivity and specificity in diagnosing adnexal torsion using Doppler US (7 studies, 845 patients, sensitivity 80% and specificity 88%) compared with the grayscale US only (12 studies, 1,187 patients, sensitivity 79% and specif... | 69503 |
acrac_69503_7 | Acute Pelvic Pain in the Reproductive Age Group | TVUS and TAUS of the pelvis is the most useful imaging modality for initial assessment when an obstetrical or gynecological etiology is suspected [13]. A combined transabdominal and transvaginal approach is typically used for pelvic US imaging. TVUS demonstrated a sensitivity of 83.3% for ovarian torsion, 84% for endom... | Acute Pelvic Pain in the Reproductive Age Group. TVUS and TAUS of the pelvis is the most useful imaging modality for initial assessment when an obstetrical or gynecological etiology is suspected [13]. A combined transabdominal and transvaginal approach is typically used for pelvic US imaging. TVUS demonstrated a sensit... | 69503 |
acrac_69503_8 | Acute Pelvic Pain in the Reproductive Age Group | In cases of salpingitis, the masses lying adjacent to the ovaries were on average 2 to 3 cm in diameter, solid (n = 14), unilocular cystic (n = 4), multilocular cystic (n = 3), or multilocular solid (n = 1), with thick walls and well vascularized at color Doppler [33]. Other specific TVUS findings, including wall thick... | Acute Pelvic Pain in the Reproductive Age Group. In cases of salpingitis, the masses lying adjacent to the ovaries were on average 2 to 3 cm in diameter, solid (n = 14), unilocular cystic (n = 4), multilocular cystic (n = 3), or multilocular solid (n = 1), with thick walls and well vascularized at color Doppler [33]. O... | 69503 |
acrac_69503_9 | Acute Pelvic Pain in the Reproductive Age Group | The rate of nonvisualization of the appendix on MRI is lower than US and reported to be 30.9% in a retrospective cohort study of 171 pregnant patients. Patients with nonvisualization of the appendix on MRI were more likely to be beyond the first trimester [40]. Evaluation for appendicitis with pelvic MRI in 51 pregnant... | Acute Pelvic Pain in the Reproductive Age Group. The rate of nonvisualization of the appendix on MRI is lower than US and reported to be 30.9% in a retrospective cohort study of 171 pregnant patients. Patients with nonvisualization of the appendix on MRI were more likely to be beyond the first trimester [40]. Evaluatio... | 69503 |
acrac_69503_10 | Acute Pelvic Pain in the Reproductive Age Group | In this study, all 4 patients with a borderline size appendix with appendicitis showed negative T1 bright appendix sign [44]. The addition of DWI showed no significant improvement to MRI detection of appendicitis in a retrospective study of 125 pregnant patients [45]. Evaluation of urinary causes of pain in pregnant pa... | Acute Pelvic Pain in the Reproductive Age Group. In this study, all 4 patients with a borderline size appendix with appendicitis showed negative T1 bright appendix sign [44]. The addition of DWI showed no significant improvement to MRI detection of appendicitis in a retrospective study of 125 pregnant patients [45]. Ev... | 69503 |
acrac_69503_11 | Acute Pelvic Pain in the Reproductive Age Group | US performance for the evaluation of appendicitis in pregnant patients appears to be similar to the same-age nonpregnant patients, as shown in a case-control study with 67 pregnant patients compared with 133 nonpregnant young patients. PPV was 94% in the pregnant group and 91% in the nonpregnant group, with correspondi... | Acute Pelvic Pain in the Reproductive Age Group. US performance for the evaluation of appendicitis in pregnant patients appears to be similar to the same-age nonpregnant patients, as shown in a case-control study with 67 pregnant patients compared with 133 nonpregnant young patients. PPV was 94% in the pregnant group a... | 69503 |
acrac_69503_12 | Acute Pelvic Pain in the Reproductive Age Group | In another study, 84% of cases with noninflamed appendix showed luminal filling when positive oral contrast reaches the cecum, thus excluding diagnosis of appendicitis with high certainty. Therefore, the use of positive oral contrast may augment diagnostic accuracy and confidence in cases of suspected acute appendiciti... | Acute Pelvic Pain in the Reproductive Age Group. In another study, 84% of cases with noninflamed appendix showed luminal filling when positive oral contrast reaches the cecum, thus excluding diagnosis of appendicitis with high certainty. Therefore, the use of positive oral contrast may augment diagnostic accuracy and c... | 69503 |
acrac_69503_13 | Acute Pelvic Pain in the Reproductive Age Group | In a small study of 51 patients, a combination of DWI and T2-weighted images increased the accuracy for the diagnosis of appendicitis, with decreased ADC values correlating with appendicitis. The presence of low ADC in the peri-appendiceal fat was also notable in the presence of complicated appendicitis [63]. That is c... | Acute Pelvic Pain in the Reproductive Age Group. In a small study of 51 patients, a combination of DWI and T2-weighted images increased the accuracy for the diagnosis of appendicitis, with decreased ADC values correlating with appendicitis. The presence of low ADC in the peri-appendiceal fat was also notable in the pre... | 69503 |
acrac_69503_14 | Acute Pelvic Pain in the Reproductive Age Group | US may be used for the evaluation of suspected appendicitis in adults with a pooled sensitivity of 83% (95% confidence interval [CI], 78%-87%) and a pooled specificity of 93% (95% CI, 90%- 96%), as shown in a meta-analysis of 31 studies with 4,341 patients. In the meta-analysis, CT demonstrated a higher pooled sensitiv... | Acute Pelvic Pain in the Reproductive Age Group. US may be used for the evaluation of suspected appendicitis in adults with a pooled sensitivity of 83% (95% confidence interval [CI], 78%-87%) and a pooled specificity of 93% (95% CI, 90%- 96%), as shown in a meta-analysis of 31 studies with 4,341 patients. In the meta-a... | 69503 |
acrac_3158181_0 | Suspected Retroperitoneal Bleed | Introduction/Background Retroperitoneal bleeding is a hemorrhage into the retroperitoneal space, the space located posterior to the parietal peritoneum and anterior to the transversalis fascia. Retroperitoneal bleeding can occur spontaneously (Wunderlich syndrome), including in association with anticoagulation therapi... | Suspected Retroperitoneal Bleed. Introduction/Background Retroperitoneal bleeding is a hemorrhage into the retroperitoneal space, the space located posterior to the parietal peritoneum and anterior to the transversalis fascia. Retroperitoneal bleeding can occur spontaneously (Wunderlich syndrome), including in associa... | 3158181 |
acrac_3158181_1 | Suspected Retroperitoneal Bleed | Clinically, retroperitoneal bleeding can present with diffuse abdominal, back, or lower quadrant abdominal pain, abdominal distension, and palpation of a flank mass [2,7]. However, these clinical findings are nonspecific for the diagnosis and further contribute to the difficulty in diagnoses. The management of retroper... | Suspected Retroperitoneal Bleed. Clinically, retroperitoneal bleeding can present with diffuse abdominal, back, or lower quadrant abdominal pain, abdominal distension, and palpation of a flank mass [2,7]. However, these clinical findings are nonspecific for the diagnosis and further contribute to the difficulty in diag... | 3158181 |
acrac_3158181_2 | Suspected Retroperitoneal Bleed | Angiography has high spatial and temporal resolution for evaluating vascular structures and the source of the bleed. Initial utilization of aortography of the abdomen and pelvis in patients with clinically suspected retroperitoneal bleed is best reserved for patients who are hemodynamically unstable with a high index o... | Suspected Retroperitoneal Bleed. Angiography has high spatial and temporal resolution for evaluating vascular structures and the source of the bleed. Initial utilization of aortography of the abdomen and pelvis in patients with clinically suspected retroperitoneal bleed is best reserved for patients who are hemodynamic... | 3158181 |
acrac_3158181_3 | Suspected Retroperitoneal Bleed | The attenuation of the hematoma on noncontrast CT can help determine the relative acuity, with high attenuation and mixed attenuation indicating acute to subacute bleeding and rebleeding, and low attenuation suggesting subacute to chronic blood products. Findings such as sentinel clot can be helpful to suggest an area ... | Suspected Retroperitoneal Bleed. The attenuation of the hematoma on noncontrast CT can help determine the relative acuity, with high attenuation and mixed attenuation indicating acute to subacute bleeding and rebleeding, and low attenuation suggesting subacute to chronic blood products. Findings such as sentinel clot c... | 3158181 |
acrac_3158181_4 | Suspected Retroperitoneal Bleed | CTA has the same limitations as CT as a diagnostic modality only, not allowing for intervention as with TAE. MRI Abdomen and Pelvis MRI has very high soft-tissue contrast and is very helpful in evaluation of the retroperitoneal structures. However, the length of examination time makes it less than ideal for initial ima... | Suspected Retroperitoneal Bleed. CTA has the same limitations as CT as a diagnostic modality only, not allowing for intervention as with TAE. MRI Abdomen and Pelvis MRI has very high soft-tissue contrast and is very helpful in evaluation of the retroperitoneal structures. However, the length of examination time makes i... | 3158181 |
acrac_3158181_5 | Suspected Retroperitoneal Bleed | Additionally, up to a moderate volume hematoma may not exert enough mass effect to prompt discovery on radiography. These limitations make radiography usually not appropriate for initial diagnosis of retroperitoneal bleed. RBC Scan Abdomen and Pelvis Tc-99m-labeled red blood cell (RBC) scintigraphy is highly sensitive ... | Suspected Retroperitoneal Bleed. Additionally, up to a moderate volume hematoma may not exert enough mass effect to prompt discovery on radiography. These limitations make radiography usually not appropriate for initial diagnosis of retroperitoneal bleed. RBC Scan Abdomen and Pelvis Tc-99m-labeled red blood cell (RBC) ... | 3158181 |
acrac_3101482_0 | Chronic Shoulder Pain PCAs | Special Imaging Considerations Several studies have looked for ways to shorten typical shoulder conventional MRI or MR arthrogram protocols while maintaining diagnostic accuracy. Isotropic 3-D imaging has been increasingly used as a substitute for conventional multiplanar 2-D MRI, with a similar sensitivity and specif... | Chronic Shoulder Pain PCAs. Special Imaging Considerations Several studies have looked for ways to shorten typical shoulder conventional MRI or MR arthrogram protocols while maintaining diagnostic accuracy. Isotropic 3-D imaging has been increasingly used as a substitute for conventional multiplanar 2-D MRI, with a si... | 3101482 |
acrac_3101482_1 | Chronic Shoulder Pain PCAs | Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Chronic Shoulder Pain Discussion of Procedures by Variant Variant 1: Chronic shoulder pain. Initial imaging. Bone Scan Sho... | Chronic Shoulder Pain PCAs. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Chronic Shoulder Pain Discussion of Procedures by Variant Variant 1: Chronic shoulder pain. In... | 3101482 |
acrac_3101482_2 | Chronic Shoulder Pain PCAs | MRI Shoulder Without IV Contrast There is insufficient evidence to support the use of MRI shoulder without IV contrast in the initial evaluation of chronic shoulder pain. US Shoulder The literature suggests that radiographic evaluation should generally be the first imaging study ordered in patients with shoulder pain [... | Chronic Shoulder Pain PCAs. MRI Shoulder Without IV Contrast There is insufficient evidence to support the use of MRI shoulder without IV contrast in the initial evaluation of chronic shoulder pain. US Shoulder The literature suggests that radiographic evaluation should generally be the first imaging study ordered in p... | 3101482 |
acrac_3101482_3 | Chronic Shoulder Pain PCAs | CT Shoulder Without and With IV Contrast There is insufficient evidence to support the use of CT shoulder without and with IV contrast in the evaluation of chronic shoulder pain when rotator cuff disorder or subacromial subdeltoid bursitis is suspected. CT Shoulder Without IV Contrast CT shoulder without IV contrast is... | Chronic Shoulder Pain PCAs. CT Shoulder Without and With IV Contrast There is insufficient evidence to support the use of CT shoulder without and with IV contrast in the evaluation of chronic shoulder pain when rotator cuff disorder or subacromial subdeltoid bursitis is suspected. CT Shoulder Without IV Contrast CT sho... | 3101482 |
acrac_3101482_4 | Chronic Shoulder Pain PCAs | US image-guided injection with local anesthetic and corticosteroid into the subacromial-subdeltoid bursa has been shown to result in improvement in pain and range of motion in patients with rotator cuff symptoms [20,21]. Subacromial bursal injections are used by some as a diagnostic tool to evaluate for rotator cuff pa... | Chronic Shoulder Pain PCAs. US image-guided injection with local anesthetic and corticosteroid into the subacromial-subdeltoid bursa has been shown to result in improvement in pain and range of motion in patients with rotator cuff symptoms [20,21]. Subacromial bursal injections are used by some as a diagnostic tool to ... | 3101482 |
acrac_3101482_5 | Chronic Shoulder Pain PCAs | Indirect MR arthrography has been shown to have a slightly higher specificity for diagnosing articular- surface partial thickness tears of the supraspinatus and infraspinatus tendons, as well as a greater specificity for diagnosing subscapularis tendon tears [35], relative to noncontrast MRI, and has shown high accurac... | Chronic Shoulder Pain PCAs. Indirect MR arthrography has been shown to have a slightly higher specificity for diagnosing articular- surface partial thickness tears of the supraspinatus and infraspinatus tendons, as well as a greater specificity for diagnosing subscapularis tendon tears [35], relative to noncontrast MRI... | 3101482 |
acrac_3101482_6 | Chronic Shoulder Pain PCAs | Radiography Shoulder Additional Views The rotator cuff tendons cannot be directly assessed radiographically, regardless of the view. Secondary findings of rotator cuff tear such as a high-riding humeral head or changes at the greater tuberosity can be seen on standard radiographic views. There have been several reports... | Chronic Shoulder Pain PCAs. Radiography Shoulder Additional Views The rotator cuff tendons cannot be directly assessed radiographically, regardless of the view. Secondary findings of rotator cuff tear such as a high-riding humeral head or changes at the greater tuberosity can be seen on standard radiographic views. The... | 3101482 |
acrac_3101482_7 | Chronic Shoulder Pain PCAs | Bone Scan Shoulder There is insufficient evidence to support the use of bone scan shoulder in the evaluation of chronic shoulder pain when radiographs demonstrate calcific tendinosis or calcific bursitis. Cases with intraosseous extension of calcium hydroxyapatite can potentially demonstrate increased radionuclide upta... | Chronic Shoulder Pain PCAs. Bone Scan Shoulder There is insufficient evidence to support the use of bone scan shoulder in the evaluation of chronic shoulder pain when radiographs demonstrate calcific tendinosis or calcific bursitis. Cases with intraosseous extension of calcium hydroxyapatite can potentially demonstrate... | 3101482 |
acrac_3101482_8 | Chronic Shoulder Pain PCAs | CT can be helpful in evaluating osseous involvement [52] and is the most accurate modality in evaluating the consistency of the deposit, which may be helpful when planning intervention [53] but is not routinely obtained. FDG-PET/CT Skull Base to Mid-Thigh There is insufficient evidence to support the use of FDG-PET/CT ... | Chronic Shoulder Pain PCAs. CT can be helpful in evaluating osseous involvement [52] and is the most accurate modality in evaluating the consistency of the deposit, which may be helpful when planning intervention [53] but is not routinely obtained. FDG-PET/CT Skull Base to Mid-Thigh There is insufficient evidence to su... | 3101482 |
acrac_3101482_9 | Chronic Shoulder Pain PCAs | MR Arthrography Shoulder Calcium hydroxyapatite may be difficult to visualize on MRI given the lack of contrast between hypointense calcium and an adjacent normal tendon. However, MR arthrography can be used to identify a concomitant rotator cuff tear. In the setting of calcific tendonitis, 93% of rotator cuff tears ar... | Chronic Shoulder Pain PCAs. MR Arthrography Shoulder Calcium hydroxyapatite may be difficult to visualize on MRI given the lack of contrast between hypointense calcium and an adjacent normal tendon. However, MR arthrography can be used to identify a concomitant rotator cuff tear. In the setting of calcific tendonitis, ... | 3101482 |
acrac_3101482_10 | Chronic Shoulder Pain PCAs | At times US may have difficulty distinguishing calcific deposits from heterotopic ossification because both can result in dense shadowing at US. US can be used if there is concern for concomitant rotator cuff tendon tear and may be a better modality than MRI in this situation given the difficulty of distinguishing calc... | Chronic Shoulder Pain PCAs. At times US may have difficulty distinguishing calcific deposits from heterotopic ossification because both can result in dense shadowing at US. US can be used if there is concern for concomitant rotator cuff tendon tear and may be a better modality than MRI in this situation given the diffi... | 3101482 |
acrac_3101482_11 | Chronic Shoulder Pain PCAs | CT Shoulder Without and With IV Contrast There is insufficient evidence to support the use of CT shoulder without and with IV contrast in the evaluation of chronic shoulder pain when labral pathology or shoulder instability is suspected. CT Shoulder Without IV Contrast CT is helpful for assessing bony glenoid deficienc... | Chronic Shoulder Pain PCAs. CT Shoulder Without and With IV Contrast There is insufficient evidence to support the use of CT shoulder without and with IV contrast in the evaluation of chronic shoulder pain when labral pathology or shoulder instability is suspected. CT Shoulder Without IV Contrast CT is helpful for asse... | 3101482 |
acrac_3101482_12 | Chronic Shoulder Pain PCAs | Although diagnosing recurrent labral tears after prior labral repair is challenging, MR arthrography is particularly helpful in this scenario in which discrete fluid or gadolinium signal within or underlying the labrum, absent labrum, and paralabral cyst are all highly suggestive of recurrent tear [94], with a greater ... | Chronic Shoulder Pain PCAs. Although diagnosing recurrent labral tears after prior labral repair is challenging, MR arthrography is particularly helpful in this scenario in which discrete fluid or gadolinium signal within or underlying the labrum, absent labrum, and paralabral cyst are all highly suggestive of recurren... | 3101482 |
acrac_3101482_13 | Chronic Shoulder Pain PCAs | Although these additional projections are used by some practitioners, they do not usually alleviate the need for advanced imaging. US Shoulder The posterior labrum can be reliably visualized with US, with posterior labral tears potentially visualized particularly if the joint is distended [101]. However, US is of limit... | Chronic Shoulder Pain PCAs. Although these additional projections are used by some practitioners, they do not usually alleviate the need for advanced imaging. US Shoulder The posterior labrum can be reliably visualized with US, with posterior labral tears potentially visualized particularly if the joint is distended [1... | 3101482 |
acrac_3101482_14 | Chronic Shoulder Pain PCAs | Image-Guided Anesthetic +/- Corticosteroid Injection Shoulder or Surrounding Structures Image-guided injection of the glenohumeral joint for adhesive capsulitis can be performed with either fluoroscopy or US guidance. Image-guided corticosteroid injection has been shown to have a significant reduction in pain and an im... | Chronic Shoulder Pain PCAs. Image-Guided Anesthetic +/- Corticosteroid Injection Shoulder or Surrounding Structures Image-guided injection of the glenohumeral joint for adhesive capsulitis can be performed with either fluoroscopy or US guidance. Image-guided corticosteroid injection has been shown to have a significant... | 3101482 |
acrac_3101482_15 | Chronic Shoulder Pain PCAs | MRI Shoulder Without IV Contrast Zhao et al [113] showed that coracohumeral ligament thickening, anterior capsule thickening, and obliteration of the subcoracoid fat are the most characteristic findings of adhesive capsulitis on conventional MRI. Chi et al [114] found a sensitivity of 77% and a specificity of 53% for a... | Chronic Shoulder Pain PCAs. MRI Shoulder Without IV Contrast Zhao et al [113] showed that coracohumeral ligament thickening, anterior capsule thickening, and obliteration of the subcoracoid fat are the most characteristic findings of adhesive capsulitis on conventional MRI. Chi et al [114] found a sensitivity of 77% an... | 3101482 |
acrac_3101482_16 | Chronic Shoulder Pain PCAs | Bone Scan Shoulder There is insufficient evidence to support the use of bone scan shoulder in the evaluation of chronic shoulder pain when biceps tendon abnormality is suspected. CT Arthrography Shoulder Reports on the accuracy of CT arthrography for biceps tendinopathy are variable. Teixeira et al [118] reported a sen... | Chronic Shoulder Pain PCAs. Bone Scan Shoulder There is insufficient evidence to support the use of bone scan shoulder in the evaluation of chronic shoulder pain when biceps tendon abnormality is suspected. CT Arthrography Shoulder Reports on the accuracy of CT arthrography for biceps tendinopathy are variable. Teixeir... | 3101482 |
acrac_3101482_17 | Chronic Shoulder Pain PCAs | Although either fluoroscopy or US can be used as imaging guidance for biceps tendon injection, US guidance is more accurate [121]. US is more accurate in injection location placement compared with blind injections with a lower risk of intratendinous injection [122,123]. Many patients with sonographically normal biceps ... | Chronic Shoulder Pain PCAs. Although either fluoroscopy or US can be used as imaging guidance for biceps tendon injection, US guidance is more accurate [121]. US is more accurate in injection location placement compared with blind injections with a lower risk of intratendinous injection [122,123]. Many patients with so... | 3101482 |
acrac_3101482_18 | Chronic Shoulder Pain PCAs | Using diagnostic criteria of having 2 or more signs of biceps tendinopathy (contour irregularity, diameter change, or abnormal signal) has a sensitivity of 78% and a specificity of 94% [132]. It has been reported that normal appearing tendons on MRI frequently have histopathologic findings of tendinopathy [133,134]. Bi... | Chronic Shoulder Pain PCAs. Using diagnostic criteria of having 2 or more signs of biceps tendinopathy (contour irregularity, diameter change, or abnormal signal) has a sensitivity of 78% and a specificity of 94% [132]. It has been reported that normal appearing tendons on MRI frequently have histopathologic findings o... | 3101482 |
acrac_3101482_19 | Chronic Shoulder Pain PCAs | CT arthrography provides excellent imaging of osseous detail allowing for characterization of glenoid morphology, version, and bone loss. Unlike nonarthrogram CT, CT arthrography allows for adequate characterization of a rotator cuff tear [16,17], which may alter the chosen arthroplasty type. Arthrogram contrast also o... | Chronic Shoulder Pain PCAs. CT arthrography provides excellent imaging of osseous detail allowing for characterization of glenoid morphology, version, and bone loss. Unlike nonarthrogram CT, CT arthrography allows for adequate characterization of a rotator cuff tear [16,17], which may alter the chosen arthroplasty type... | 3101482 |
acrac_3101482_20 | Chronic Shoulder Pain PCAs | Image-Guided Anesthetic +/- Corticosteroid Injection Shoulder or Surrounding Structures Intra-articular corticosteroid injection using either fluoroscopy or US guidance is often used in the conservative management of glenohumeral arthritis [122] and may be performed in some situations before advanced imaging is obtaine... | Chronic Shoulder Pain PCAs. Image-Guided Anesthetic +/- Corticosteroid Injection Shoulder or Surrounding Structures Intra-articular corticosteroid injection using either fluoroscopy or US guidance is often used in the conservative management of glenohumeral arthritis [122] and may be performed in some situations before... | 3101482 |
acrac_3101482_21 | Chronic Shoulder Pain PCAs | A standard axillary view can demonstrate posterior subluxation of the humeral head and abnormal glenoid morphology in patients with severe osteoarthritis [145-147]. A measurement of the critical shoulder angle can be drawn on routine AP radiographs by measuring the angle between a line along the glenoid surface and a l... | Chronic Shoulder Pain PCAs. A standard axillary view can demonstrate posterior subluxation of the humeral head and abnormal glenoid morphology in patients with severe osteoarthritis [145-147]. A measurement of the critical shoulder angle can be drawn on routine AP radiographs by measuring the angle between a line along... | 3101482 |
acrac_3101482_22 | Chronic Shoulder Pain PCAs | CT Shoulder Without and With IV Contrast There is insufficient evidence to support the use of CT shoulder without and with IV contrast in the evaluation of chronic shoulder pain with a history of prior rotator cuff repair when rotator cuff disorder or subacromial subdeltoid bursitis is suspected. CT Shoulder Without IV... | Chronic Shoulder Pain PCAs. CT Shoulder Without and With IV Contrast There is insufficient evidence to support the use of CT shoulder without and with IV contrast in the evaluation of chronic shoulder pain with a history of prior rotator cuff repair when rotator cuff disorder or subacromial subdeltoid bursitis is suspe... | 3101482 |
acrac_3101482_23 | Chronic Shoulder Pain PCAs | Of note, contrast within the subacromial subdeltoid bursa on routine and MR arthrogram examinations is a nonspecific finding that can potentially be seen in a nonwatertight rotator cuff repair [151]. T2 hyperintensity of the repaired rotator cuff tendon is a common postoperative finding, particularly in the first 2 yea... | Chronic Shoulder Pain PCAs. Of note, contrast within the subacromial subdeltoid bursa on routine and MR arthrogram examinations is a nonspecific finding that can potentially be seen in a nonwatertight rotator cuff repair [151]. T2 hyperintensity of the repaired rotator cuff tendon is a common postoperative finding, par... | 3101482 |
acrac_3158170_0 | Dialysis Fistula Malfunction | Introduction/Background Chronic kidney disease is a common disease that as of 2018 affected 14.9% of the surveyed adult United States population [1]. Chronic kidney disease can result in end stage renal disease, a condition with high morbidity and mortality that affects 725,000 patients in the United States as of 2016... | Dialysis Fistula Malfunction. Introduction/Background Chronic kidney disease is a common disease that as of 2018 affected 14.9% of the surveyed adult United States population [1]. Chronic kidney disease can result in end stage renal disease, a condition with high morbidity and mortality that affects 725,000 patients i... | 3158170 |
acrac_3158170_1 | Dialysis Fistula Malfunction | A stenotic lesion can provoke access dysfunction regardless of its site within the access circuit [9]. Arteriovenous (AV) access dysfunction includes 3 distinct classes of events, namely thrombotic flow-related complications or dysfunction, nonthrombotic flow-related complications or dysfunction, and infectious complic... | Dialysis Fistula Malfunction. A stenotic lesion can provoke access dysfunction regardless of its site within the access circuit [9]. Arteriovenous (AV) access dysfunction includes 3 distinct classes of events, namely thrombotic flow-related complications or dysfunction, nonthrombotic flow-related complications or dysfu... | 3158170 |
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