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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Sharp VJ, Barnes KT, Erickson BA. Assessment of asymptomatic microscopic hematuria in adults. [Review]. American Family Physician. 88(11):747-54, 2013 Dec 01. Review/Other-Dx N/A To review the assessment of asymptomatic microscopic hematuria in adults. No results stated in abstract. 4
2. Davis R, Jones JS, Barocas DA, et al. Diagnosis, evaluation and follow-up of asymptomatic microhematuria (AMH) in adults: AUA guideline. J Urol. 2012;188(6 Suppl):2473-2481. Review/Other-Dx 191 articles To provide a clinical framework for the diagnosis, evaluation and follow-up of asymptomatic microhematuria. Guideline statements are provided for diagnosis, evaluation and follow-up. The panel identified multiphasic CT as the preferred imaging technique and developed guideline statements for persistent or recurrent asymptomatic microhematuria as well as follow-up. 4
3. Dillman JR, Rigsby CK, Iyer RS, et al. ACR Appropriateness Criteria® Hematuria-Child. J Am Coll Radiol 2018;15:S91-S103. 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 in a child. No results stated in abstract. 4
4. Davis R, Jones JS, Barocas DA, et al. Diagnosis, Evaluation and Follow-up of Asymptomatic Microhematuria (AMH) in Adults.  Available at: https://www.auanet.org/guidelines/asymptomatic-microhematuria-(2012-reviewed-for-currency-2016). Review/Other-Dx N/A To provide a clinical framework for the diagnosis, evaluation, and follow-up of asymptomatic microhematuria (AMH) No results stated in abstract. 4
5. Edwards TJ, Dickinson AJ, Natale S, Gosling J, McGrath JS. A prospective analysis of the diagnostic yield resulting from the attendance of 4020 patients at a protocol-driven haematuria clinic. BJU Int. 2006;97(2):301-305; discussion 305. Review/Other-Dx 4,020 patients To clarify the prevalence of disease as determined by age, sex and the degree of hematuria at presentation, and to ascertain the merits of using US, IVU or both when imaging the upper urinary tract, in a prospective cohort of patients attending a protocol-based hematuria clinic. In all, 2,627 men and 1,393 women presented with microscopic (53.2%) or macroscopic hematuria (46.8%). The overall prevalence of malignant disease was 12.1%, but for macroscopic hematuria it was 18.9% and for microscopic hematuria 4.8%. Age and sex also influenced the observed rates of disease. Of the upper tract tumors, 70 were identified after abnormal US, with 3 cases of transitional cell carcinoma identified on IVU after a normal US. 4
6. Stanford EJ, Mattox TF, Parsons JK, McMurphy C. Prevalence of benign microscopic hematuria among women with interstitial cystitis: implications for evaluation of genitourinary malignancy. Urology. 2006;67(5):946-949. Review/Other-Dx 100 women To assess the prevalence of benign microscopic hematuria among a cohort of women with clinical interstitial cystitis. The mean age +/- standard deviation was 37 +/- 15 years, with no difference noted in those with or without microscopic hematuria (P=0.71). Microscopic hematuria was present in 24 (24%) of the 100 women. No patient had gross hematuria, positive urine culture, or cystoscopic findings suspicious for malignancy. The mean Pelvic Pain and Urgency/Frequency score was 17 +/- 6. The potassium sensitivity test was positive in 92 (92%) of 100 women, and 8 patients had only cystoscopic findings diagnostic of IC. The likelihood of a positive potassium sensitivity testor positive cystoscopic findings among patients with microscopic hematuria was similar to that of patients without microscopic hematuria. The potassium sensitivity test results correlated with the cystoscopic findings (P<0.001). Of 36 patients with positive cystoscopic findings, 28 (78%) had a positive potassium sensitivity test, and 28 (30%) of 92 with a positive potassium sensitivity test had positive cystoscopy findings. 4
7. Lisanti CJ, Toffoli TJ, Stringer MT, DeWitt RM, Schwope RB. CT evaluation of the upper urinary tract in adults younger than 50 years with asymptomatic microscopic hematuria: is IV contrast enhancement needed?. AJR Am J Roentgenol. 203(3):615-9, 2014 Sep. Observational-Dx 442 patients To compare Computed Tomography urography (CTU) with unenhanced CT in the evaluation of upper urinary tracts in adults younger than 50 years with asymptomatic microscopic hematuria. Four hundred forty-five examinations in 442 patients met inclusion criteria. CTU reports showed zero malignancy-related hematuria findings, 64 non-malignancy-related hematuria findings (62 renal calculi and two others), and 138 incidental non-hematuria-related findings. Unenhanced CT interpretation had a sensitivity of 100% (64/64) and a specificity of 89.2% (337/378). The theoretic risk of an upper urinary tract malignancy is 0-1.1%. 3
8. Mace LR, Galloway TL, Ma A, et al. Diagnostic yield of CT urography in the evaluation of hematuria in young patients in a military population. Abdominal Radiology. 42(7):1906-1910, 2017 07. Observational-Dx 137 patients To assess the diagnostic yield of a computed tomography urography (CTU) study in patients less than 50 years of age, who have a history of military service, and who are at increased risk of urological cancers secondary to harmful practices and work-related exposures. Of the 137 included patients, 84 had micro-hematuria and 53 had gross hematuria. There were a total of 99 negative examinations of the 137 included patients. Contrast was requested 14 times to confirm 11 benign cysts. No findings concerning for malignancy were found by the readers or on subsequent record reviews for each patient. 3
9. Albani JM, Ciaschini MW, Streem SB, Herts BR, Angermeier KW. The role of computerized tomographic urography in the initial evaluation of hematuria. J Urol. 177(2):644-8, 2007 Feb. Observational-Dx 259 patients compared to 253 patients To determine the usefulness of CTU for the initial evaluation of patients with hematuria as an alternative to excretory urography. A source of hematuria was identified in 107 patients (41.3%) in the CTU cohort and in 103 patients (40.7%) in the excretory urography cohort. CTU alone identified a source of hematuria in 25.5% of these patients with the most commonly diagnosed lesions being renal calculi (18.9%), ureteral calculi (2.7%) and renal pelvic masses (2.3%) in the upper tract (0.94 sensitivity), and bladder masses (8.1%), prostatic abnormalities (5.4%) and inflammatory disorders (3.5%) in the lower tract (0.40 sensitivity, 0.99 specificity). The overall detection rate (19.5%), most commonly diagnosed lesions, and lower urinary tract sensitivity and specificity were similar in the excretory urography cohort. However, excretory urography exhibited a markedly lower sensitivity in detecting upper tract lesions (0.50). 3
10. Chlapoutakis K, Theocharopoulos N, Yarmenitis S, Damilakis J. Performance of computed tomographic urography in diagnosis of upper urinary tract urothelial carcinoma, in patients presenting with hematuria: Systematic review and meta-analysis. [Review] [17 refs]. Eur J Radiol. 73(2):334-8, 2010 Feb. Meta-analysis 5 articles To review and meta-analyze published literature, in order to evaluate the performance of CTU for the detection of upper urinary tract urothelial tumors. CTU proved to be a very sensitive and specific method for the detection of urothelial malignancy, with sensitivity ranging between 88% and 100%, and specificity between 93% and 100%. Pooled sensitivity was 96% (95% CI: 88%–100%) and pooled specificity was 99% (95% CI: 98%–100%). Direct comparison of the method with IVU, confirmed the superiority of CTU over IVU in terms of sensitivity and specificity. Major drawbacks of CTU are increased radiation risk, injection of iodinated contrast media which may potentially be accompanied by serious side effects and increased cost, estimated as roughly 3 times that of IVU. M
11. Sadow CA, Silverman SG, O'Leary MP, Signorovitch JE. Bladder cancer detection with CT urography in an Academic Medical Center. Radiology. 2008;249(1):195-202. Observational-Dx 838 CT urograms in 779 patients To evaluate the performance characteristics of CTU for the detection of bladder cancer in patients at risk for the disease. The overall sensitivity, specificity, accuracy, PPV, and NPV for bladder cancer detection were 79% (117/149), 94% (649/689), 91% (766/838), 75% (117/157), and 95% (649/681) for CTU and 95% (142/149), 92% (634/689), 93% (776/838), 72% (142/197), and 99% (634/641) for cystoscopy. The NPV of CTU was higher in patients evaluated for hematuria alone (98%, 589/603). However, the accuracy of CTU was considerably lower in patients with a prior urothelial malignancy (78%, 123/158). 3
12. Wang LJ, Wong YC, Huang CC, Wu CH, Hung SC, Chen HW. Multidetector computerized tomography urography is more accurate than excretory urography for diagnosing transitional cell carcinoma of the upper urinary tract in adults with hematuria. J Urol. 2010;183(1):48-55. Observational-Dx 60 patients To compare accuracy measures of excretory urography and multidetector CTU for diagnosing upper urinary tract transitional cell carcinoma in adult patients presenting with hematuria. Of 34 men and 26 women with hematuria (mean age 60.73 +/- 12.95 years) 19 (31.7%) had a final diagnosis of 24 upper urinary tract transitional cell carcinomas. The sensitivity, specificity and accuracy of excretory urography were 0.750, 0.860 and 0.849, respectively. In contrast, the sensitivity, specificity and accuracy of multidetector CTU were 0.958, 1.000 and 0.996, respectively. Overall the area under the receiver operating characteristic curve for multidetector CTU was significantly larger than that for excretory urography (0.978 vs 0.815, P=0.005). 2
13. Park SB, Kim JK, Lee HJ, Choi HJ, Cho KS. Hematuria: portal venous phase multi detector row CT of the bladder--a prospective study. Radiology. 2007;245(3):798-805. Observational-Dx 118 patients To prospectively determine the accuracy of portal venous phase helical multidetector row CT for bladder lesion evaluation in patients with hematuria by using cystoscopy as the reference standard. Multidetector row CT showed excellent per lesion (kappa = 0.839) and per patient (kappa = 0.881) agreement between the 2 reviewers. Respective per lesion and per patient agreement between the CT and cystoscopic findings was also excellent in the first (kappa = 0.866 and kappa = 0.881) and second (kappa = 0.802 and kappa = 0.863) reviewers. The sensitivity and specificity of multidetector row CT were 89%–92% and 88%–97%, respectively, in the per lesion analysis and 95% and 91%–93%, respectively, in the per patient analysis for both reviewers. All statistical parameters of diagnostic accuracy were similar between the 2 reviewers (P>.05). 2
14. Martingano P, Cavallaro MF, Bertolotto M, Stacul F, Ukmar M, Cova MA. Magnetic resonance urography vs computed tomography urography in the evaluation of patients with haematuria. Radiologia Medica. 118(7):1184-98, 2013 Oct. Observational-Dx 35 patients To evaluate by direct comparison the image quality of magnetic resonance urography (MRU) and computed tomography urography (CTU) and to assess the diagnostic confidence of the two techniques in detecting urothelial malignancy in patients with haematuria CTU provided better visibility of urothelial structures (p<0.01) and allowed for greater diagnostic confidence (ROC area 0.994 vs. 0.938) than MRU, with a good inter-reader agreement (WK=0.62). Nevertheless, in obstructive patients with impaired excretory function, MRU, thanks to the static-fluid technique, offered better visualisation than CTU. 2
15. Leyendecker JR, Barnes CE, Zagoria RJ. MR urography: techniques and clinical applications. Radiographics. 2008; 28(1):23-46; discussion 46-27. Review/Other-Dx N/A To review techniques and clinical applications of MRU. MRU is clinically useful in the evaluation of suspected urinary tract obstruction, hematuria, and congenital anomalies, as well as surgically altered anatomy, and can be particularly beneficial in pediatric or pregnant patients or when ionizing radiation is to be avoided. 4
16. Israel GM, Hindman N, Bosniak MA. Evaluation of cystic renal masses: comparison of CT and MR imaging by using the Bosniak classification system. Radiology. 2004; 231(2):365-371. Review/Other-Dx 59 patients with 69 renal masses/ 2 reviewers To retrospectively compare CT and MRI in the evaluation of cystic renal masses by using the Bosniak classification system. CT and MRI demonstrate similar findings in most cystic renal lesions, but in some cases MRI may depict more septa, thickening of the wall or septa and enhancement which may upgrade a lesion. Renal cystic lesions that are on the borderline between category IIF and III need to be interpreted with caution and perhaps compared with CT prior to recommending treatment strategies. 4
17. Unsal A, Caliskan EK, Erol H, Karaman CZ. The diagnostic efficiency of ultrasound guided imaging algorithm in evaluation of patients with hematuria. Eur J Radiol. 2011;79(1):7-11. Observational-Dx 141 patients To assess the efficiency of the following imaging algorithm, including IVU or CTU based on US selection, in the radiological management of hematuria. US and IVU results of 97 cases were congruent in group 1. 8 simple cysts were detected with US and 1 nonobstructing ureter stone was detected with IVU in remaining 9 patients. The only discordant case in clinical comparison was found to have urinary bladder cancer on conventional cystoscopy. US and CTU results were congruent in 30 cases. Additional lesions were detected with CTU (3 ureter stones, 1 ureter TCC, 1 advanced RCC) in remaining 5 patients. US + CTU combination results were all concordant with clinical diagnosis. Except 1 case, radio-clinical agreement was achieved. 2
18. Tan WS, Sarpong R, Khetrapal P, et al. Can Renal and Bladder Ultrasound Replace Computerized Tomography Urogram in Patients Investigated for Microscopic Hematuria?. Journal of Urology. 200(5):973-980, 2018 11.J Urol. 200(5):973-980, 2018 11. Observational-Dx 3556 patients To determine the incidence of urinary tract cancer and compare the diagnostic accuracy of Computed tomography urogram (CTU) and renal and bladder ultrasound (RBUS) at identifying urinary tract cancer. 3,556 patients with a median age of 68 years were recruited, of which 2166 had RBUS and 1692 had CTU in addition to cystoscopy. The incidence of bladder, renal and upper tract urothelial cancer (UTUC) were 11.0%, 1.4% and 0.8% respectively in macroscopic hematuria patients. Patients with microscopic hematuria had a 2.7%, 0.4% and 0% incidence of bladder, renal and UTUC respectively. The sensitivity and negative predictive value (NPV) of RBUS for the detection of renal cancer was 85.7% and 99.9% respectively but 14.3% and 99.7% for the detection of UTUC. RBUS was poor at identifying renal calculi. Sensitivity of RBUS was lower than CTU for the detection of bladder cancer (both <85%). Cystoscopy has a specificity and PPV of 98.3% and 83.9% respectively. 3
19. Brown MA, Holt JL, Mangos GJ, Murray N, Curtis J, Homer C. Microscopic hematuria in pregnancy: relevance to pregnancy outcome. Am J Kidney Dis. 45(4):667-73, 2005 Apr. Observational-Dx 1000 pregnant women To determine the prevalence and clinical significance of microscopic hematuria during pregnancy. One hundred seventy-eight of 902 women (20%) who entered the study had dipstick hematuria on at least 2 occasions in pregnancy; 66 of 126 women (53%) who had hematuria before 32 weeks attended the nephrology clinic, where microscopic hematuria was confirmed in 40 women (61%). Renal imaging results were normal in all except 1 woman, and all women had a serum creatinine level of 0.90 mg/dL or less (<80 micromol/L). The development of preeclampsia or gestational hypertension or delivery of a small-for-gestational-age baby were similar in women with and without dipstick hematuria. Microscopic hematuria persisted in half (15 women) of those who attended for follow-up after 3 months postpartum. 3
20. Blick CG, Nazir SA, Mallett S, et al. Evaluation of diagnostic strategies for bladder cancer using computed tomography (CT) urography, flexible cystoscopy and voided urine cytology: results for 778 patients from a hospital haematuria clinic. BJU Int. 2012;110(1):84-94. Observational-Dx 778 patients To evaluate and compare the diagnostic accuracy of CTU with flexible cystoscopy and voided urine cytology for diagnosing bladder cancer. To evaluate diagnostic strategies using CTU as: (i) an additional test or (ii) a replacement test or (iii) a triage test for diagnosing bladder cancer in patients referred to a hospital hematuria rapid diagnosis clinic. The prevalence of bladder cancer in the clinical cohort was 20% (156/778). For the diagnostic strategy using CTU as an additional test for diagnosing bladder cancer, when scores of 1 were classified as negative and scores of 2 and 3 as positive, sensitivity was 1.0 (95% CI, 0.98–1.00), specificity was 0.94 (95% CI, 0.91–0.95), the PPV was 0.80 (95% CI, 0.73–0.85) and the NPV was 1.0 (95% CI, 0.99–1.00). For the diagnostic strategy using CTU as a replacement test for flexible cystoscopy for diagnosing bladder cancer, (using scores as above), sensitivity was 0.95 (95% CI, 0.90–0.97), specificity was 0.83 (95% CI, 0.80–0.86), the PPV was 0.58 (95% CI, 0.52–0.64), and the NPV was 0.98 (95% CI, 0.97–0.99). Similarly using flexible cystoscopy for diagnosing bladder cancer, (using scores as above), sensitivity was 0.98 (95% CI, 0.94–0.99), specificity was 0.94 (95% CI, 0.92–0.96), the PPV was 0.80 (95% CI, 0.73–0.85) and the NPV was 0.99 (95% CI, 0.99–1.0). For using CTU and flexible cystoscopy as a triage test for rigid cystoscopy and follow-up (option 1), patients with a positive CTU score are referred directly for rigid cystoscopy, and patients with an equivocal or normal score were referred for flexible cystoscopy. Sensitivity was 1.0 (95% CI, 0.98–1.0), specificity was 0.94 (95% CI, 0.91–0.95), the PPV was 0.80 (95% CI, 0.73–0.85), and the NPV was 1.0 (95% CI, 0.99–1.0). 0.98 (95% CI, 0.97–0.99), the PPV was 0.93 (95% CI, 0.87–0.96), and the NPV was 0.99 (95% CI, 0.97–0.99). For voided urine cytology, if scores of 0-3 were classified as negative and 4-5 as positive for bladder cancer, sensitivity was 0.38 (95% CI, 0.31–0.45), specificity was 0.98 (95% CI, 0.97–0.99), the PPV was 0.82 (95% CI, 0.72–0.88) and the NPV was 0.84 (95% CI, 0.81–0.87). 3
21. Gandrup KL, Logager VB, Bretlau T, Nordling J, Thomsen HS. Diagnosis of bladder tumours in patients with macroscopic haematuria: a prospective comparison of split-bolus computed tomography urography, magnetic resonance urography and flexible cystoscopy. Scandinavian Journal of Urology. 49(3):224-9, 2015 Jun. Observational-Dx 294 patients To compare split-bolus computed tomography urography (CTU), magnetic resonance urography (MRU) and flexible cystoscopy in patients with macroscopic haematuria regarding the diagnosis of bladder tumours. At flexible cystoscopy, MRU and CTU, 32, 19 and 15 bladder lesions were identified, respectively. Histopathology showed that 13 of the 29 biopsied lesions were transitional cell carcinomas. Compared with the histopathology, the sensitivity and specificity for detection of tumours by CTU and MRU were 61.5% and 94.9%, and 79.9% and 93.4%, respectively. False-positive detection of bladder tumours, compared with histopathology, was reported in seven CTUs and nine MRUs, whereas the number of false-negative findings was five for CTUs and three for MRUs. 2
22. Helenius M, Brekkan E, Dahlman P, Lonnemark M, Magnusson A. Bladder cancer detection in patients with gross haematuria: Computed tomography urography with enhancement-triggered scan versus flexible cystoscopy. Scandinavian Journal of Urology. 49(5):377-81, 2015. Observational-Dx 435 patients To compare a Computed tomography urography (CTU) protocol including an enhancement-triggered scan and flexible cystoscopy for detecting bladder tumours. Of 435 patients, 55 patients were diagnosed with bladder tumour. CTU detected bladder tumour in 48 patients (87%). Five CTU examination reports were false positive. With CTU, sensitivity for finding bladder tumour was 0.87, specificity 0.99, positive predictive value (PPV) 0.91 and negative predictive value (NPV) 0.98. Cystoscopy detected bladder tumour in 48 patients (87%) and had one false-positive finding, resulting in sensitivity of 0.87, specificity 1.0, PPV 0.98 and NPV 0.98. 3
23. Turney BW, Willatt JM, Nixon D, Crew JP, Cowan NC. Computed tomography urography for diagnosing bladder cancer. BJU Int. 98(2):345-8, 2006 Aug. Observational-Dx 200 patients To evaluate the use of CTU for diagnosing bladder tumors in patients with macroscopic hematuria and aged >40 years. The prevalence of bladder tumors was 24%; when CTU was compared with the histopathological findings, there was 1 false-positive and 3 false-negative diagnoses, indicating a sensitivity of 0.93 and a specificity of 0.99, with a 0.98 positive and 0.97 NPV for detecting bladder cancer. A review of the 3 false-negative cases showed that one was missed on original CTU reporting, the second had the appearance of prostate cancer on CTU and the third was a squamous metaplasia. 3
24. Abou-El-Ghar ME, El-Assmy A, Refaie HF, El-Diasty T. Bladder cancer: diagnosis with diffusion-weighted MR imaging in patients with gross hematuria. Radiology. 251(2):415-21, 2009 May. Observational-Dx 130 patients To prospectively evaluate the usefulness of diffusion-weighted MRI for the detection of bladder neoplasms in patients with gross hematuria of lower urinary tract origin. The consensus diagnostic performance of diffusion-weighted MRI for identification of bladder tumors was: sensitivity, 98.1% (104/106); specificity, 92.3% (24/26); PPV, 100% (104/104); NPV, 92.3% (24/26); and accuracy, 97.0% (128/132). 2 cases were falsely negative on T2-weighted MRI but were correctly diagnosed by using diffusion-weighted MRI. The agreement between diffusion-weighted MRI results and cystoscopic findings was excellent (kappa = 0.94) for identification of bladder neoplasm. Diffusion-weighted MRI had a sensitivity and PPV of 98.5% (128/130) and 100% (128/128), respectively, for determining the cause of hematuria. 2
25. Rheaume-Lanoie J, Lepanto L, Fradet V, Billiard JS, Tang A. Diagnostic performance of ultrasound for macroscopic hematuria in the era of multidetector computed tomography urography. Canadian Association of Radiologists Journal. 65(3):253-9, 2014 Aug. Observational-Dx 86 patients To evaluate the diagnostic performance of ultrasound for detecting urinary tract neoplasm in the setting of macroscopic hematuria by using multidetector computed tomography urography (MDCTU) and cystoscopy as the reference standard. Urinary tract neoplasm was diagnosed in 20% of the patients (17/86). Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of ultrasound for detecting urinary tract neoplasms were 35.3% (6/17), 89.9% (62/69), 46.2% (6/13), 84.9% (62/73), 3.48 (95% confidence interval, 1.34-9.02), and 0.72 (95% confidence interval, 0.5-1.3), respectively. 3
26. Drudi FM, Cantisani V, Liberatore M, et al. Role of low-mechanical index CEUS in the differentiation between low and high grade bladder carcinoma: a pilot study. Ultraschall Med. 31(6):589-95, 2010 Dec. Observational-Dx 36 patients To assess the efficacy of low-mechanical index contrast-enhanced ultrasonography (CEUS) in the differentiation of a series of histologically proven bladder lesions identified via conventional cystoscopy and biopsied. 22 high-grade and 14 low-grade transitional cell carcinomas (TCCs) were histologically diagnosed (mean diameter 2.1 cm; range: 1 - 4.5 cm). The sensitivity and specificity of CDUS were 86.4% (19 / 22; 95% CI = 66.7 - 95.3%) and 42.9% (6 / 14; 95% CI = 21.4 - 67.4%), respectively. The sensitivity and specificity of CEUS were 90.9% (20 / 22; 95% CI = 72.2 - 97.5%) and 85.7% (12 / 14; 95% CI = 60.1 - 95.9%), respectively. The sensitivity and specificity of CEUS using TICs were 95.4% (21 / 22; 95% CI = 78.2 - 99.2%) and 85.7% (12 / 14; 95% CI = 60.1 - 95.9%), respectively. There was no significant difference between the sensitivity of CDUS versus CEUS, CDUS versus TIC, and CEUS versus TIC (p > 0.05; McNemar's test). The specificity of CEUS and TIC was significantly higher than that of CDUS (p < 0.05; McNemar test). 2
27. Wang XH, Wang YJ, Lei CG. Evaluating the perfusion of occupying lesions of kidney and bladder with contrast-enhanced ultrasound. Clin Imaging. 35(6):447-51, 2011 Nov-Dec. Observational-Dx 47 cases To evaluate the clinical diagnostic value of contrast-enhanced ultrasound (CEUS) for occupying lesions of kidney and bladder. CEUS results showed that there were 22 cases of malignant renal tumors, 11 cases of benign lesions, two cases of renal column hypertrophy, and 12 cases of malignant bladder tumors (15 lesions). Renal cell carcinoma exhibited various CEUS manifestation, with the majority showing fast filling and hyper-enhancement. CEUS manifestation of renal hamartoma was characterized by slow filling and slow outflow. Renal cystic lesions always exhibited no enhancement within the cysts. Renal column hypertrophy exhibited the same enhancement pattern as the renal cortex. CEUS manifestation of bladder carcinoma was mainly characterized by quick filling, quick outflow, and hyperenhancement. 3
28. 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
29. 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
30. 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
31. American College of Radiology. Manual on Contrast Media. Available at: https://www.acr.org/Clinical-Resources/Contrast-Manual. Review/Other-Dx N/A To assist radiologists in recognizing and managing risks associated with the use of contrast media. No abstract available. 4
32. Expert Panel on MR Safety, Kanal E, Barkovich AJ, et al. ACR guidance document on MR safe practices: 2013. J Magn Reson Imaging. 37(3):501-30, 2013 Mar. Review/Other-Dx N/A To help guide MR practitioners regarding MR safety issues and provide a basis for them to develop and implement their own MR policies and practices. No abstract available. 4
33. 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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