ACR Appropriateness Criteria® Right Lower Quadrant Pain: 2022 Update

Area of Science:

• Radiology
• Abdominal Imaging
• Diagnostic Procedures

Background:

• Right lower quadrant (RLQ) abdominal pain is common, with appendicitis being the most frequent surgical cause in the US.
• Other differential diagnoses include right colonic diverticulitis, ureteral stones, and infectious enterocolitis.
• Effective imaging has significantly reduced the negative appendectomy rate from 25% to 1-3%.

Framework:

• The ACR Appropriateness Criteria provide evidence-based guidelines for imaging in specific clinical conditions.
• Methodologies like Grading of Recommendations Assessment, Development, and Evaluation (GRADE) are used to assess evidence quality.
• The RAND/UCLA Appropriateness Method guides the selection of imaging procedures for clinical scenarios.

Implementation:

• Contrast-enhanced CT is the primary imaging modality for evaluating adults with RLQ pain.
• Magnetic Resonance Imaging (MRI) offers comparable sensitivity and specificity to CT and is increasingly utilized.
• For pregnant patients, unenhanced MRI and ultrasound are the preferred diagnostic imaging modalities.

Implications:

• Accurate imaging is crucial for timely diagnosis and appropriate treatment of RLQ abdominal pain.
• Advancements in MRI technology are enhancing its diagnostic capabilities.
• Expert interpretation remains vital for ultrasound and MRI, especially in complex cases like pregnancy.