title: ACR Appropriateness Criteria Crohn Disease.
abstract: Crohn disease is a chronic inflammatory disorder involving the gastrointestinal tract, characterized by episodic flares and times of remission. Underlying structural damage occurs progressively, with recurrent bouts of inflammation. The diagnosis and management of this disease process is dependent on several clinical, laboratory, imaging, endoscopic, and histologic factors. In recent years, with the maturation of CT enterography, and MR enterography, imaging has played an increasingly important role in relation to Crohn Disease. In addition to these specialized examination modalities, ultrasound and routine CT have potential uses. Fluoroscopy, radiography, and nuclear medicine may be less beneficial depending on the clinical scenario. The imaging modality best suited to evaluating this disease may change, depending on the target population, severity of presentation, and specific clinical situation. This document presents seven clinical scenarios (variants) in both the adult and pediatric populations and rates the appropriateness of the available imaging options. They are summarized in a consolidated table, and the underlying rationale and supporting literature are presented in the accompanying narrative. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three 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 in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
authors.affiliation: University of Wisconsin Hospital and Clinics, Madison, Wisconsin. Electronic address: dkim@uwhealth.org.
authors.forename: David H
authors.initials: DH
authors.lastname: Kim
authors.affiliation: Virginia Commonwealth University Medical Center, Richmond, Virginia.
authors.forename: Laura R
authors.initials: LR
authors.lastname: Carucci
authors.affiliation: Cleveland Clinic, Cleveland, Ohio.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Baker
authors.affiliation: University of South Alabama, Mobile, Alabama.
authors.forename: Brooks D
authors.initials: BD
authors.lastname: Cash
authors.affiliation: C.S. Mott Children's Hospital, Ann Arbor, Michigan.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Dillman
authors.affiliation: University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Barry W
authors.initials: BW
authors.lastname: Feig
authors.affiliation: Mallinckrodt Institute of Radiology, Saint Louis, Missouri.
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: Fowler
authors.affiliation: Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Gage
authors.affiliation: Brown University Rhode Island Hospital, Providence, Rhode Island.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Noto
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Martin P
authors.initials: MP
authors.lastname: Smith
authors.affiliation: Northwestern University, Chicago, Illinois.
authors.forename: Vahid
authors.initials: V
authors.lastname: Yaghmai
authors.affiliation: University of California San Francisco, San Francisco, California.
authors.forename: Judy
authors.initials: J
authors.lastname: Yee
authors.affiliation: Inland Imaging Associates and University of Washington, Seattle, Washington.
authors.forename: Tasneem
authors.initials: T
authors.lastname: Lalani
mesh_terms: D003424:Crohn Disease / Q000175:diagnosis* / Q000628:therapy*; D003952:Diagnostic Imaging / Q000592:standards*; D005762:Gastroenterology / Q000592:standards*; D006801:Humans; D017410:Practice Guidelines as Topic; D011871:Radiology / Q000592:standards*; D014481:United States
keywords: Appropriateness Criteria; CT; Crohn disease; MR; imaging; ultrasound