TY - JOUR
T1 - ACR appropriateness criteria® acute onset flank pain-suspicion of stone disease
AU - Coursey, Courtney A.
AU - Casalino, David D.
AU - Remer, Erick M.
AU - Arellano, Ronald S.
AU - Bishoff, Jay T.
AU - Dighe, Manjiri
AU - Fulgham, Pat
AU - Goldfarb, Stanley
AU - Israel, Gary M.
AU - Lazarus, Elizabeth
AU - Leyendecker, John R.
AU - Majd, Massoud
AU - Nikolaidis, Paul
AU - Papanicolaou, Nicholas
AU - Prasad, Srinivasa
AU - Ramchandani, Parvati
AU - Sheth, Sheila
AU - Vikram, Raghunandan
PY - 2012/9
Y1 - 2012/9
N2 - Low dose (<3 mSv) noncontrast CT (NCCT) is the imaging study of choice for accurate evaluation of patients with acute onset of flank pain and suspicion of stone disease (sensitivity 97%, specificity 95%). NCCT can reliably characterize the location and size of an offending ureteral calculus, identify complications, and diagnose alternative etiologies of abdominal pain such as appendicitis. By comparison, the sensitivity of radiographs (59%) and ultrasound (24-57%) for the detection of renal and ureteral calculi is relatively poor. Ultrasound can accurately diagnose pelvicaliectasis and ureterectasis, but it may take several hours for these findings to develop. In the pregnant patient, however, ultrasound is a first line test as it does not expose the fetus to ionizing radiation. MR is an accurate test for the diagnosis of pelvicaliectasis and ureterectasis, but is less sensitive than CT for the diagnosis of renal and ureteral calculi. For patients with known stone disease whose stones are visible on radiographs, radiographs are a good tool for post-treatment follow-up.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
AB - Low dose (<3 mSv) noncontrast CT (NCCT) is the imaging study of choice for accurate evaluation of patients with acute onset of flank pain and suspicion of stone disease (sensitivity 97%, specificity 95%). NCCT can reliably characterize the location and size of an offending ureteral calculus, identify complications, and diagnose alternative etiologies of abdominal pain such as appendicitis. By comparison, the sensitivity of radiographs (59%) and ultrasound (24-57%) for the detection of renal and ureteral calculi is relatively poor. Ultrasound can accurately diagnose pelvicaliectasis and ureterectasis, but it may take several hours for these findings to develop. In the pregnant patient, however, ultrasound is a first line test as it does not expose the fetus to ionizing radiation. MR is an accurate test for the diagnosis of pelvicaliectasis and ureterectasis, but is less sensitive than CT for the diagnosis of renal and ureteral calculi. For patients with known stone disease whose stones are visible on radiographs, radiographs are a good tool for post-treatment follow-up.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
KW - Appropriateness Criteria
KW - comparative studies
KW - computed tomography
KW - nephroureterolithiasis
KW - ultrasound
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U2 - 10.1097/RUQ.0b013e3182625974
DO - 10.1097/RUQ.0b013e3182625974
M3 - Review article
C2 - 22902840
AN - SCOPUS:84865796052
SN - 0894-8771
VL - 28
SP - 227
EP - 233
JO - Ultrasound Quarterly
JF - Ultrasound Quarterly
IS - 3
ER -