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ACR appropriateness criteria right upper quadrant pain
Gail M Yarmish1, Martin P Smith2, Max P Rosen3
1Staten Island University Hospital, Staten Island, New York.
Journal of the American College of Radiology : JACR
|February 4, 2014
Summary
Ultrasound is the preferred initial imaging test for suspected acute cholecystitis due to its availability and ability to evaluate gallbladder morphology and bile ducts. Other imaging like CT or MRI may be used for inconclusive cases.
Area of Science:
- Radiology
- Medical Imaging
- Gastroenterology
Background:
- Acute cholecystitis commonly presents with right upper quadrant pain.
- Ultrasound is frequently the first imaging modality used in these cases.
- While cholescintigraphy offers higher sensitivity, ultrasound is preferred for practical reasons.
Purpose of the Study:
- To outline the role of various imaging modalities in diagnosing acute cholecystitis.
- To highlight the advantages of ultrasound as the initial imaging choice.
- To provide guidance on imaging selection based on clinical scenarios and patient factors.
Main Methods:
- Review of the ACR Appropriateness Criteria for acute cholecystitis.
- Analysis of current medical literature on imaging for right upper quadrant pain.
- Application of a modified Delphi consensus methodology by expert panels.
Main Results:
- Ultrasound is favored initially for its availability, speed, safety (no radiation), and comprehensive evaluation capabilities.
- CT and MRI are useful for equivocal ultrasound findings and identifying complications.
- MRI is the preferred modality for pregnant patients with inconclusive ultrasound results.
Conclusions:
- Ultrasound is the primary imaging modality for suspected acute cholecystitis.
- Advanced imaging like CT and MRI serve crucial roles in complex or inconclusive cases.
- Evidence-based guidelines inform the appropriate selection of imaging techniques for accurate diagnosis and management.
Keywords:
Appropriateness Criteriaabdominal paincholecystitischolescintigraphycomparative studiesultrasoundMore Related Videos
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