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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Johnson JR, Russo TA. Acute Pyelonephritis in Adults. N Engl J Med 2018;378:48-59. Review/Other-Dx 1 patient To discuss management strategies and formal guidelines related to a case. No results stated in abstract. 4
2. Czaja CA, Scholes D, Hooton TM, Stamm WE. Population-based epidemiologic analysis of acute pyelonephritis. Clin Infect Dis 2007;45:273-80. Observational-Dx 3236 patients To better describe the epidemiology of acute pyelonephritis in a well-defined US population over a 5-year period, including the incidence and microbial etiology among both outpatients and inpatients. Among the female population, annual rates of outpatient and inpatient pyelonephritis were 12-13 cases per 10,000 population and 3-4 cases per 10,000 population, respectively; among the male population, the rates were 2-3 cases per 10,000 population and 1-2 cases per 10,000 population, respectively. Rates were relatively stable from year to year. Incidence was highest among young women, followed by infants and the elderly population. The ratio of outpatient to inpatient cases was highest among young women (ranging from 5 : 1 to 6 : 1). Escherichia coli caused 80% of cases of acute pyelonephritis in women and 70% of cases in men and was less dominant in older age groups. Among E. coli strains, the rate of ciprofloxacin resistance increased from 0.2% of isolates to 1.5% of isolates (P=.03), and the rate of trimethoprim-sulfamethoxazole resistance decreased from 25% of isolates to 13% of isolates (P<.01) from 1997 to 2001. Among outpatient cases, the rate of fluoroquinolone use increased from 35% to 61%, whereas the rate of trimethoprim-sulfamethoxazole use decreased from 53% to 32% over the 5-year period (P<.01). 4
3. Stamm WE, Hooton TM, Johnson JR, et al. Urinary tract infections: from pathogenesis to treatment. J Infect Dis 1989;159:400-6. Review/Other-Dx N/A To review the pathogenesis and management of infections occurring in young women between late adolescence and the mid-forties. No results stated in abstract. 4
4. Talan DA, Takhar SS, Krishnadasan A, et al. Fluoroquinolone-Resistant and Extended-Spectrum beta-Lactamase-Producing Escherichia coli Infections in Patients with Pyelonephritis, United States(1). Emerg Infect Dis 2016;22:1594-603. Observational-Dx 521 patients To determine the prevalence of E. coli antimicrobial resistance among patients with acute pyelonephritis who sought care at a US emergency department (ED)–based sentinel research network. Among the 521 study patients, median age was 37 (range 18–88, interquartile range 26–52) years; 455 (87.3%) were female (Table 1). Most (446 [85.6%]) patients had a community-acquired infection; 74 (14.2%) had a healthcare-associated infection (70 with hospitalization and 9 with nursing home residence in the previous 90 days). A total of 286 (54.9%) patients had uncomplicated pyelonephritis; 235 (45.1%) had complicated pyelonephritis. 4
5. Scholes D, Hooton TM, Roberts PL, Gupta K, Stapleton AE, Stamm WE. Risk factors associated with acute pyelonephritis in healthy women. Ann Intern Med 2005;142:20-7. Review/Other-Dx 788 nonpregnant women To evaluate infection characteristics, incidence, and risk factors associated with acute pyelonephritis in a sample of women. 7% of case-patients were hospitalized. Escherichia coli was the infecting pathogen in 85% of cases. In multivariable models, factors associated with pyelonephritis risk were frequency of sexual intercourse in the previous 30 days (odds ratio, 5.6 [95% CI, 2.8 to 11.0] for > or =3 times per week), recent urinary tract infection (UTI) (odds ratio, 4.4 [CI, 2.8 to 7.1]), diabetes (odds ratio, 4.1 [CI, 1.6 to 10.9]), recent incontinence (odds ratio, 3.9 [CI. 2.6 to 5.9]), new sexual partner in the previous year (odds ratio, 2.2 [CI, 1.4 to 3.6]), recent spermicide use (odds ratio, 1.7 [CI, 1.1 to 2.8]), and UTI history in the participant's mother (odds ratio, 1.6 [CI, 1.1 to 2.5]). Risk factors for selected subgroups (patients < or = 30 years of age, patients > 30 years of age, patients with no UTI history, and inpatients) were also evaluated. 4
6. Ikaheimo R, Siitonen A, Heiskanen T, et al. Recurrence of urinary tract infection in a primary care setting: analysis of a 1-year follow-up of 179 women. Clin Infect Dis 1996;22:91-9. Observational-Dx 179 adult women (age range, 17-82 years) To evaluate the role of bacterial virulence factors in the recurrence of lower UTI. Episodes of symptomatic urinary tract infection (UTI) were recorded, and urinary isolates were compared with the index episode isolate; 147 UTI episodes were detected during the follow-up. Of these episodes, 131 were classified as recurrences occurring at least 1 month after the index episode; 44% of the patients had recurrences. A history of UTI increased the risk of recurrence; only 11.8% of the 17 patients without previous episodes of UTI had at least one recurrence, while 47.5% of those with previous episodes had at least one recurrence (OR, 6.8; univariate logistic regression). E. coli caused 78% of the recurrent episodes. Phenotypic and genotypic analysis of E. coli strains showed that one-third of the recurrences were caused by the index episode strain, which could persist and cause recurrences throughout the 1-year follow-up period. 4
7. Godaly G, Ambite I, Svanborg C. Innate immunity and genetic determinants of urinary tract infection susceptibility. Curr Opin Infect Dis 2015;28:88-96. Review/Other-Dx N/A To review the molecular basis of urinary tract infection susceptibility. No results stated in abstract. 4
8. Nikolaidis P, Dogra VS, Goldfarb S, et al. ACR Appropriateness Criteria R Acute Pyelonephritis. Journal of the American College of Radiology. 15(11S):S232-S239, 2018 Nov. 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 Acute Pyelonephritis. No abstract available. 4
9. Velasco M, Martinez JA, Moreno-Martinez A, et al. Blood cultures for women with uncomplicated acute pyelonephritis: are they necessary? Clin Infect Dis 2003;37:1127-30. Observational-Dx 583 cases To assess the utility of blood cultures in the management of uncomplicated pyelonephritis in women. We found that 97.6% of cases were nondiscordant. Clinical and microbiological evolution of infection did not differ between the 2 groups, and no changes of antibiotic therapy were required on the basis of blood culture results. 4
10. Kim Y, Seo MR, Kim SJ, et al. Usefulness of Blood Cultures and Radiologic Imaging Studies in the Management of Patients with Community-Acquired Acute Pyelonephritis. Infect Chemother 2017;49:22-30. Observational-Dx 827 patients To examine the usefulness of blood cultures and radiologic imaging studies for developing therapeutic strategies in community-acquired acute pyelonephritis (CA-APN) patients. Positive urine and blood cultures were obtained in 69.3% (568/820) and 42.7% (277/648), respectively, of a total of 827 CA-APN patients. Blood culture identified the urinary pathogen in 60 of 645 (9.3%) patients for whom both urine and blood cultures were performed; the organisms isolated from urine were inconsistent with those from blood in 11 and only blood cultures were positive in 49 patients. Final clinical failure was more common in the bacteremic patients than the non-bacteremic ones (8.0% vs. 2.7%, P = 0.003), as was hospital mortality (3.6% vs. 0.3%, P = 0.003). Likewise, durations of hospitalization and fever were significantly longer. Bacteremia was independent risk factor for mortality (OR 9.290, 1.145-75.392, P = 0.037). With regard to radiologic studies, the detection rate of APN was 84.4% (445/527) by abdominal computed tomography and 40% (72/180) by abdominal ultrasonography. Eighty-one of 683 patients (11.9%) were found to have renal abscess, perinephric abscess, urolithiasis, hydronephorosis/hydroureter or emphysematous cystitis, which could potentially impact on clinical management. Patients with Pitt score = 1, flank pain or azotemia were significantly more likely to have such structural abnormalities. 4
11. American College of Radiology. ACR Appropriateness Criteria®: Acute Onset Flank Pain-Suspicion of Stone Disease (Urolithiasis). Available at: https://acsearch.acr.org/docs/69362/Narrative/. 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 a specific clinical condition. No abstract available. 4
12. Wolfman DJ, Marko J, Nikolaidis P, et al. ACR Appropriateness Criteria® Hematuria. J Am Coll Radiol 2020;17:S138-S47. 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 hematuria. No results stated in abstract. 4
13. Venkatesan AM, Oto A, Allen BC, et al. ACR Appropriateness Criteria® Recurrent Lower Urinary Tract Infections in Females. J Am Coll Radiol 2020;17:S487-s96. 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 recurrent lower urinary tract infections in females. No results stated in abstract. 4
14. Soulen MC, Fishman EK, Goldman SM, Gatewood OM. Bacterial renal infection: role of CT. Radiology. 1989; 171(3):703-707. Observational-Dx 62 patients Retrospective review of imaging studies of patients hospitalized for acute renal infections. Abnormality more likely when fever >72 hours. CT better than US for diagnosis both abscess and pyelonephritis. 4
15. Craig WD, Wagner BJ, Travis MD. Pyelonephritis: radiologic-pathologic review. Radiographics. 2008;28(1):255-277; quiz 327-258. Review/Other-Dx N/A Review imaging of pyelonephritis. CT, when performed before, immediately after, and at delayed intervals from contrast material injection, is the preferred modality for evaluating acute bacterial pyelonephritis. CT is also preferred over conventional radiography and US for assessing emphysematous pyelonephritis. 4
16. Abraham G, Reddy YN, George G. Diagnosis of acute pyelonephritis with recent trends in management. Nephrol Dial Transplant 2012;27:3391-4. Review/Other-Dx N/A To review the diagnosis and management of acute pyelonephritis. No results stated in abstracts. 4
17. Pierce C, Keniston A, Albert RK. Imaging in Acute Pyelonephritis: Utilization, Findings, and Effect on Management. South Med J. 112(2):118-124, 2019 02. Observational-Dx 739 patients To determine the frequency, timing, and types of imaging obtained in patients with a discharge diagnosis of acute pyelonephritis, and how often imaging findings affect therapy. Of 739 patients, 468 (63%) were imaged within 24 hours of admission, 262/414 (63%) of whom had risk factors for complications and 206/325 of whom (63%) did not. Among these, studies were positive in 117/468 (25%), 78/262 (30%) in those with risk factors, and 39/206 (19%) of those without risk factors. Of the 117 patients with positive imaging findings within 24 hours of admission, 58 (50%) underwent invasive procedures, 47 (60%) with risk factors and 11 (28%) without. Among all of the patients, interventions were directed at relieving obstructions much more commonly than treating abscess (51 patients vs 8). 3
18. Enikeev DV, Glybochko P, Alyaev Y, Enikeev M, Rapoport L. Imaging technologies in the diagnosis and treatment of acute pyelonephritis. Urologia. 84(3):179-184, 2017 Aug 01. Observational-Dx 207 patients To evaluate the possibilities of ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) in diagnosing acute pyelonephritis (AP) and renal abscess. We identified the ultrasound (US), magnetic resonance (MR), and CT-signs of acute renal inflammation at different stages of the process.The main us-signs were decreased mobility of the kidney, its enlargement, thickened parenchyma, hydrophilic parenchyma and an impairment of corticomedullary differentiation.The typical CT-signs of AP were enlargement of the kidney with its thickened parenchyma and an impairment of corticomedullary differentiation.The main MR-signs of AP were enlargement of the kidney (>12 cm lengthwise), thickened parenchyma (<2 cm in the median segment of the kidney) and an impairment of corticomedullary differentiation. 4
19. Lee A, Kim HC, Hwang SI, et al. Clinical Usefulness of Unenhanced Computed Tomography in Patients with Acute Pyelonephritis. J Korean Med Sci. 33(38):e236, 2018 Sep 17. Observational-Dx 149 patients To evaluate a clinical usefulness of UCT versus ECT in acute pyelonephritis (APN). The average patient age was 61.2 (± 10) years: 31 patients were men. Ninety-nine (66.4%) patients showed stones (18.7%), perinephric infiltration (56%), swelling (21%), and hydronephrosis (6.7%) on UCT. Seventeen patients (11.4%) had an atypical clinical course, requiring additional tests for accurate diagnosis. In 7 patients UCT and ECT results did not differ; in 10 patients, the diagnosis changed on ECT. On ECT, 112/149 (75.2%) patients had stones (16.7%), perinephric infiltrations (57%), swelling (21%), and hydronephrosis (6.7%); 62.5% showed parenchymal involvement: 34 (22.8%) patients had no abnormal ECT findings. APN CT findings are similar on stone, perinephric infiltration, swelling and hydronephrosis on both CTs. Twelve patients (8.0%) had an abnormal ECT finding, i.e., low-grade (1 and 2) parenchymal involvement. Six (4%) patients developed contrast-induced acute kidney injury within 2 days after ECT. 3
20. Bova JG, Potter JL, Arevalos E, Hopens T, Goldstein HM, Radwin HM. Renal and perirenal infection: the role of computerized tomography. J Urol. 1985; 133(3):375-378. Review/Other-Dx 24 patients Retrospective study to determine CT contribution to diagnosis of renal inflammatory disease. CT differentiates those requiring surgery from those managed medically. 4
21. Dalla-Palma L, Pozzi-Mucelli F, Pozzi-Mucelli RS. Delayed CT findings in acute renal infection. Clin Radiol. 1995; 50(6):364-370. Review/Other-Dx 12 patients Report on delayed CT findings in acute renal infection. Delayed CT appears to be useful because it improves diagnostic confidence and gives a more exact evaluation of the extent of infection. 4
22. Taniguchi LS, Torres US, Souza SM, Torres LR, D'Ippolito G. Are the unenhanced and excretory CT phases necessary for the evaluation of acute pyelonephritis?. Acta Radiol. 58(5):634-640, 2017 May. Observational-Dx 100 patients To establish the accuracy, reproducibility, and degree of confidence in CT diagnosis of acute pyelonephritis (APN) and urolithiasis using only images obtained during the nephrographic phase. The accuracy of only nephrographic phase for diagnosis of APN and urolithiasis was in the range of 90.3-91.78% and 96.27-99.25%, respectively. There was no significant difference in comparison with the triphasic reading (z: -0.4 - 0.2; P = 0.34-0.83). The average degree of confidence for APN also showed no significant variation for both readers ( P = 0.4 and 0.08). Almost perfect inter-observer agreements for the diagnosis of APN (k = 0.86, P < 0.001) and for urolithiasis (k = 0.84, P < 0.001) were observed when considering only the nephrographic phase. 2
23. Sfakianaki E, Sfakianakis GN, Georgiou M, Hsiao B. Renal scintigraphy in the acute care setting. Semin Nucl Med. 2013;43(2):114-128. Review/Other-Dx N/A To highlight the possible applications of renal scintigraphy in the acute care setting, including colic, APN, urine leaks,and ARF. No results stated in abstract. 4
24. Sattari A, Kampouridis S, Damry N, et al. CT and 99mTc-DMSA scintigraphy in adult acute pyelonephritis: a comparative study. J Comput Assist Tomogr. 2000; 24(4):600-604. Review/Other-Dx 36 patients Prospective study to evaluate the relative value of CT and Tc-99m-DMSA scintigraphy in the diagnosis of acute pyelonephritis in adult patients suspected of having UTI. 12 patients with clinical and biological signs of UTI had no CT or Tc-99m-DMSA scintigraphy abnormalities. Among these patients, lower UTI was found in 10 patients and 2 patients had ureteral obstruction. In the 24 remaining patients, the diagnosis of acute pyelonephritis was made. Among these patients, a correlation was found between CT and Tc-99m-DMSA scintigraphy in 11 cases. In two cases, both examinations were normal, and in 9 cases, both were abnormal. In 11 cases of the 13 remaining patients, abnormal CT was found with normal Tc-99m-DMSA scintigraphy, whereas the 2 last cases had normal CT and abnormal Tc-99m-DMSA scintigraphy results. In two cases, bilateral lesions found on CT manifested as unilateral abnormalities on Tc-99m-DMSA scintigraphy images. Authors conclude that CT is more accurate than Tc-99m-DMSA scintigraphy in the detection of acute pyelonephritis lesions in adult patients. 4
25. Lee JH, Kim MK, Park SE. Is a routine voiding cystourethrogram necessary in children after the first febrile urinary tract infection? Acta Paediatr. 2012;101(3):e105-109. Observational-Dx 618 children To estimate the value of identifying vesicoureteral reflux (VUR) on a voiding cystourethrogram (VCUG) and the benefit of VUR management according to imaging strategies at the first febrile urinary tract infection (UTI). Abnormal US or DMSA scans had a sensitivity of 100% and a negative predictive value (NPV) of 100% to detect high-grade reflux. In hydronephrotic kidneys, DMSA scanning had a sensitivity of 88.2% and a NPV of 97.1% to detect high-grade reflux. 2
26. Choi YD, Yang WJ, Do SH, Kim DS, Lee HY, Kim JH. Vesicoureteral reflux in adult women with uncomplicated acute pyelonephritis. Urology. 2005;66(1):55-58. Review/Other-Dx 86 patients To evaluate the significance of vesicoureteral reflux (VUR) in adult women with uncomplicated acute pyelonephritis. There were only 2 (2.3%) cases of VUR among 86 patients with uncomplicated acute pyelonephritis. No VUR was found in group I, and grade II reflux was found in 2 patients of group II. 4
27. Vivier PH, Sallem A, Beurdeley M, et al. MRI and suspected acute pyelonephritis in children: comparison of diffusion-weighted imaging with gadolinium-enhanced T1-weighted imaging. Eur Radiol. 2014;24(1):19-25. Observational-Dx 39 patients To evaluate the performance of diffusion-weighted imaging (DWI) against the reference standard of gadolinium-enhanced T1-weighted imaging (Gd-T1-WI) in children. Thirty-two kidneys (41 %) had hypo-enhancing areas on Gd-T1-W images. The sensitivity and specificity of DWI were 100 % (32/32) and 93.5 % (43/46). DWI demonstrated excellent agreement (kappa = 0.92,) with Gd-T1-W, with no significant difference (P = 0.25) in detection of abnormal lesions. Interobserver reproducibility was excellent with DWI (kappa = 0.79). 2
28. Rathod SB, Kumbhar SS, Nanivadekar A, Aman K. Role of diffusion-weighted MRI in acute pyelonephritis: a prospective study. Acta Radiologica. 56(2):244-9, 2015 Feb. Observational-Dx 42 patients To describe results of the first prospective study to evaluate accuracy of quantitative ADC values to differentiate nephritis from renal abscesses in patients with acute pyelonephritis using contrast-enhanced CT as the gold standard. For the diagnosis of pyelonephritis, DW MRI had a higher sensitivity of 95.3% as compared to that of non-contrast CT (66.7%) and contrast-enhanced CT (88.1%). Areas of nephritis had significantly lower ADC values (P < 0.001) than the normal renal cortical parenchyma. Also, renal abscesses had significantly lower ADC values (P < 0.001) than areas of nephritis. However, CT is more useful for the diagnosis of renal calculi and emphysematous pyelonephritis. 3
29. Faletti R, Cassinis MC, Fonio P, et al. Diffusion-weighted imaging and apparent diffusion coefficient values versus contrast-enhanced MR imaging in the identification and characterisation of acute pyelonephritis. Eur Radiol 2013;23:3501-8. Observational-Dx 88 patients To compare contrast-enhanced (CEMR) and diffusion-weighted (DWI) magnetic resonance imaging in diagnosing acute pyelonephritis (APN) and to assess ADC measurement reliability in differentiating among normal renal parenchyma, APN and abscesses. Agreement between CEMR and DWI was 94.3 % (83/88 patients; P < 0.05). In the APN group, DWI was awarded the highest visibility score compared to CEMR (P = 0.05), while in the abscess group CEMR had the highest score (P = 0.04). The difference between ADC values of the APN-healthy parenchyma and abscess-APN groups was significant (P < 0.05). The area under the ROC curve of ADC values of the APN-healthy and abscess-APN groups were found to be 0.94 (95 % CI; cutoff value = 2) and 0.78 (95 % CI; cutoff value = 1.2) respectively. 3
30. De Pascale A, Piccoli GB, Priola SM, et al. Diffusion-weighted magnetic resonance imaging: new perspectives in the diagnostic pathway of non-complicated acute pyelonephritis. Eur Radiol. 2013;23(11):3077-3086. Observational-Dx 279 patients To compare DW-MRI with GE-MRI to test its diagnostic accuracy in APN. Two hundred and forty-four patients were diagnosed as having APN; 35 were negative. One hundred and sixty-three APN cases were considered non-complicated and selected for the study. Among the 414 MR examinations, comparing DW-MRI with GE-MRI, positive correlation was found in 258 cases, negative in 133. There were 14 false-negatives and 9 false-positives. DW-MRI achieved sensitivity 95.2 %, specificity 94.9 %, positive predictive value 96.9 %, negative predictive value 92.3 % and accuracy 94.6 %. 3
31. Chua ME, Ming JM, Farhat WA. Magnetic resonance urography in the pediatric population: a clinical perspective. [Review]. Pediatric Radiology. 46(6):791-5, 2016 May. Review/Other-Dx N/A To discuss the clinical role of MRU in the pediatric population and its future direction. No results stated in abstract. 4
32. Leyendecker JR, Clingan MJ. Magnetic resonance urography update--are we there yet? Semin Ultrasound CT MR 2009;30:246-57. Review/Other-Dx N/A To discuss the utility of magnetic resonance (MR) urography. No results stated in abstract. 4
33. Cerwinka WH, Grattan-Smith JD, Jones RA, et al. Comparison of magnetic resonance urography to dimercaptosuccinic acid scan for the identification of renal parenchyma defects in children with vesicoureteral reflux. J Pediatr Urol. 2014;10(2):344-351. Observational-Dx 25 patients To compare the accuracy of dimercaptosuccinic acid (DMSA) renal scan to magnetic resonance urography (MRU) in the identification of renal parenchyma defects (RPD). The ultimate consensus diagnosis was 18 kidneys with RPDs in 15 patients, of which five were classified as mild RPDs, six as moderate RPDs, and seven as severe RPDs. Although DMSA scan and MRU were similar in their ability to diagnose RPDs, MRU was considered to represent the true diagnosis in 11 of the 12 discordant cases in consensus review by four pediatric radiologists. MRU showed a much higher inter-observer agreement with a weighted kappa of 0.96 for both kidneys compared to 0.71 for the right kidney and 0.86 for the left kidney by DMSA scan. 3
34. Cerwinka WH, Kirsch AJ. Magnetic resonance urography in pediatric urology. Curr Opin Urol. 2010; 20(4):323-329. Review/Other-Dx N/A To describe current techniques and applications of MRU and review recent advances. MRU has the potential to revolutionize imaging of the urinary tract in children. It integrates exquisite anatomical information with a variety of functional data and avoids ionizing radiation. MRU is increasingly employed as a problem solver when conventional imaging studies remain inconclusive and its growing application will likely improve availability and cost in the future. 4
35. Kovanlikaya A, Okkay N, Cakmakci H, Ozdogan O, Degirmenci B, Kavukcu S. Comparison of MRI and renal cortical scintigraphy findings in childhood acute pyelonephritis: preliminary experience. Eur J Radiol. 2004; 49(1):76-80. Observational-Dx 20 children To compare MRI and renal cortical scintigraphy findings in childhood acute pyelonephritis and to determine pyelonephritic foci in the acute phase. Sensitivity and specificity of MRI in the detection of pyelonephritic lesions were found to be 90.9% and 88.8%, respectively. There is no statistically significant difference in lesion detection between the two diagnostic modalities (P>0.05). Post-gadolinium MRI show significant correlation with renal cortical scintigraphy in the determination of renal pathology. Moreover, the ability of discriminating acute pyelonephritic foci and renal scar in early stages of disease is the superiority of MRI. 1
36. Yoo JM, Koh JS, Han CH, et al. Diagnosing Acute Pyelonephritis with CT, Tc-DMSA SPECT, and Doppler Ultrasound: A Comparative Study. Korean J Urol 2010;51:260-5. Observational-Dx 207 patients To define the most practical modality for routine clinical use for the diagnosis of acute pyelonephritis (APN). CT showed significantly superior sensitivity compared with that of DUS (81.0% vs. 33.3%, respectively, n=147). DMSA scintigraphy also showed significantly superior sensitivity compared with that of DUS (74.7% vs. 33.3%, respectively, n=150). Compared with DMSA scintigraphy, CT showed superior sensitivity, but the difference was not statistically significant (81.0% vs. 74.8%, respectively, n=147, p=0.163). 2
37. Fontanilla T, Minaya J, Cortes C, et al. Acute complicated pyelonephritis: contrast-enhanced ultrasound. Abdom Imaging. 2012;37(4):639-646. Review/Other-Dx 48 patients To describe in detail the contrast-enhanced US findings in APN, and to determine if abscess and focal pyelonephritis may be distinguished. No results stated. 4
38. Kim B, Lim HK, Choi MH, et al. Detection of parenchymal abnormalities in acute pyelonephritis by pulse inversion harmonic imaging with or without microbubble ultrasonographic contrast agent: correlation with computed tomography. J Ultrasound Med. 2001; 20(1):5-14. Observational-Dx 30 patients with acute pyelonephritis and 10 healthy volunteers Comparison of pulse inversion harmonic imaging with or without contrast agent with US and tissue harmonic imaging to evaluate the ability of pulse inversion harmonic imaging with or without microbubble US contrast agent in depicting renal parenchymal changes in acute pyelonephritis. The detection and conspicuity of renal parenchymal abnormalities in acute pyelonephritis on tissue harmonic imaging, pulse inversion harmonic imaging, and contrast-enhanced pulse inversion harmonic imaging were significantly better than those on conventional US. In 2 of 10 healthy volunteers all 4 techniques yielded false-positive diagnoses of parenchymal abnormalities. Tissue harmonic imaging and pulse inversion harmonic imaging is significantly better than conventional US. 3
39. Mitterberger M, Pinggera GM, Colleselli D, et al. Acute pyelonephritis: comparison of diagnosis with computed tomography and contrast-enhanced ultrasonography. BJU Int. 2008; 101(3):341-344. Observational-Dx 100 patients To assess the value of contrast-enhanced US with the contrast pulse-sequence technique for detecting renal parenchymal changes in acute pyelonephritis, compared with contrast-enhanced CT as the reference standard. On contrast CT, 84 patients (84%) had renal parenchymal changes suggestive of acute pyelonephritis; on contrast US, 82/84 (98%) showed renal parenchymal changes, and acute pyelonephritis was correctly diagnosed. 76 patients (90%) had unilateral and 8 (10%) had bilateral acute pyelonephritis, and in two (2%) with acute pyelonephritis the diagnosis could not be confirmed by US/contrast pulse-sequence (false-negative). No false-positive findings were detected on US/contrast pulse-sequence, which had a sensitivity of 98%, a specificity of 100%, a PPV of 100%, and NPV of 89%. Contrast pulse-sequence US is accurate for detecting parenchymal changes in acute pyelonephritis; it is very sensitive and specific, and allows small renal parenchymal changes to be detected with no radiation exposure. 2
40. Kawashima A, Sandler CM, Goldman SM. Imaging in acute renal infection. BJU Int. 2000; 86 Suppl 1:70-79. Review/Other-Dx N/A To review value of the current role of and controversies in imaging the kidneys to evaluate patients with acute renal infection. While renal imaging is not routinely indicated in cases of uncomplicated renal infection, CT is a readily available, highly sensitive modality for the diagnosis and management of patients with acute renal infection. 4
41. Bykov S, Chervinsky L, Smolkin V, Halevi R, Garty I. Power Doppler sonography versus Tc-99m DMSA scintigraphy for diagnosing acute pyelonephritis in children: are these two methods comparable? Clin Nucl Med. 2003;28(3):198-203. Observational-Dx 40 patients (78 kidneys) Prospective study to assess the role of renal power Doppler US to detect acute pyelonephritis in hospitalized children under aged 6 with first time febrile UTI and clinically suspected pyelonephritis, and to determine if power Doppler US can replace Tc-99m DMSA in children. 27/78 (35%) kidneys appeared abnormal on DMSA. In 7/27 (26%) of these kidneys, power Doppler was normal. 51/78 (65%) kidneys appeared normal on DMSA. In 3/51 (6%) of these kidneys, power Doppler demonstrated apparent disease. Sensitivity, specificity, PPV and NPV for power Doppler US was 87%, 74%, 87% and 87% respectively. When considering lesions, power Doppler missed 16 lesions in 27 kidneys detected by DMSA (26% false negative rate; sensitivity 58%). A positive power Doppler renal US should obviate the use of DMSA in children with clinically suspected pyelonephritis. However, it cannot replace DMSA in the diagnosis of acute pyelonephritis in children. 1
42. Halevy R, Smolkin V, Bykov S, Chervinsky L, Sakran W, Koren A. Power Doppler ultrasonography in the diagnosis of acute childhood pyelonephritis. Pediatr Nephrol. 2004; 19(9):987-991. Observational-Dx 62 patients Comparative study to determine if power Doppler US is as sensitive as radionuclide scans in detecting childhood pyelonephritis. Power Doppler US had sensitivity of 87% and specificity of 92.3%. It does not require radiation; therefore, it may be a practical tool for the diagnosis of acute pyelonephritis in children. 1
43. Bafaraj SM. Value of Magnetic Resonance Urography Versus Computerized Tomography Urography (CTU) in Evaluation of Obstructive Uropathy: An Observational Study. Curr Med Imaging Rev. 14(1):129-134, 2018 Feb. Observational-Dx 70 patients To determine whether magnetic resonance urography or computerized tomography urography is the best imaging modality among patients with suspected obstructive uropathy. Only 54.3% of the participants had urinary stones. Mean size of the renal stone was 11 mm; while mean size of the ureteral stone was 3.8 mm. The approach of magnetic resonance is not only limited to diagnosis, but is also effectively involved in the real time investigations. MRU has more reliability in terms of the diagnosis and anatomic presentation of the kidneys along with the vasculature. All cases of urinary stones were detected by computed tomography (100%); whereas, 78.9% cases were detected by magnetic resonance urography. 3
44. Tamm EP, Silverman PM, Shuman WP. Evaluation of the patient with flank pain and possible ureteral calculus. Radiology 2003;228:319-29. Review/Other-Dx N/A To discuss the use of nonenhanced computed tomography evaluate patients with flank pain. No results stated in abstract. 4
45. Moore CL, Scoutt L. Sonography first for acute flank pain? J Ultrasound Med 2012;31:1703-11. Observational-Dx 1 patient To describes the case of a patient presenting with acute flank pain and a classic clinical picture of a first episode of renal colic. No results stated in abstract. 4
46. American College of Radiology. ACR-SPR Practice Parameter for Imaging Pregnant or Potentially Pregnant Patients with Ionizing Radiation. Available at: http://www.acr.org/~/media/ACR/Documents/PGTS/guidelines/Pregnant_Patients.pdf. Review/Other-Dx N/A To assist practitioners in providing appropriate radiologic care for pregnant or potentially pregnant adolescents and women by describing specific training, skills and techniques. No abstract available. 4
47. American College of Radiology. ACR Committee on Drugs and Contrast Media. Manual on Contrast Media. Available at: https://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast_Media.pdf. Review/Other-Dx N/A Guidance document to assist radiologists in recognizing and managing the small but real risks inherent in the use of contrast media. No abstract available. 4
48. Hill JB, Sheffield JS, McIntire DD, Wendel GD, Jr. Acute pyelonephritis in pregnancy. Obstet Gynecol 2005;105:18-23. Review/Other-Dx 440 To examine the incidence of pyelonephritis and the incidence of risk factors, microbial pathogens, and obstetric complications in women with acute antepartum pyelonephritis. Although there were no significant differences in ethnicity, pyelonephritis was associated with nulliparity (44% versus 37%, P = .003) and young age (P = .003). Thirteen percent of the women had a known risk factor for pyelonephritis. Acute pyelonephritis occurred more often in the second trimester (53%), and the predominant uropathogens were Escherichia coli (70%) and gram-positive organisms, including group B beta Streptococcus (10%). Complications included anemia (23%), septicemia (17%), transient renal dysfunction (2%), and pulmonary insufficiency (7%). 4
49. McAleer SJ, Loughlin KR. Nephrolithiasis and pregnancy. Curr Opin Urol. 2004;14(2):123-127. Review/Other-Dx N/A To determine the most appropriate way to evaluate urinary calculus in pregnant women. A combination of US and radiographs is recommended for pregnant patients. 4
50. Wieseler KM, Bhargava P, Kanal KM, Vaidya S, Stewart BK, Dighe MK. Imaging in pregnant patients: examination appropriateness. Radiographics. 2010;30(5):1215-1229; discussion 1230-1213. Review/Other-Dx N/A Review examination appropriateness when imaging pregnant patients. Modalities that do not use ionizing radiation, such as US and MRI, should be the preferred examinations for evaluating an acute condition in a pregnant patient. However, no examination should be withheld when an important clinical diagnosis is under consideration. Exposure to ionizing radiation may be unavoidable, but there is no evidence to suggest that the risk to the fetus after a single imaging study and an interventional procedure is significant. All efforts should be made to minimize the exposure, with consideration of the risk vs benefit for a given clinical scenario. 4
51. Rasmussen PE, Nielsen FR. Hydronephrosis during pregnancy: a literature survey. Eur J Obstet Gynecol Reprod Biol. 1988;27(3):249-259. Review/Other-Dx N/A To review occurrence of hydronephrosis and hydroureters during pregnancy. Conclusion is reached after survey of literature that there is every probability that hydronephrosis during pregnancy develops as a result of compression of the ureters between the pregnant uterus and the linea terminalis. It seems acute hydronephrosis or worsening of an existing hydronephrosis has been somewhat overlooked as a possible cause of uncertain abdominal pain during pregnancy. These conditions should be examined by means of US, and an attempt at treatment by a change in position should be made. In cases of continued pain or affected renal function, treatment should consist of the insertion of a ureteral catheter. 4
52. Fiorentino M, Pesce F, Schena A, Simone S, Castellano G, Gesualdo L. Updates on urinary tract infections in kidney transplantation. J Nephrol 2019;32:751-61. Review/Other-Dx N/A To review the definitions, incidence, risk factors and the management of UTI in kidney transplant recipients. No results stated in abstract. 4
53. Granata A, Andrulli S, Fiorini F, et al. Diagnosis of acute pyelonephritis by contrast-enhanced ultrasonography in kidney transplant patients. Nephrol Dial Transplant. 2011;26(2):715-720. Observational-Dx 56 patients To evaluate the diagnostic value of contrast-enhanced US in APN compared with MRI as the reference test. 37/56 patients (66.1%) resulted positive for APN with the reference test, gadolinium-enhanced MRI. 35/37 patients showed positive results for APN with contrast-enhanced US, and 19 patients showed negative results for APN with both MRI and contrast-enhanced US: sensitivity 95% (CI 82–99), specificity 100% (CI 83–100), accuracy 96% (CI 88–99), PPV 100% (CI 90–100), NPV 90% (CI 71–97) and K statistics 0.92 (P<0.01). 2
54. Faletti R, Cassinis MC, Gatti M, et al. Acute pyelonephritis in transplanted kidneys: can diffusion-weighted magnetic resonance imaging be useful for diagnosis and follow-up?. Abdominal Radiology. 41(3):531-7, 2016 Mar. Observational-Dx 22 patients, 24 controls for ADC in healthy parenchyma. To assess reliability of diffusion-weighted magnetic resonance imaging (DW-MRI) in the management of acute pyelonephritis (APN) foci in transplanted kidneys. Forty-six APN foci were found in 22/24 patients. At the acute stage, the difference in ADC between healthy parenchyma and APN foci was significant (2.06 +/- 0.16 vs. 1.43 +/- 0.32 x 10(-3) mm(2)/s; p < 0.0001). The performance of ADC as APN indicator was tested by the receiving operating characteristics (ROC) curve: the area under curve AUC = 0.99 witnessed an excellent discriminatory ability, with threshold APN/normal parenchyma 1.9 x 10(-3) mm(2)/s. At the 1-month follow-up 43/46 APN foci were no longer visible, with ADC values significantly higher than at the acute stage; all laboratory data were physiological, with WBC significantly reduced from the acute phase (5.2 +/- 1.6 x 10(9)/L vs. 10.6 +/- 4.8 x 10(9)/L; p < 0.0001). The other 3 patients underwent further therapy and exams, including a third MR. 3
55. American College of Radiology. ACR–SPR Practice Parameter for the Safe and Optimal Performance of Fetal Magnetic Resonance Imaging (MRI). Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/mr-fetal.pdf Review/Other-Dx N/A To promote safe and optimal performance of fetal magnetic resonance imaging (MRI). No abstract available. 4
56. American College of Radiology. ACR-ACOG-AIUM-SMFM-SRU Practice Parameter for the Performance of Standard Diagnostic Obstetrical Ultrasound. Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/us-ob.pdf Review/Other-Dx N/A To promote the safe and effective use of diagnostic and therapeutic radiology by describing the key elements of standard ultrasound examinations in the first, second, and third trimesters of pregnancy. No abstract available. 4
57. American College of Radiology. ACR Committee on MR Safety. 2024 ACR Manual on MR Safety. Available at: https://www.acr.org/-/media/ACR/Files/Radiology-Safety/MR-Safety/Manual-on-MR-Safety.pdf. Review/Other-Dx N/A Guidance document to promote the use of magnetic resonance (MR) safe practices. No abstract available. 4
58. 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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