American College of Radiology
ACR Appropriateness Criteria®

Soft-Tissue Masses

Variant 1: Soft-tissue mass. Superficial or palpable. Initial imaging study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography area of interest Usually appropriate Varies Varies Varies Varies 9 9 1 0 0 0 0 0 2 0 9
US area of interest Usually appropriate O 0 mSv O 0 mSv [ped] 7 7 0 0 0 1 0 1 6 3 1
MRI area of interest without IV contrast May be appropriate (Disagreement) O 0 mSv O 0 mSv [ped] 5 1 7 0 2 0 1 0 1 1 0
MRI area of interest without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 7 1 1 1 1 0 0 1 0
FDG-PET/CT area of interest Usually not appropriate ☢☢☢☢ 10-30 mSv 1 1 10 0 1 0 0 0 0 0 1
CT area of interest without IV contrast Usually not appropriate Varies Varies Varies Varies 1 1 7 1 2 1 0 0 1 0 0
CT area of interest without and with IV contrast Usually not appropriate Varies Varies Varies Varies 1 1 10 0 0 0 2 0 0 0 0
CT area of interest with IV contrast Usually not appropriate Varies Varies Varies Varies 1 1 8 2 0 1 0 1 0 0 0
Variant 2: Soft-tissue mass. Nonsuperficial (deep) or nonspecific clinical assessment or located in an area difficult to adequately evaluate with radiographs (flank, paraspinal region, groin, or deep soft tissues of the hands and feet.). Initial imaging study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Radiography area of interest Usually appropriate Varies Varies Varies Varies 9 9 0 0 0 0 0 0 1 1 10
US area of interest May be appropriate O 0 mSv O 0 mSv [ped] 5 5 1 0 0 2 4 3 2 0 0
CT area of interest without and with IV contrast May be appropriate (Disagreement) Varies Varies Varies Varies 5 5 2 1 2 0 4 0 3 0 0
CT area of interest without IV contrast May be appropriate (Disagreement) Varies Varies Varies Varies 5 4 4 0 2 0 4 1 1 0 0
MRI area of interest without and with IV contrast May be appropriate (Disagreement) O 0 mSv O 0 mSv [ped] 5 5 4 0 0 1 3 1 3 0 0
MRI area of interest without IV contrast May be appropriate (Disagreement) O 0 mSv O 0 mSv [ped] 5 6 3 0 0 1 2 5 1 0 0
FDG-PET/CT area of interest Usually not appropriate ☢☢☢☢ 10-30 mSv 1 1 10 0 0 0 1 0 1 0 0
CT area of interest with IV contrast Usually not appropriate Varies Varies Varies Varies 1 1 7 0 2 1 1 0 1 0 0
Variant 3: Soft-tissue mass. Nondiagnostic initial evaluation (ultrasound and/or radiograph). Next imaging study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI area of interest without and with IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 9 9 0 0 0 1 0 2 0 3 6
MRI area of interest without IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 9 9 0 0 0 0 2 0 2 2 6
CT area of interest with IV contrast May be appropriate (Disagreement) Varies Varies Varies Varies 5 5 2 1 0 0 5 1 2 1 0
CT area of interest without IV contrast May be appropriate Varies Varies Varies Varies 4 4 3 1 2 3 2 1 0 0 0
CT area of interest without and with IV contrast Usually not appropriate Varies Varies Varies Varies 1 1 7 1 1 1 2 0 0 0 0
FDG-PET/CT area of interest Usually not appropriate ☢☢☢☢ 10-30 mSv 1 1 7 1 2 0 1 0 1 0 0
Variant 4: Soft-tissue mass. Nondiagnostic initial evaluation. Presenting with spontaneous hemorrhage or suspicion of vascular mass. Next imaging study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI area of interest without and with IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 9 9 1 0 0 1 0 1 0 2 7
CT area of interest without and with IV contrast Usually appropriate Varies Varies Varies Varies 7 7 0 0 0 0 3 3 3 1 2
CTA area of interest with IV contrast May be appropriate Varies Varies Varies Varies 6 6 0 0 0 1 5 0 4 2 0
MRA area of interest with IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 6 6 0 0 1 0 3 4 4 0 0
MRI area of interest without IV contrast May be appropriate (Disagreement) O 0 mSv O 0 mSv [ped] 5 5 2 0 0 3 5 2 0 0 0
CT area of interest without IV contrast May be appropriate Varies Varies Varies Varies 4 4 3 0 3 4 2 0 0 0 0
CT area of interest with IV contrast May be appropriate Varies Varies Varies Varies 4 4 4 0 0 3 4 0 1 0 0
FDG-PET/CT area of interest May be appropriate ☢☢☢☢ 10-30 mSv 4 4 2 1 2 3 4 0 0 0 0
US area of interest Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 7 0 2 0 2 1 0 0 0
Variant 5: Soft-tissue mass. Nondiagnostic initial evaluation. Patient non-MRI compatible or with metal limiting MR evaluation. Next imaging study.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT area of interest with IV contrast Usually appropriate Varies Varies Varies Varies 9 9 0 1 0 0 1 1 2 1 6
CT area of interest without and with IV contrast Usually appropriate Varies Varies Varies Varies 8 8 1 0 0 0 2 2 1 0 6
CT area of interest without IV contrast May be appropriate Varies Varies Varies Varies 6 6 0 0 1 0 4 3 2 1 1
FDG-PET/CT area of interest May be appropriate ☢☢☢☢ 10-30 mSv 5 5 2 0 0 2 8 0 0 0 0
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.