ACR Appropriateness Criteria® acute onset flank pain--suspicion of stone disease.
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.
Department of Radiology, Emory University Hospital, 1364 Clifton Rd. NE, Atlanta, GA 30322, USA. cc766@columbia.edu
Courtney A
CA
Coursey
David D
DD
Casalino
Erick M
EM
Remer
Ronald S
RS
Arellano
Jay T
JT
Bishoff
Manjiri
M
Dighe
Pat
P
Fulgham
Stanley
S
Goldfarb
Gary M
GM
Israel
Elizabeth
E
Lazarus
John R
JR
Leyendecker
Massoud
M
Majd
Paul
P
Nikolaidis
Nicholas
N
Papanicolaou
Srinivasa
S
Prasad
Parvati
P
Ramchandani
Sheila
S
Sheth
Raghunandan
R
Vikram
D003952:Diagnostic Imaging; D021501:Flank Pain / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011859:Radiography; D014463:Ultrasonography; D014545:Urinary Calculi / Q000150:complications* / Q000175:diagnosis*