American College of Radiology
ACR Appropriateness Criteria®

Acute Pyelonephritis

Variant 1: Acute pyelonephritis. Uncomplicated patient (eg, no history of diabetes or immune compromise or history of stones or obstruction or prior renal surgery or lack of response to therapy). Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT abdomen and pelvis with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
2 (18203942) 4
6 (25876836) 4
7 (2655002) 4
CT abdomen and pelvis without IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
2 (18203942) 4
6 (25876836) 4
7 (2655002) 4
CT abdomen and pelvis without and with IV contrast Usually not appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
2 (18203942) 4
7 (2655002) 4
6 (25876836) 4
Fluoroscopy intravenous urography Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
2 (18203942) 4
Fluoroscopy voiding cystourethrography Usually not appropriate ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
2 (18203942) 4
MRI abdomen without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 15 1 0 0 0 0 0 0 0
MRI abdomen without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 15 1 0 0 0 0 0 0 0
MRI abdomen and pelvis without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
2 (18203942) 4
MRI abdomen and pelvis without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
2 (18203942) 4
Tc-99m DMSA scan kidney Usually not appropriate ☢☢☢ 1-10 mSv 1 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
2 (18203942) 4
Radiography abdomen and pelvis (KUB) Usually not appropriate ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
2 (18203942) 4
Fluoroscopy antegrade pyelography Usually not appropriate ☢☢☢ 1-10 mSv 1 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
2 (18203942) 4
US color Doppler kidneys and bladder retroperitoneal Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 13 3 0 0 0 0 0 0 0
Variant 2: Acute pyelonephritis. Complicated patient (eg, diabetes or immunocompromised or history of stones or prior renal surgery or not responding to therapy). Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT abdomen and pelvis with IV contrast Usually appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 0 1 1 0 3 7 4
References Study Quality
2 (18203942) 4
8 (16937102) 4
13 (17318482) 4
14 (9391748) 4
18 (18463916) 4
19 (24443116) 3
CT abdomen and pelvis without and with IV contrast Usually appropriate ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 8 8 0 0 0 0 1 2 0 7 6
References Study Quality
2 (18203942) 4
8 (16937102) 4
20 (27563103) 2
MRI abdomen without and with IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 6 6 1 0 0 1 2 6 5 1 0
CT abdomen and pelvis without IV contrast May be appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 0 2 7 6 0 1 0
References Study Quality
2 (18203942) 4
4 (3888134) 2
7 (2655002) 4
11 (3883000) 4
12 (7789019) 4
13 (17318482) 4
14 (9391748) 4
15 (10961277) 4
16 (9225387) 4
17 (8596845) 3
MRI abdomen without IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 5 5 1 1 0 3 5 6 0 0 0
MRI abdomen and pelvis without IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 5 5 0 1 1 4 7 3 0 0 0
References Study Quality
7 (2655002) 4
13 (17318482) 4
18 (18463916) 4
19 (24443116) 3
MRI abdomen and pelvis without and with IV contrast May be appropriate (Disagreement) O 0 mSv O 0 mSv [ped] 5 6 0 0 2 2 3 6 3 0 0
References Study Quality
18 (18463916) 4
27 (27039324) 3
28 (11483420) 3
29 (15845792) 4
30 (23884301) 2
US color Doppler kidneys and bladder retroperitoneal May be appropriate O 0 mSv O 0 mSv [ped] 5 5 0 0 1 2 9 4 0 0 0
Tc-99m DMSA scan kidney May be appropriate ☢☢☢ 1-10 mSv 4 4 0 3 3 4 5 0 1 0 0
References Study Quality
5 (23414827) 4
27 (27039324) 3
28 (11483420) 3
29 (15845792) 4
36 (19230904) 3
37 (12592126) 1
38 (15241674) 1
39 (10966194) 4
Radiography abdomen and pelvis (KUB) Usually not appropriate ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 2 2 5 7 1 1 1 0 0 0 1
Fluoroscopy intravenous urography Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 10 3 1 0 0 0 1 0 1
References Study Quality
2 (18203942) 4
8 (16937102) 4
Fluoroscopy voiding cystourethrography Usually not appropriate ☢☢ 0.1-1mSv ☢☢ 0.03-0.3 mSv [ped] 1 1 9 1 3 1 1 0 0 0 1
References Study Quality
9 (22040289) 2
10 (15993478) 4
Fluoroscopy antegrade pyelography Usually not appropriate ☢☢☢ 1-10 mSv 1 1 10 1 0 3 0 1 0 0 1
Please refer to the supporting documentation for a more complete discussion of the concepts and their definitions below.
Final Tabulations:
A histogram of the number of panel members who rated the recommendation as noted in the column heading (ie, 1, 2, 3, …etc.)
Disagree:
The variation of the individual ratings from the median rating indicates panel disagreement on the final recommendation.
References:
Lists the references associated with the recommendation
SQ:
Study Quality (1, 2, 3, 4, Good M or Inadequate M) of the references listed.
RRL:
Information on the Relative Radiation Level (RRL) designations can be found here.