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Published on: July 19, 2013
ACR Appropriateness Criteria(®) myelopathy
David J Seidenwurm1, Franz J Wippold, Rebecca S Cornelius
1Radiological Associates of Sacramento, Sacramento, CA, USA. seidenwurmd@radiological.com
Summary
Diagnosing myelopathy requires advanced imaging to identify treatable causes. Imaging choices depend on clinical presentation, prioritizing trauma assessment and differentiating intrinsic from extrinsic spinal cord compression.
Area of Science:
- Radiology and Medical Imaging
- Neurology
- Spinal Cord Diseases
Background:
- Myelopathy necessitates accurate imaging for diagnosis and treatment planning.
- Distinguishing between mechanical instability, intrinsic disease, and extrinsic compression is critical.
Purpose of the Study:
- To outline imaging strategies for diagnosing myelopathy.
- To detail the ACR Appropriateness Criteria for myelopathy imaging.
Main Methods:
- Clinical features (pain, fever, trauma, progression) guide imaging selection.
- Computed Tomography (CT) for acute trauma; Magnetic Resonance Imaging (MRI) for other cases.
- Contrast-enhanced MRI for suspected tumor/infection; vascular imaging for vascular abnormalities.
Main Results:
- CT is the initial choice for acute trauma.
- MRI is preferred for non-traumatic myelopathy.
- Contrast-enhanced MRI and vascular imaging are used in specific clinical scenarios.
Conclusions:
- Imaging selection for myelopathy is tailored to clinical presentation and suspected etiology.
- Sequential imaging may be required for complex cases and treatment monitoring.
- ACR Appropriateness Criteria provide evidence-based guidelines for optimal imaging selection.