ACR Appropriateness Criteria® Acute Onset Flank Pain-Suspicion of Stone Disease (Urolithiasis)

Expert Panel on Urological Imaging

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Noncontrast CT (NCCT) is the imaging study of choice for initial evaluation of patients with acute onset of flank pain and suspicion of stone disease without known prior stone disease. NCCT can reliably characterize the location and size of an offending ureteral calculus, identify complications, and diagnose alternative etiologies of abdominal pain. Although less sensitive in the detection of stones, ultrasound may have a role in evaluating for signs of obstruction. Radiography potentially has a role, although has been shown to be less sensitive than NCCT. For patients with known disease and recurrent symptoms of urolithiasis, NCCT remains the test of choice for evaluation. In pregnancy, given radiation concerns, ultrasound is recommended as the initial modality of choice with potential role for noncontrast MRI. In scenarios where stone disease suspected and initial NCCT is inconclusive, contrast-enhanced imaging, either with MRI or CT/CT urogram may be appropriate. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

Original languageEnglish (US)
Pages (from-to)S315-S328
JournalJournal of the American College of Radiology
Volume20
Issue number11
DOIs
StatePublished - Nov 2023

Funding

Dr Catanzano reports grants or contracts from AUR Venture Grant - Where's Waldo; royalties or licenses from SpringerNature - Imaging education textbook; payment for expert testimony from Round Tree Group. Dr Diaz De Leon reports leadership roles as MRI Modality Lead Director for Abdominal Imaging. Dr Gupta reports leadership roles as Chair, ACR Meetings Committee. Dr Khatri reports leadership roles as Body MRI Fellowship Director, Chief, Division of Body MRI, Interim Chief, Division of Abdominal Imaging, UT Southwestern Medical Center, Dallas. Dr Nicola reports royalties or licenses from Elsevier. All other authors state that they have no conflict of interest related to the material discussed in this article. Drs Catanzano, Chang, Nicola, Savage, Valente, and Yoo are partners, and the other authors are non-partner/non-partnership track/employees.

Keywords

  • AUC
  • Appropriateness Criteria
  • CT
  • MRI
  • appropriate use criteria
  • radiography
  • ultrasound
  • urolithiasis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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