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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Kransdorf MJ, Murphey MD, Wessell DE, et al. ACR Appropriateness Criteria® Soft-Tissue Masses. J Am Coll Radiol 2018;15:S189-S97. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for soft-tissue masses. No results stated in abstract. 4
2. Reis SP, Majdalany BS, AbuRahma AF, et al. ACR Appropriateness Criteria® Pulsatile Abdominal Mass Suspected Abdominal Aortic Aneurysm. J Am Coll Radiol 2017;14:S258-S65. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for pulsatile abdominal mass suspected abdominal aortic aneurysm. No results stated in abstract. 4
3. American College of Radiology. ACR Appropriateness Criteria®: Clinically Suspected Adnexal Mass. Available at: https://acsearch.acr.org/docs/69466/Narrative/. Review/Other-Dx N/A To assess the appropriateness of modalities for scenarios related to clinically suspected adnexal mass. No abstract available. 4
4. Makni A, Jouini M, Kacem M, Safta ZB. Extra-hepatic intra-abdominal hydatid cyst: which characteristic, compared to the hepatic location?. Updates Surg. 65(1):25-33, 2013 Mar. Observational-Dx 34 patients To  study the epidemiological, diagnostic difficulties and therapeutic principles of Primary and Isolated Extrahepatic intra-abdominal Hydatid Cysts (PIEHC). Abdominal pain was the main symptom, and was found in 27 patients (79.4 %). Physical examination revealed an abdominal mass in 19 patients (55.9 %). In 6 patients (17.6 %) the PIEHC was incidental. Abdominal ultrasound and abdominal CT scan helped to highlight all cystic masses. The diagnosis was established preoperatively in 28 patients (84.8 %). Five patients (14.7 %) were operated with a diagnosis other than PIEHC. The diagnosis was made intraoperatively in one case (2.9 %). A laparotomy in 24 cases (70 %) was the surgical approach often used. Majority of the patients, 25 cases (73.5 %), received a conservative procedure. Only 3 patients (8.8 %) had recurrences and were reoperated. 4
5. Tarcoveanu E, Moldovanu R, Bradea C, Vlad N, Ciobanu D, Vasilescu A. Laparoscopic Treatment of Intraabdominal Cystic Lymphangioma. Chirurgia (Bucur). 111(3):236-41, 2016 May-Jun. Observational-Dx 9 patients To clarify the clinical manifestations of this disease, revealing the diagnostic difficulties and the therapeutic problems. There were 8 women and 1 man with median age at diagnosis was 35,6 years (range 20-51 years). Clinically, the main symptom was an abdominal pain found in 8 patients (88.8%). Physical examination revealed an abdominal mass in 5 patients (55.5%). The CL was asymptomatic in four patients; the discovery of CL was performed preoperatively during an ultrasound for another pathology (n=3) or intraoperatively (n=1). US exam CT scan usually allow the preoperative diagnosis. The most common site was shared equally between the mesentery (n = 3; 33%) and left retroperitoneum (n = 3;33%), followed by the right retroperitoneum and the posterior cavity of the lesser omentum and great omentum, each one case. The most common procedures performed were: laparoscopic total cystectomy of a closed cyst in two patients and evacuation of larger cysts followed by total cystectomy in seven patients. No conversion, no mortalities and no morbidity was noted. Mean hospital stay was 3.4 days. No recidive after 28 months in the average after treatment. 4
6. Zhou Z, Zhou J, Wu Z, Peng B. Laparoscopic splenectomy for adult lymphangiomas of the spleen: case series and review of literature. Hepatogastroenterology. 61(130):285-90, 2014 Mar-Apr. Observational-Tx 7 patients To further elucidate the feature of this tumor and laparoscopic management of spleen lymphangiomas. Patients' symptoms included abdominal pain (28.6%), palpable abdominal mass with nausea (14.3%). Four patients (57.1%) were asymptomatic at diagnosis. The preoperative diagnosis depended on ultrasonography, computed tomography and final needle aspiration. No patient had multiple splenic lesions before. Mean operative time was 112 min. Mean estimated blood loss was 78.6 ml. Pathological examinations confirmed the preoperative diagnosis. No preoperative and postoperative complications have occurred. There were no recurrences at a median follow-up of 31 months. 4
7. Zhu QQ, Zhu WR, Wu JT, Chen WX, Wang SA. Comparative study of intestinal tuberculosis and primary small intestinal lymphoma. World J Gastroenterol. 20(15):4446-52, 2014 Apr 21. Observational-Dx 41 intestinal tuberculosis patients; 37 primary small lymphoma patients To characterize the clinical, radiological, endoscopic and pathological features of intestinal tuberculosis (ITB) and primary small intestinal lymphoma (PSIL). Night sweating, fever, pulmonary TB and ascites were discovered significantly more often in ITB than in PSIL patients (P < 0.05), however, abdominal mass, hematochezia and intestinal perforation were found significantly more frequently in PSIL than in ITB patients (P < 0.05). Ring-like and rodent-like ulcers occurred significantly more often in ITB than in PSIL patients (P < 0.05), however, enterorrhagia and raised lesions were significantly more frequent in PSIL than in ITB patients (P < 0.05). The rate of granuloma was significantly higher in ITB than in PSIL patients (87.8% vs 13.5%, chi(2) = 43.050, P < 0.05), and the incidence of confluent granulomas with caseous necrosis was significantly higher in ITB than in PSIL patients (47.2% vs 0.0%, chi(2) = 4.034, P < 0.05). Multi-segmental lesions, mural stratification, mural gas sign, and intestinal stricture were more frequent in ITB than in PSIL patients (P < 0.05), however, a single-layer thickening of bowel wall, single segmental lesions, and intussusception were more common in PSIL than in ITB patients (P < 0.05). Necrotic lymph nodes, comb sign and inflammatory mass were more frequent in ITB than in PSIL patients (P < 0.05). The bowel wall enhancement in ITB patients was greater than that in PSIL patients (P < 0.05), while the thickening and lymph node enlargement in PSIL patients were higher than those in ITB patients (P < 0.05). 3
8. Dixon AK, Fry IK, Kingham JG, McLean AM, White FE. Computed tomography in patients with an abdominal mass: effective and efficient? A controlled trial. Lancet. 1981;1(8231):1199-1201. Experimental-Dx 53 patients; 28 had CT as initial imaging technique To evaluate CT vs non-cross-sectional imaging in diagnosing palpable abdominal mass. Time to diagnosis and in-patients days less with CT. CT diagnosed 96% correctly. Combination of non-cross-sectional imaging studies correct in 88%. CT seems accurate in the investigation of a palpable abdominal mass and particularly useful in excluding a pathological cause. The need for the latter is emphasized by the fact that no lesion could be found in 23/53 patients. 1
9. Williams MP, Scott IH, Dixon AK. Computed tomography in 101 patients with a palpable abdominal mass. Clin Radiol. 1984;35(4):293-296. Observational-Dx 101 patients Retrospective review to assess CT for verifying presence of a mass, and characterizing it. 99% sensitivity, 97% specificity, 99% PPV, and 97% NPV. Such high PPV and NPV indicate the value of CT in determining the presence or absence of a lesion to account for a clinically apparent mass, especially when there is doubt as to its presence or organ of origin. As to the cause of the mass, CT correctly identified the responsible organ or structure in 64/69 patients with a lesion (93%) and suggested the likely nature in 61 (88%). 3
10. Roberts AS, Shetty AS, Mellnick VM, Pickhardt PJ, Bhalla S, Menias CO. Extramedullary haematopoiesis: radiological imaging features. [Review]. Clin Radiol. 71(9):807-14, 2016 Sep. Review/Other-Dx N/A To review the common and uncommon imaging appearances of EMH by anatomical compartment. No results stated in abstract. 4
11. Lipnik AJ, Brown DB. Image-Guided Percutaneous Abdominal Mass Biopsy: Technical and Clinical Considerations. [Review]. Radiol Clin North Am. 53(5):1049-59, 2015 Sep. Review/Other-Dx N/A To describe  the basic technique of percutaneous biopsy, including the different modalities available for imaging guidance. No results stated in abstract. 4
12. Sainani NI, Arellano RS, Shyn PB, Gervais DA, Mueller PR, Silverman SG. The challenging image-guided abdominal mass biopsy: established and emerging techniques 'if you can see it, you can biopsy it'. [Review]. Abdom Imaging. 38(4):672-96, 2013 Aug. Review/Other-Dx N/A To review techniques of image-guided abdominal mass biopsy. No results stated in abstract. 4
13. Vanoeteren X, Devreese K, De Munter P. Abdominal actinomycosis: a rare complication after cholecystectomy. Acta Clin Belg. 69(2):152-6, 2014 Apr. Review/Other-Dx 1 patient To present a case of abdominal actinomycosis occurring in a 74-year-old female with a history of cholecystectomy 42 months before presentation. No results stated in abstract. 4
14. Blake MA, Kalra MK, Sweeney AT, et al. Distinguishing benign from malignant adrenal masses: multi-detector row CT protocol with 10-minute delay. Radiology. 238(2):578-85, 2006 Feb. Observational-Dx 99 patients To retrospectively evaluate the accuracy of precontrast attenuation, relative percentage washout (RPW), and absolute percentage washout (APW) in distinguishing benign from malignant adrenal masses at multi-detector row computed tomography (CT). By using an RPW of 37.5% and excluding cysts and myelolipomas, all malignant lesions were detected with a sensitivity of 100% (17 of 17 lesions) and a specificity of 95% (90 of 95 lesions). Area under the binomial ROC curve (A(z)) values were 0.912, 0.985, and 0.892 for precontrast attenuation, RPW, and APW, respectively. Precontrast attenuation of less than 0 or more than 43 HU indicated benign and malignant entities, respectively. Incorporation of these criteria into the APW analysis yielded a sensitivity of 100% (17 of 17 lesions) and a specificity of 98% (93 of 95 lesions) for a threshold washout value of 52.0%. This attenuation-corrected APW generated the greatest A(z) value (ie, 0.988). Combining all the information available from the protocol yielded a sensitivity of 100% (17 of 17 lesions) and a specificity of 98% (98 of 100 lesions) for differentiating benign from malignant masses. 3
15. Love L, Malone A, Churchill R, et al. Intravenous contrast bolus in computed tomography investigation of mass lesion. Diagn Imaging Clin Med. 53(2):57-66, 1984. Review/Other-Dx N/A To describe using bolus intravenous contrast and 5-sceond scanning capability. No results stated in abstract. 4
16. Aspelin P, Hildell J, Karlsson S, Sigurjonson S. Ultrasonic evaluation of palpable abdominal masses. Acta Chir Scand. 1980;146(7):501-506. Review/Other-Dx 50 patients To evaluate US to diagnose and characterize palpable abdominal masses. Of the 45 patients with a mass, US verified the mass in 43 patients (96%) and a correct origin of the mass was found in 41 patients (91%). The exact nature of the lesion was diagnosed in 32 patients (71%). In 2 patients US was falsely negative. 4
17. Barker CS, Lindsell DR. Ultrasound of the palpable abdominal mass. Clin Radiol. 1990;41(2):98-99. Observational-Dx 104 patients Retrospective study to assess US as the initial imaging study in patients with palpable abdominal mass. Sensitivity, specificity, PPV and NPV all greater than 95%. 69 patients had an abnormality responsible for the clinically palpable mass and 35 patients did not. There was 1 false positive US diagnosis and 1 false negative. The correct organ of origin was suggested in 60 patients and the correct pathological diagnosis in 53 patients. The high PPV (99%) and NPV (97%) for the presence or absence of a lesion in these patients compare very well with the investigation of such patients by CT. It is suggested that US should be the initial investigation. 3
18. Colquhoun IR, Saywell WR, Dewbury KC. An analysis of referrals for primary diagnostic abdominal ultrasound to a general X-ray department. British Journal of Radiology. 61(724):297-300, 1988 Apr. Review/Other-Dx 1,861 patients To identify inappropriate requests by correlating referral patterns, clinical diagnoses and the findings from US examination. Abnormalities were found in 30% of examinations. Comparison of outpatient and family practitioner referrals in cases of suspected gallstones (24%:27%) indicated the value of general practitioner access. There was also evidence, in the absence of a dilated common bile duct, that there was little value in extending the examination of the gallbladder. In post-cholecystectomy syndrome, endoscopic retrograde cholangiography is shown to be the investigation of choice. When only indication was pain, US positive in 15%. When mass was palpable, US positive in 38%. 4
19. Holm HH, Gammelgaard J, Jensen F, Smith EH, Hillman BJ. Ultrasound in the diagnosis of a palpable abdominal mass. A prospective study of 107 patients. Gastrointest Radiol. 1982;7(2):149-151. Review/Other-Dx 107 consecutive patients To determine the reliability of US in a consecutive series of patients with the clinical finding of a palpable abdominal mass. 29 different US diagnoses were reached. In 98 (97%) of the patients the US diagnoses were correct. Two uterine leiomyomas were erroneously diagnosed as ovarian in origin, and a massive adrenal carcinoma was misdiagnosed as a hepatic tumor. It is suggested that US scanning is the method of choice in evaluating patients with a palpable abdominal mass. 4
20. Annuar Z, Sakijan AS, Annuar N, Kooi GH. Ultrasound in the diagnosis of palpable abdominal masses in children. Med J Malaysia. 1990;45(4):281-287. Observational-Dx 125 children To evaluate US plus clinical data used to diagnose the nature of palpable abdominal masses in pediatric patients. US correctly diagnosed 78% of masses (scans read as negative had no follow-up). Correct diagnoses of all cases of adrenal hematoma, psoas abscess, liver hematoma, liver abscess and one case of liver metastases were achieved with correlation of relevant clinical information. 4
21. White M, Stella J. Ovarian torsion: 10-year perspective. Emerg Med Australas. 2005;17(3):231-237. Review/Other-Dx 52 cases A retrospective case review to define the presenting symptoms and clinical progress of surgically proven cases of ovarian torsion presenting to a tertiary women’s hospital. Median time to diagnosis was 22 hours (interquartile range: 7.8–55.0). The diagnosis was mostly made at surgery (36, 69.2%, 95% CI, 60.5%–77.9%) with clinically suspicion in 10 (19.2%, 95% CI, 17.2%–21.3%) and US suspicion/confirmation in 6 (11.5%, 95% CI, 10.5%–12.5%) cases. US was performed in 31 (59.6%, 95% CI, 51.7%–67.6%) cases. Underlying pathologies included: ovarian cysts (27, 51.9%, 95% CI, 44.9%–59.0%) and tumors (16, 30.8%, 95% CI, 26.9%–34.6%) –mostly benign. Ovarian preservation occurred in 16 (30.8%, 95% CI, 26.9%–34.6%) cases with no demonstrable association to patient age, time to diagnosis or known risk factors. The main clinical features included: sudden pain, nausea/vomiting and palpable abdominal mass. Clinical characteristics lack sensitivity and specificity and US diagnosis is not definitive. Laparoscopy remains the investigation of choice. 4
22. Arishenkoff S, Eddy C, Roberts JM, et al. Accuracy of Spleen Measurement by Medical Residents Using Hand-Carried Ultrasound. Journal of Ultrasound in Medicine. 34(12):2203-7, 2015 Dec. Experimental-Dx 12 residents To determine whether medical residents could reliably assess spleen size using hand-carried ultrasound after a brief educational intervention. Twelve first-year residents (8 male and 4 female; mean age +/- SEM, 28 +/- 1 years; all with limited prior ultrasound training) and 19 patients and staff members (10 male and 9 female; mean age, 60 +/- 4 years; body mass index, 24 +/- 2 kg/m(2)) were recruited. The greatest longitudinal measurements were 14.0 +/- 0.7 cm with conventional ultrasound administered by the sonographer and 13.2 +/- 0.9 cm with hand-carried ultrasound administered by the residents (P > .05, not significant). The correlation between conventional and hand-carried ultrasound was r = 0.81 (P < .001). 2
23. Colli A, Prati D, Fraquelli M, et al. The use of a pocket-sized ultrasound device improves physical examination: results of an in- and outpatient cohort study. PLoS ONE [Electronic Resource]. 10(3):e0122181, 2015. Observational-Dx 1962 patients To assess whether the use of pocket mobile ultrasound devices (PUD) in the context of physical examination can reduce the prescription of additional tests when used by physicians in different clinical settings. he 1962 patients included 37% in-patients, 26% gastroenterology outpatients, 37% from general practices. Further testing after PUD examination was deemed unnecessary in 63%. Only 5% of patients with negative PUD not referred for further testing were classified false negatives with respect to the final diagnosis. In patients undergoing further tests, the sensitivity was 91%, and the specificity 83%. 3
24. Atamanalp SS. Sigmoid volvulus: diagnosis in 938 patients over 45.5 years. Techniques in Coloproctology. 17(4):419-24, 2013 Aug. Review/Other-Dx 938 patients To investigate the diagnosis approach to 938 patients with sigmoid volvulus treated at an institution and their clinical outcomes. A total of 210 (25.1%) of 837 patients, who provided information on anamnesis and clinical features, had recurrent episodes of volvulus; 215 patients (25.7%) had comorbidities, and 108 patients (12.9%) presented with toxic or hypovolemic shock. The mean duration of symptoms was 38.7 h (range 6 h to 7 days), and the most common clinical features were abdominal pain and tenderness (827/837 patients, 98.8%), distention (805 patients, 96.2%), and obstipation (771 patients, 92.1%). The final diagnosis was made with endoscopy in 519 patients (55.3%), endoscopy followed by surgery in 154 patients (16.4%) and at surgery in 265 patients (28.3%). The correct diagnosis rate was 71.6% based on clinical findings compared with 66.7% based on radiography, 81.4% based on both clinical and radiography findings, and 100.0% based on CT or MRI findings. 4
25. Baleato-Gonzalez S, Vilanova JC, Garcia-Figueiras R, Juez IB, Martinez de Alegria A. Intussusception in adults: what radiologists should know. Emerg Radiol. 2012;19(2):89-101. Review/Other-Dx N/A To illustrate several causes of adult intussusception with a variety of radiological findings on radiography, US, CT, MRI, and endoscopy seen at our institution. Imaging plays a major role in the diagnosis and in determining the appropriate treatment. 4
26. Chang CJ, Hsieh TH, Tsai KC, Fan CM. Sigmoid volvulus in a young woman nearly misdiagnosed as fecal impaction. J Emerg Med. 2013;44(3):611-613. Review/Other-Dx 1 woman To report a previously healthy young woman with the triad of constipation, progressive abdominal distension, and severe abdominal pain, with plain-film x-ray studies mimicking stool impaction and CT disclosing the typical findings of sigmoid volvulus. Sigmoid volvulus is rarely seen in developed countries. Clinical manifestations vary with disease progression, but it typically presents with a triad of constipation, progressive abdominal distension, and severe abdominal pain. Plain-film x-ray studies can demonstrate a coffee bean or "omega loop" (inverted-U sigmoid) sign in <60% cases, but it was reported as high as 86% in CT. The whirl sign on CT might also be observed. The cause is multifactorial and colonic length is the most important predisposing factor. Flexible colon fiberscopic decompression followed by elective definitive surgery is the treatment choice, but exploratory laparotomy is mandatory if any complicated entity occurs. The mortality rate is still >50% when bowel gangrene develops. 4
27. Osiro SB, Cunningham D, Shoja MM, Tubbs RS, Gielecki J, Loukas M. The twisted colon: a review of sigmoid volvulus. Am Surg. 2012;78(3):271-279. Review/Other-Dx N/A A review of sigmoid volvulus. Abdominal radiography is used to diagnose sigmoid volvulus in most cases with CT scan or MRI as the confirmatory tests when necessary. 4
28. Patel DR, Levine MS, Rubesin SE, Zafar H, Lev-Toaff AS. Comparison of small bowel follow through and abdominal CT for detecting recurrent Crohn's disease in neoterminal ileum. Eur J Radiol. 82(3):464-71, 2013 Mar. Observational-Dx 52 patients To assess the findings of recurrent Crohn's disease in the neoterminal ileum on small bowel follow through and CT as well as the overall diagnostic performance of these imaging tests. Small bowel follow through had a sensitivity of 90%, specificity of 85%, PPV of 95%, and NPV of 73% for detecting recurrent Crohn's disease, and CT had a sensitivity of 77%, specificity of 69%, PPV of 88%, and NPV of 50%. These tests combined had a sensitivity of 95%, specificity of 69%, PPV of 90%, and NPV of 82%. The most common findings were luminal narrowing, thickened folds, and ulcers (especially aphthoid lesions) on small bowel follow through and bowel wall thickening on CT. CT also revealed extraenteric collections not visualized on SBFT in 3 patients (8%). 3
29. Williams KJ, Hayes AJ. A guide to oncological management of soft tissue tumours of the abdominal wall. [Review]. Hernia. 18(1):91-7, 2014 Feb. Review/Other-Dx N/A To present the available literature on the diagnosis and management of both fibromatosis and soft tissue sarcoma, in the context of our experience in a tertiary referral centre for sarcoma. Appropriate cross-sectional imaging and a pre-operative tissue diagnosis by percutaneous core biopsy are necessary to define management. Desmoid fibromatosis can be managed initially by observation with serial imaging, with surgery being reserved for those patients who demonstrate progression. Soft tissue sarcoma can display a range of pathologies from relatively indolent tumours to locally aggressive sarcomas that can readily metastasise. An accurate pre-operative histological diagnosis and staging enables a multidisciplinary approach to management. This may include chemotherapy and radiotherapy, but the mainstay of treatment remains wide surgical resection and abdominal wall reconstruction. Patient outcomes are worse if referral is delayed or if the sarcoma is incompletely resected without an initial tissue diagnosis. 4
30. Bashir U, Moskovic E, Strauss D, et al. Soft-tissue masses in the abdominal wall. [Review]. Clin Radiol. 69(10):e422-31, 2014 Oct. Review/Other-Dx N/A To describe a diagnostic approach, imaging features of the most common causes of abdominal wall masses, and highly specific characteristics of less common diseases. No results stated in abstract. 4
31. Lakkaraju A, Sinha R, Garikipati R, Edward S, Robinson P. Ultrasound for initial evaluation and triage of clinically suspicious soft-tissue masses. Clin Radiol. 64(6):615-21, 2009 Jun. Observational-Dx 358 consecutive patients To evaluate the efficacy of ultrasound as a first-line investigation in patients with a clinical soft-tissue mass. Two hundred and eighty-four of the 358 (79%) lesions were classified as benign (categories 1-5). On follow-up 15 of the 284 patients were re-referred but none (284/284) had a malignancy on follow-up (24-30 months). Overall at ultrasound 33 lesions were larger than 5 cm, 42 lesions were deep to deep fascia with 20 showing both features. In this subgroup of 95 patients there were six malignant tumours with the rest benign. Seventy-three of the 358 patients underwent MRI; the results of which indicated that there were 60 benign or non-tumours, 10 possible sarcomas, and three indeterminate lesions. Overall six of 12 (6/358, 1.68% of total patients) lesions deemed to represent possible sarcomas on imaging were sarcomas. Ultrasound is an effective diagnostic triage tool for the evaluation of soft-tissue masses referred from primary care. 3
32. Ahn SE, Park SJ, Moon SK, Lee DH, Lim JW. Sonography of Abdominal Wall Masses and Masslike Lesions: Correlation With Computed Tomography and Magnetic Resonance Imaging. J Ultrasound Med. 35(1):189-208, 2016 Jan. Review/Other-Dx N/A To review benign neoplasms, malignant neoplasms, infections, inflammations,and miscellaneous conditions of the abdominal wall. No results stated in abstract. 4
33. Mostafa HA, Saad JH, Nadeem Z, Alharbi F. Rectus abdominis endometriosis. A descriptive analysis of 10 cases concerning this rare occurrence. Saudi Med J. 34(10):1035-42, 2013 Oct. Observational-Dx 10 patients To report 10 cases of rectus abdominis endometrioma, emphasizing the clinical presentations, imaging investigations, cytohistological findings, and surgical treatment employed. This study was carried out in 10 women with a mean age of 33.9 years. Nine cases had previous history of cesarean section (CS) while one patient had laparoscopy converted to laparotomy for ovarian cyst. All patients were presented with abdominal pain but only 3 had a palpable mass. Ten lesions within the rectus abdominis muscle were detected with automated ultrasound and MRI depicted one lesion, which was missed by ultrasound in a patient who had 2 concomitant lesions. Preoperative fine needle aspiration (FNA) was carried out in 2 patients. Wide surgical excision was performed in all cases. Histopathology was confirmatory in each instance. No complications or recurrence were recorded on follow-up (6-24 months; mean 13.2 months). 4
34. Smithson A, Ruiz J, Perello R, Valverde M, Ramos J, Garzo L. Diagnostic and management of spontaneous rectus sheath hematoma. EUR. J. INTERN. MED.. 24(6):579-82, 2013 Sep. Observational-Dx 24 patients To describe the management of a spontaneous rectus sheath hematoma. 24 patients were included (66% women; mean age: 74years; range: 54-87). All cases presented predisposing factors mainly anticoagulant therapy in 21 (87.5%) patients, hypertension in 19 (79.1%) and abdominal surgery in 12 (50%) cases. Eighteen (75%) referred triggering factors like coughing being the most common one, present in 17 (70.8%) patients. The main clinical findings were abdominal pain in 21 (87.5%) cases and the existence of an abdominal mass in 20 (83.3%). The diagnosis was confirmed by abdominal ultrasonography and/or computerized tomography in 23 (95.8%) patients. Nineteen cases (79.1%) responded to conservative management while 5 (20.8%) required interventional treatment, which consisted in an arteriography with selective embolization of the epigastric arteries in all cases. Four (80%) of the patients needing interventional treatment were receiving low molecular weight heparin. Nine (37.5%) patients developed hypovolemic shock and 1 (4%) died. 4
35. Solak A, Sahin N, Genc B, Sever AR, Genc M, Sivrikoz ON. Diagnostic value of susceptibility-weighted imaging of abdominal wall endometriomas during the cyclic menstrual changes: a preliminary study. Eur J Radiol. 82(9):e411-6, 2013 Sep. Observational-Dx 14 patients To investigate the value of susceptibility-weighted imaging (SWI) for the evaluation of cyclic morphological and hemorrhagic changes in abdominal wall endometriomas (AWE). There was no significant difference in the size of the lesions in the early days of the menstruation compared to the mid-menstrual period. The SWI taken on mid-cycle phase showed that the center was hyperintense and the peripheral zone was hypointense in all lesions. A signal void related to increased blood and the shrinkage of complete disappearance of hyperintensity in the venter of the lesion was seen 15 (88%) of the 17 cases on the SWI series performed during the menstrual phase scan. 3
36. Zhang J, Liu X. Clinicopathological features of endometriosis in abdominal wall--clinical analysis of 151 cases. Clin Exp Obstet Gynecol. 43(3):379-83, 2016. Observational-Dx 151 patients To explore the clinicopathological features of abdominal wall endometriosis (AWE). Most patients (80.1%) presented with cyclic pain and/or cyclic abdominal masses. The latent period of AWE patients was 31.48 +/- 28.27 months (three to 192 months), which was not correlated with factors related to previous cesarean section (CS) (such as age at CS, incision site, gestational week at CS, baby's birth weight, lactation period, postpartum menstruation recovery, choices of contraceptives, etc). The duration of disease was 33.07 +/- 28.58 months (two to 168 months), which was negatively correlated with the latent period (r = -0.267, p = 0.043). The pre-operational ultrasonography detection rate was 97.4% (147/151 cases). The lesion size detected by preoperative ultrasonography was significantly smaller than that measured intraoperatively by palpation (21.6 +/- 20.7mm vs. 30.21 +/- 30.9mm p < 0.05). Moreover, only 26.5% (40/151 cases), in AWE patients the infiltration depth was revealed by preoperative ultrasonography. All patients received surgical treatment. The symptoms were relieved in 93.4% (141/151 cases) patients after surgery. The recurrence rate was 7.3% (11/151 cases) while the average recurrent time was 19.8 +/- 15.99 months. The recurrence rate was significantly lower in postoperative medication group than that in non-medication one (p < 0.05). In addition, the morphologic features of AWE lesions also contributed to recurrence. The duration of disease in large scar endometrioma (LSE) group (the diameter of lesions >/= three cm) was significantly longer than that in small scar endometrioma (SSE) group (the diameter of lesions < three cm), while SSE group had higher recurrence rate (p < 0.05). 4
37. Otero S, Moskovic EC, Strauss DC, et al. Desmoid-type fibromatosis. [Review]. Clin Radiol. 70(9):1038-45, 2015 Sep. Review/Other-Dx N/A To discuss the typical imaging characteristics of desmoid-type fibromatosis lesions and suggest diagnostic and follow-up magnetic resonance imaging protocols, with details of suitable sequences and scanning intervals No results stated in abstract. 4
38. Virmani V, Sethi V, Fasih N, Ryan J, Kielar A. The abdominal wall lumps and bumps: cross-sectional imaging spectrum. [Review]. Can Assoc Radiol J. 65(1):9-18, 2014 Feb. Review/Other-Dx N/A To review the cross-sectional imaging spectrum of abnormalities that affect the abdominal wall, with emphasis on magnetic resonance imaging (MRI). No results stated in abstract. 4
39. Rindos NB, Mansuria S. Diagnosis and Management of Abdominal Wall Endometriosis: A Systematic Review and Clinical Recommendations. [Review]. Obstet Gynecol Surv. 72(2):116-122, 2017 Feb. Review/Other-Dx N/A To review the diagnosis and management of abdominal wall endometriosis (AWE),  a condition that generally develops after surgery but may arise spontaneously. No results stated in abstract. 4
40. Gaskin CM, Helms CA. Lipomas, lipoma variants, and well-differentiated liposarcomas (atypical lipomas): results of MRI evaluations of 126 consecutive fatty masses. AJR Am J Roentgenol. 182(3):733-9, 2004 Mar. Observational-Dx 126 masses To evaluate the reliability of MRI in distinguishing simple lipomas, lipoma variants, and well-differentiated liposarcomas (atypical lipomas) and to identify various imaging mimics of well-differentiated liposarcoma. The success of MRI in identifying well-differentiated liposarcomas among other fatty masses was as follows: sensitivity, 100%; specificity, 83%; accuracy, 84%; positive predictive value, 38%; and negative predictive value, 100%. MRI was 100% specific in the diagnosis of simple lipoma. Sixty-three percent of lesions considered suspicious for well-differentiated liposarcoma were actually simple lipomas (13%) and benign lipoma variants (50%), including chondroid lipoma (13%), osteolipoma (6%), hibernoma (6%), lipoleiomyoma (6%), angiolipoma (6%), and infarcted lipoma (13%). 3
41. Jaffe TA, O'Connell MJ, Harris JP, Paulson EK, Delong DM. MDCT of abdominal wall hernias: is there a role for valsalva's maneuver? AJR Am J Roentgenol 2005;184:847-51. Observational-Dx 100 patients To evaluate the role of Valsalva's maneuver during MDCT for the diagnosis and characterization of abdominal wall hernias. The three reviewers identified a mean of 72 abdominal wall hernias (72%). The reviewers agreed (kappa = 0.723) with respect to the presence of a hernia. AP diameters increased an average of 1.33 cm during Valsalva's maneuver (p < 0.001). The transverse diameter of the fascial defect increased an average of 0.66 cm and the AP diameter of the hernia sac increased an average of 0.79 cm during Valsalva's maneuver (p < 0.001). Fifty percent of the hernias became more apparent with Valsalva's maneuver. Ten percent of the hernias could be detected only on the scan obtained during Valsalva's maneuver. Conversely, in no patients was the hernia detected only on the rest scan. 3
42. Gayer G, Park C. Abdominal Wall Masses: CT Findings and Clues to Differential Diagnosis. [Review]. Semin Ultrasound CT MR. 39(2):230-246, 2018 Apr. Review/Other-Dx N/A To highlight  the importance of integrating pertinent clinical history to narrow the differential diagnosis. No results stated in abstract. 4
43. Yarmish G, Sala E, Goldman DA, et al. Abdominal wall endometriosis: differentiation from other masses using CT features. Abdom Radiol. 42(5):1517-1523, 2017 05. Observational-Dx 105 patients To assess the utility of morphologic and quantitative CT features in differentiating abdominal wall endometriosis (AWE) from other masses of the abdominal wall. 24.8% (26/105) of patients had histologically proven abdominal wall endometriosis. The other most common diagnoses included adenocarcinoma NOS (21%; 22/105), desmoid (14.3%; 15/105), and leiomyosarcoma (8.6%; 9/105). CT features significantly associated with endometriosis for both readers were location below the umbilicus (P = 0.0188), homogeneous density (P = 0.0188), and presence of linear infiltration irradiating peripherally from a central soft tissue nodule (i.e., "gorgon" sign) (P < 0.0001). The highest combined sensitivity (0.69, 95% CI: 0.48-0.86) and specificity (0.97, 95% CI: 0.91-1.00) for both readers occurred for patients having all three of these features present. Border type (P = 0.0199) was only significant for R2, peritoneal extension (P = 0.0188) was only significantly for R1, and the remainder of features were insignificant (P = 0.06-60). There was overlap in Hounsfield units on non-contrast CT (N = 26) between AWE (median: 45HU, range: 39-54) and other abdominal wall masses (median: 38.5HU, range: 15-58). 3
44. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
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