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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Yew KS, George MK, Allred HB. Acute Abdominal Pain in Adults: Evaluation and Diagnosis. American Family Physician. 107(6):585-596, 2023 Jun. Review/Other-Dx N/A Acute abdominal pain, defined as nontraumatic abdominal pain lasting fewer than seven days, is a common presenting concern with a broad differential diagnosis. No results stated in abstract. 4
2. Nagurney JT, Brown DF, Chang Y, Sane S, Wang AC, Weiner JB. Use of diagnostic testing in the emergency department for patients presenting with non-traumatic abdominal pain. J Emerg Med 2003;25:363-71. Observational-Dx 124 subjects The objective of the study was to measure the utilization and diagnostic value of tests used in the Emergency Department (ED) on patients with undifferentiated non-traumatic abdominal or flank pain. The primary resident was available and was interviewedfor 89% of the subjects; the attending was interviewedfor the remaining 11%. The mean subject agewas 43.5 years (range: 21–96, SD 16.9 years). Mencomprised 39% of the study population; 27% of subjectswere admitted. Among the 116 subjects for whom thesedata were available, the median duration of pain beforethe ED visit was 1 day (range 1 h–28 days, IQs 0.5, 3.0days). Fifteen percent of subjects presented with flankpain only, 32% with vomiting, 22% with diarrhea, and8% with fever. There were 89 separate clinical diagnosesmade, which were grouped into 25 diagnostic categories.The mostcommon test performed was the CBC (93%), followedby the Chemistry 7 package (91%). With respect toimaging, 39% had abdominal/pelvic CT scans performed,and 25% underwent ultrasonography. Amongthose with human chorionic gonadotropin (HCG) testsperformed, 36% had serum tests, 47% had urine tests,and 13% had both. Other tests performed included EKGsto rule out cardiac ischemia in five subjects with epigastricpain, as well as assorted other tests such as gastrointestical(GI) endoscopy or stool for ova and parasites.Overall, 24 subjects (19%) had tests added after theirinitial evaluation and test-ordering. The most frequentreasons given for ordering additional tests were the initialtest results coming back as normal (10 subjects, 8%)or an unexpected elevation of the WBC (7 subjects, 6%).The median elapsed time between ordering the initialtests and ordering additional tests was 1.25 h (range 10min–2.5 h; IQs 1.0, 2.0 h). 3
3. Amari K, Fukumori N, Anzai K, Yamashita SI. The Diagnostic Process for the Evaluation of Acute Abdominal Pain by Resident Trainees in Japan: A Cross-sectional Study. Internal Medicine. 59(10):1257-1265, 2020. Observational-Dx 466 patients Acute abdominal pain (AAP) of diverse etiology is a common chief complaint of patients who present to the emergency department (ED). AAP may pose a diagnostic challenge to physicians in training. We aimed to evaluate whether or not resident trainee doctors examine patients presenting with AAP in a Japanese acute-care hospital following Kendall’s diagnostic algorithm. The concordance rate between the diagnostic procedures performed by residents and those suggested by Kendall’s diagnostic algorithm was 61.2%. A low concordance rate was observed among patients with peritoneal signs, shock or toxic appearance (25.0%), suggested acute coronary syndromes (ACS) (55.1%), epigastric or right upper-quadrant pain (52.8%), and left upper-quadrant pain (55.6%). Abdominal ultrasonography is one of the recommended examinations for patients with signs of peritoneal irritation, shock or toxic appearance, right lower-quadrant pain, and left upper- or lower-quadrant pain, but the rates were relatively low at 25.0%, 34.4%, 31.8%, and 26.7%, respectively. 3
4. Pines J, Uscher Pines L, Hall A, Hunter J, Srinivasan R, Ghaemmaghami C. The interrater variation of ED abdominal examination findings in patients with acute abdominal pain. Am J Emerg Med 2005;23:483-7. Observational-Dx 122 surveys The physical examination of the abdomen is crucial to emergency department (ED) management of patients with abdominal pain. We sought to determine the interrater variation between attending and resident physicians in detecting abdominal exam findings. There was almost perfect agreement on the presence of masses and substantial agreement on the need for imaging studies. There was moderate agreement on guarding, distension, tenderness, and need for laboratory tests and surgical consultation. For 88 (72%) patients with tenderness, substantial agreement was calculated for epigastric tenderness, moderate agreement on right upper quadrant, supraumbilical, suprapubic, left lower quadrant, right lower quadrant tenderness, and fair agreement on left upper quadrant tenderness. Sixty-one (50%) patients received pain medicine in the ED. 3
5. Samaras N, Chevalley T, Samaras D, Gold G. Older patients in the emergency department: a review. Ann Emerg Med 2010;56:261-9. Review/Other-Dx N/A This article will review the most common conditions encountered in older patients, including delirium, dementia, falls, and polypharmacy, and suggest simple and efficient strategies for their evaluation and management. No results stated in abstract. 4
6. Cartwright SL, Knudson MP. Evaluation of acute abdominal pain in adults. Am Fam Physician 2008;77:971-8. Review/Other-Dx N/A To evaluate for acute abdominal pain in adults. No results stated in abstract. 4
7. Cervellin G, Mora R, Ticinesi A, et al. Epidemiology and outcomes of acute abdominal pain in a large urban Emergency Department: retrospective analysis of 5,340 cases. Ann Transl Med 2016;4:362. Review/Other-Dx 5,340 cases of AAP To investigate the epidemiology and the outcomes of AAP in an adult population admitted to an urban ED. The mean age was 49 years. The most frequent causes were nonspecific abdominal pain (NSAP) (31.46%), and renal colic (31.18%). Biliary colic/cholecystitis, and diverticulitis were more prevalent in patients aged >65 years (13.17% vs. 5.95%, and 7.28% vs. 2.47%, respectively). Appendicitis (i.e., 4.54% vs. 1.47%) and renal colic (34.48% vs. 20.84%) were more frequent in patients aged <65 years. NSAP was the most common cause in both age classes. Renal colic was the most frequent cause of ED admission in men, whereas NSAP was more prevalent in women. Urinary tract infection was higher in women. Overall, 885 patients (16.57%) were hospitalized. Four hundred and eighty-five patients had repeated ED visits throughout the study period. Among these, 302 patients (6.46%) were readmitted within 30 days, whereas 187 patients (3.82%) were readmitted within 5 days. Renal colic was the first cause for ED readmission, followed by NSAP. In 13 cases readmitted to the ED within 5 days, and in 16 cases readmitted between 5-30 days the diagnosis was changed. 4
8. Ecanow JS, Gore RM. Evaluating Patients with Left Upper Quadrant Pain. [Review]. Radiologic Clinics of North America. 53(6):1131-57, 2015 Nov. Review/Other-Dx N/A Evaluating patients with left upper quadrant pain. No results stated in abstract. 4
9. Vij A, Zaheer A, Kamel IR, et al. ACR Appropriateness Criteria® Epigastric Pain. J Am Coll Radiol 2021;18:S330-S39. 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 epigastric pain. No results stated in abstract. 4
10. Porter KK, Zaheer A, Kamel IR, et al. ACR Appropriateness Criteria® Acute Pancreatitis. J Am Coll Radiol 2019;16:S316-S30. 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 pancreatitis. No results stated in abstract. 4
11. Gupta RT, Kalisz K, Khatri G, et al. ACR Appropriateness Criteria® Acute Onset Flank Pain-Suspicion of Stone Disease (Urolithiasis). J Am Coll Radiol 2023;20:S315-S28. 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 onset flank pain-suspicion of stone disease (urolithiasis). No results stated in abstract. 4
12. Smith AD, Nikolaidis P, Khatri G, et al. ACR Appropriateness Criteria R Acute Pyelonephritis: 2022 Update. Journal of the American College of Radiology. 19(11S):S224-S239, 2022 11.J. Am. Coll. Radiol.. 19(11S):S224-S239, 2022 11. 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 results stated in abstract. 4
13. Beache GM, Mohammed TH, Hurwitz Koweek LM, et al. ACR Appropriateness Criteria® Acute Nonspecific Chest Pain-Low Probability of Coronary Artery Disease. J Am Coll Radiol 2020;17:S346-S54. Review/Other-Tx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for acute nonspecific chest pain-low probability of coronary artery disease. No results stated in abstract. 4
14. Jokerst C, Chung JH, Ackman JB, et al. ACR Appropriateness Criteria® Acute Respiratory Illness in Immunocompetent Patients. J Am Coll Radiol 2018;15:S240-S51. 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 respiratory illness in immunocompetent patients. No results stated in abstract. 4
15. Shah VN, Parsons MS, Boulter DJ, et al. ACR Appropriateness Criteria® Thoracic Back Pain. J Am Coll Radiol 2024;21:S504-S17. 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 thoracic back pain. No results stated in abstract. 4
16. Scheirey CD, Fowler KJ, Therrien JA, et al. ACR Appropriateness Criteria® Acute Nonlocalized Abdominal Pain. J Am Coll Radiol 2018;15:S217-S31. 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 nonlocalized abdominal pain. No results stated in abstract. 4
17. Cox M, Li Z, Desai V, et al. Acute nontraumatic splenic infarctions at a tertiary-care center: causes and predisposing factors in 123 patients. Emergency Radiology. 23(2):155-60, 2016 Apr. Review/Other-Dx 123 patients To document causes or predisposing conditions in patients found to have acute splenic infarctions on imaging. One hundred twenty-three patients with acute splenic infarcts were identified, 65 female and 58 male. The average age was 57 years (range of 22 to 88). Active malignancy was present in 40 patients or 33 %. The most common malignancy in patient with nontraumatic splenic infarctions was pancreatic cancer, present in 16 patients (13 %). In these patients, splenic infarction was due to direct invasion of vessels in the splenic hilum. Acute pancreatitis (severe) was directly responsible for splenic infarction in seven additional cases (6 %). Additional visceral infarcts were present in 18 patients (15 %), most commonly concomitant hepatic or renal infarcts. Documented atrial fibrillation was present in 12 patients, but only 2 cases of left-sided cardiac thrombi were seen on CT (1 atrial, and 1 ventricular thrombus). Eight cases of endocarditis with valvular vegetations were documented on echocardiography (7 %). Splenomegaly was present in 32 patients (26 %) with acute splenic infarction. In patients with nontraumatic splenic infarctions, there appears to be a relatively high association with active malignancy (up to a third of patients). 4
18. Pozo AL, Godfrey EM, Bowles KM. Splenomegaly: investigation, diagnosis and management. Blood Rev 2009;23:105-11. Review/Other-Dx Not listed Examine the tools that are available in this diagnostic pathway, and suggests a safe management strategy for those challenging patients with isolated splenomegaly It is difficult to establish an evidence-based management strategy for the patient with splenomegaly, but certain conclusions are clear. The finding of splenomegaly should always be taken seriously, but the urgency of diagnosis depends on the individual clinical picture. 4
19. Pachter HL, Hofstetter SR, Elkowitz A, Harris L, Liang HG. Traumatic cysts of the spleen--the role of cystectomy and splenic preservation: experience with seven consecutive patients. [Review] [58 refs]. Journal of Trauma-Injury Infection & Critical Care. 35(3):430-6, 1993 Sep. Review/Other-Dx 7 adult patients (5 males and 2 females) To describe the the role of cystectomy and splenic preservation from the experience of seven consecutive patients. No results stated in the abstract. 4
20. Esterson YB, Sheth S, Kawamoto S. Splenic sequestration in the adult: cross sectional imaging appearance of an uncommon diagnosis. Clin Imaging 2021;69:369-73. Review/Other-Dx One male To review the computed tomography (CT) and ultrasound appearance of splenic sequestration, which include splenic enlargement and an irregular rim of hypoenhancing or hypoechoic tissue at the periphery of the spleen, and discuss imaging differential considerations. No results stated in the abstract. 4
21. Sheth S, Ruzal-Shapiro C, Piomelli S, Berdon WE. CT imaging of splenic sequestration in sickle cell disease. Pediatric Radiology. 30(12):830-3, 2000 Dec. Review/Other-Dx 7 children To study computed tomography (CT) imaging of splenic sequestration in sickle cell disease. No results stated in the abstract. 4
22. Al-Habbal Y, Christophi C, Muralidharan V. Aneurysms of the splenic artery - a review. [Review]. Surgeon Journal of the Royal Colleges of Surgeons of Edinburgh & Ireland. 8(4):223-31, 2010 Aug.Surg.. 8(4):223-31, 2010 Aug. Review/Other-Dx N/A To review the recent advances and current concepts in the management of splenic artery aneurysm (SAA). No results stated in the abstract. 4
23. Ham H, McInnes MD, Woo M, Lemonde S. Negative predictive value of intravenous contrast-enhanced CT of the abdomen for patients presenting to the emergency department with undifferentiated upper abdominal pain. Emergency Radiology. 19(1):19-26, 2012 Jan. Observational-Dx 127 patients To calculate the negative predictive value (NPV) CT of the abdomen in patients presenting to the emergency department (ED) with undifferentiated upper abdominal pain. The NPV was 64% (95% CI 55-72). The FN group had a higher proportion of patients with epigastric pain (p = 0.02) and a lower proportion of patients with left upper quadrant pain (p = 0.02). The WBC, lipase, and ALT were all higher in the FN group compared with the TN group. The most commonly missed pathologies were inflammatory conditions of the biliary tract and upper gastrointestinal systems. The NPV of CT for evaluation of undifferentiated upper abdominal pain in the ED was low at 64% 4
24. Pandharipande PV, Reisner AT, Binder WD, et al. CT in the Emergency Department: A Real-Time Study of Changes in Physician Decision Making. Radiology 2016;278:812-21. Observational-Dx 1280 patients To determine how physicians' diagnoses, diagnostic uncertainty, and management decisions are affected by the results of computed tomography (CT) in emergency department settings. Both surveys were completed for 1280 patients by 245 physicians. The leading diagnosis changed in 235 of 460 patients with abdominal pain (51%), 163 of 387 with chest pain and/or dyspnea (42%), and 103 of 433 with headache (24%). Pre-CT diagnostic confidence was inversely associated with the likelihood of a diagnostic change (P < .0001). Median changes in confidence were substantial (increases of 25%, 20%, and 13%, respectively, for patients with abdominal pain, chest pain and/or dyspnea, and headache; P < .0001); median post-CT confidence was high (95% for all three groups). CT helped confirm or exclude at least 95% of alternative diagnoses. Admission decisions changed in 116 of 457 patients with abdominal pain (25%), 72 of 387 with chest pain and/or dyspnea (19%), and 81 of 426 with headache (19%). During follow-up, 70 of 450 patients with abdominal pain (15%), 53 of 387 with chest pain and/or dyspnea (14%), and 49 of 433 with headache (11%) returned for the same indication. In general, changes in leading diagnosis, diagnostic confidence, and admission decisions were not well explained with site or participant characteristics. 2
25. Tirkes T, Ballenger Z, Steenburg SD, Altman DJ, Sandrasegaran K. Computerized tomography of the acute left upper quadrant pain. Emergency Radiology. 23(4):353-6, 2016 Aug. Observational-Dx 100 patients The purpose of this study was to evaluate the clinical utility of computerized tomography (CT) of the abdomen in the emergent setting of left upper quadrant pain. Sensitivity of CT was 69% (95%CI: 52%-83%) for 39 patients who eventually were diagnosed with an acute abdominal abnormality. Twenty-seven patients had an acute abnormal finding on abdominal CT that represented the cause of the patient’s pain (positive predictive value of 100%, 95%CI: 87%-100%). Of the remaining 73 patients with negative CT report, 12 were diagnosed clinically (either in the ED or on follow-up visit to specialist) with a pathology that was undetectable on the CT imaging (negative predictive value of 83%, 95%CI: 73%-91%). None of the remaining 61 patients with negative CT were found to have pathology by clinical evaluation (Specificity of 100%, 95%CI: 94%-100%). 4
26. Ishihara K, Ishida R, Saito T, Teramoto K, Hosomura Y, Shibuya H. Computed tomography features of portal hypertensive gastropathy. Journal of Computer Assisted Tomography. 28(6):832-5, 2004 Nov-Dec. Review/Other-Dx 32 patients The aim of this study was to detect the computed tomographyfeatures in portal hypertensive gastropathy (PHG). Nine patients with PHG had delayed enhancement on theinner layers of gastric walls, but in 17 of 22 patients without PHG,delayed enhancement was not observed. 4
27. McCormick PA, Malone DE, Docherty JR, Kiat C, Christopher BT, Chin JL. Patterns of splenic arterial enhancement on computed tomography are related to changes in portal venous pressure. European Journal of Gastroenterology & Hepatology. 31(3):352-356, 2019 03. Observational-Tx 147 patients One of the striking features of splenic imaging is variable heterogeneous gyriform arterial enhancement on dynamiccomputed tomography (CT). We speculated that these patterns of arterial enhancement may reflect changes in splenic microcirculationrelated to changes in portal venous pressure. Splenic arterial heterogeneity increased in 55% of transplant patients compared with 14% in the TACE patients and 4%in the waiting list patients (P<0.0001). Mean Hounsfield units in areas of splenic enhancement were 71.7 ± 2 before transplantand 90.1 ± 2.5 after transplant (P< 0.01). In contrast, there were no significant changes following TACE (86.3 ± 4.2 vs. 83.5 ± 4.5;P= NS) or in waiting list patients (80.9 ± 4.6 vs. 73.8 ± 3.7; P= NS). 3
28. Razavi SA, Johnson JO, Kassin MT, Applegate KE. The impact of introducing a no oral contrast abdominopelvic CT examination (NOCAPE) pathway on radiology turn around times, emergency department length of stay, and patient safety. Emerg Radiol 2014;21:605-13. Observational-Dx 6409 CTs To evaluate the impact of the no oral contrast abdominopelvic CT examination (NOCAPE) on radiology turn around time (TAT), emergency department (ED) length of stay (LOS), and patient safety metrics. The NOCAPE pathway reduced median order to complete TAT by 32 min (22.9 %) compared to IV and oral contrast AP CT examinations (traditional pathway) (P < 0.001). Median order to final TAT was 2.9 h in NOCAPE patients and 3.5 h in the traditional pathway, a 36-min (17.1 %) reduction (P < 0.001). Overall, the NOCAPE pathway reduced ED LOS by a median of 43 min (8.8 %) compared to the traditional pathway (8.2 vs 7.5 h) (P = 0.003). Recall and bounce back rates were 3.2 %, and only one patient had change in impression after oral contrast CT was repeated. 3
29. Uyeda JW, Yu H, Ramalingam V, Devalapalli AP, Soto JA, Anderson SW. Evaluation of Acute Abdominal Pain in the Emergency Setting Using Computed Tomography Without Oral Contrast in Patients With Body Mass Index Greater Than 25. J Comput Assist Tomogr 2015;39:681-6. Observational-Dx 1992 patients To evaluate the rate of delayed or missed diagnoses and need for additional computed tomography (CT) imaging in emergency department patients with abdominal pain who are imaged without oral contrast. Of the 1992 patients included in this study, 4 patients (0.2%) underwent repeat CT studies directly related to the absence of oral contrast on the original examination. Of the 1992 CT scans, 1193(59.8%) were interpreted as negative, none of which required surgery or direct intervention. In patients with acute appendicitis, there was a sensitivity of CT in this patient population of 100% with a specificity of 99.5%. 3
30. Antopolsky M, Hiller N, Salameh S, Goldshtein B, Stalnikowicz R. Splenic infarction: 10 years of experience. Am J Emerg Med 2009;27:262-5. Review/Other-Dx 48 patients The aim of this study was to study the clinical presentation of splenic infarction. We found 49 episodes of acute splenic infarction. Abdominal or left flank pain was the mostcommon symptoms (80%), and left upper quadrant tenderness was the most common sign (35%).Splenic infarction was the presenting symptom of underlying disease in 16.6% of the patients. Based onthe computed tomography results, ultrasound was diagnostic only in 18% of patients. There was no in hospitalmortality or serious complications. 4
31. Lee MW, Yeon SH, Ryu H, et al. Volumetric splenomegaly in patients with essential thrombocythemia and prefibrotic/early primary myelofibrosis. International Journal of Hematology. 114(1):35-43, 2021 Jul. Review/Other-Dx 76 patients Non-palpable, volumetric splenomegaly at diagnosis was evaluated using computed tomography in patients with essential thrombocythemia (ET) and prefibrotic/early primary myelofibrosis (pre-PMF). Seventy-six patients with ET (median age, 62.5 years) and 19 patients with pre-PMF (median age, 65 years) were followed up for a median of 2.4 years (range 0.1-17.6 years) and 4.2 years (range 0.2-19.6 years), respectively. Spleen volume was significantly greater in pre-PMF patients than in ET patients (377.9 ± 92.2 cm3 vs. 224.9 ± 115.2 cm3, P < 0.001). No, borderline volumetric, overt volumetric, and palpable splenomegaly were found in 42 (55.3%), 24 (31.6%), 10 (13.2%), and 0 (0%) patients with ET, respectively, and in 0 (0%), 8 (42.1%), 19 (52.6%), and 1 (5.2%) patient with pre-PMF, respectively (P < 0.001). Volumetric splenomegaly did not affect thrombosis-free survival in patients with ET or those with pre-PMF. This study indicates that all patients with pre-PMF present with splenomegaly, whereas half of the patients with ET have a normal-sized spleen at diagnosis. 4
32. Luther M, Henes FO, Zabelina T, et al. Spleen volume and length determined by computed tomography impact outcome after allogeneic stem cell transplantation for myelofibrosis. Bone Marrow Transplantation. 58(7):755-761, 2023 Jul. Review/Other-Dx 93 we determined spleen length and volume by CT and evaluated the impact of both quantitative parameters on post-transplant outcome of 93 uniformly treatedpatients with MF. Median spleen volume was 1.58 dm3 (range 0.13–6.15), medianspleen length was 20 cm (range 9.8–36.7). A significant positivecorrelation was seen between spleen length and volume using bothPearson (Pearson’s r =0.95, p < 0.001) and Spearman (rho=0.96,p < 0.001) correlation tests. Neither of the median values used as acut-off showed consistent impact in univariate and multivariateanalysis on any of the outcome parameters 4
33. Shen S, DeNardo GL, Yuan A, Hartmann-Siantar C, O'Donnell RT, DeNardo SJ. Splenic volume change and nodal tumor response in non-Hodgkin's lymphoma patients after radioimmunotherapy using radiolabeled Lym-1 antibody. Cancer Biotherapy & Radiopharmaceuticals. 20(6):662-70, 2005 Dec. Observational-Dx 29 patients To evaluate the implications of splenic volume change in response to radioimmunotherapy (RIT) using radiolabeled Lym- 1 antibody. Of 29 NHL patients, 13 that had splenic volumes equal or less than 310 mL, there was little or no change in splenic volume after RIT, despite splenic radiation doses as high as 23.1 Gy (median 8.0 Gy). Similarly, in a reference group of 9 breast cancer patients, there was little or no change in splenic volume after RIT, despite doses as high as 14.4 Gy (median 11.5 Gy). In the remaining 16 NHL patients, splenic volumes decreased in 13 patients, with initial volumes of 380-1,400 mL, by 68-548 mL despite splenic radiation doses as low as 1.1 Gy (median 3.2 Gy); splenic volumes increased in the other 3 patients after RIT. Although not statistically significant in this small series, therapeutic remission, defined conventionally by nodal tumor response, was more likely when splenic volume decreased after RIT. All 10 NHL patients with greater than a 15% decrease in their splenic volumes after RIT had nodal tumor response (5 complete response, 5 partial response). There were 12 responders (5 complete response and 7 partial response) in 19 NHL patients with less than a 15% decrease in splenic volume after RIT. 3
34. Warshauer DM, Molina PL, Worawattanakul S. The spotted spleen: CT and clinical correlation in a tertiary care center. Journal of Computer Assisted Tomography. 22(5):694-702, 1998 Sep-Oct. Review/Other-Dx 45 patients The goal of our study was to examine the prevalence of multiple hypodense splenic nodules and their associated diagnoses and to correlate computed tomography (CT) appearance with clinical presentation and diagnosis. During the search period, there were 8,764 patients examined. Multiple hypodense splenic nodules were identified in 45 patients. Sixteen patients had malignant neoplasia as an etiology, with two patients having a benign tumor. Ten patients had an infectious etiology; nine patients had an inflammatory but noninfectious etiology; in eight patients, a diagnosis was not established; five of these patients were followed for > 18 months. 4
35. Ozturk O, Eldem G, Peynircioglu B, et al. Outcomes of partial splenic embolization in patients with massive splenomegaly due to idiopathic portal hypertension. World Journal of Gastroenterology. 22(43):9623-9630, 2016 Nov 21. Review/Other-Tx 11 patients To determine the outcomes of partial splenic embolization (PSE) for massive splenomegaly due to idiopathic portal hypertension (IPH). A total of 11 patients, with median age of 33.27 ± 4.8 years, were included in the study. Mean spleen size was 22.9 cm (21-28 cm), and severe hypersplenism was diagnosed in all patients before PSE. Post-PSE, leukocyte and platelet counts increased significantly, reaching peak levels in the second week with gradual decreases thereafter. Liver function tests did not exhibit significant changes during post-intervention follow-up. All patients developed post-embolization syndrome, and one patient experienced serious complications; all complications were successfully treated with conservative therapy and no death occurred. 4
36. Tasar M, Ugurel MS, Kocaoglu M, Saglam M, Somuncu I. Computed tomography-guided percutaneous drainage of splenic abscesses. Clinical Imaging. 28(1):44-8, 2004 Jan-Feb. Review/Other-Tx 9 patients (male) The aim of the study is to evaluate the role of computed tomography (CT)-guided percutaneous drainage in the management of solitary splenic abscesses. All patients tolerated the intervention well, except for one complicating with splenic rupture and hemorrhage, who underwent emergency splenectomy. The remaining eight patients recovered within 4 weeks without any splenic sequela. A mean of 3.9 days was needed before removing the drainage catheter based on regression criteria. 4
37. Jain L, Mackenzie S, Bomanji JB, et al. 18F-Fluorodeoxyglucose positron emission tomography-computed tomography imaging in HIV-infected patients with lymphadenopathy, with or without fever and/or splenomegaly. International Journal of STD & AIDS. 29(7):691-694, 2018 06. Review/Other-Dx 120 patients (88 male) To audit whether 18F-Fluorodeoxyglucose positron emission tomography-computed tomography (18FDG PET-CT) imaging could discriminate between different diagnoses in HIV-infected patients presenting with lymphadenopathy, with or without fever and/or splenomegaly. No results stated in the abstract. 4
38. Kim D, Woodham BL, Chen K, Kuganathan V, Edye MB. Rapid MRI Abdomen for Assessment of Clinically Suspected Acute Appendicitis in the General Adult Population: a Systematic Review. J Gastrointest Surg 2023;27:1473-85. Review/Other-Dx 2044 patients o perform a systematic review on the use of magnetic resonance imaging (MRI) of the abdomen to evaluate clinically suspected appendicitis in the general adult population. We examined the diagnostic accuracy, the reported trends of MRI use, and the factors that affect the utility of MRI abdomen, including study duration and cost-benefits. Twenty-seven eligible primary studies and 6 secondary studies were included, totaling 2,044 patients from eight countries. The sensitivity and specificity of MRI for diagnosing appendicitis were 96% (95% CI: 93-97%) and 93% (95% CI: 80-98%), respectively. MRI can identify complicated appendicitis and accurately propose alternative diagnoses. The duration of MRI protocols in each primary study ranged between 2.26 and 30 minutes, and only one study used intravenous contrast agents in addition to the non-contrast sequences. Decision analysis suggests significant benefits for replacing computed tomography (CT) with MRI and a potential for cost reduction. Reported trends in MRI usage showed minimal utilisation in diagnostic settings even when MRI was available. 4
39. Byott S, Harris I. Rapid acquisition axial and coronal T2 HASTE MR in the evaluation of acute abdominal pain. Eur J Radiol. 85(1):286-290, 2016 Jan. Observational-Dx 468 cases To assess T2 HASTE MR in acute abdominal imaging and ascertain if it is a reliable alternative to CT in patients under 60. 468 cases included in the study. 349 were negative for acute abdominal pathology, 116 positive for acute abdominal pathology and 3 were indeterminate. In the MR positive group (n=116), 64 had surgery confirming findings (34 appendicitis, 14 SBO, 3 ovarian torsion, 3 LBO, intussusception, ovarian carcinoma, ovarian dermoid, 2 pelvic inflammatory disease, diverticular abscess, crohns, 4 endoscopy for acute bowel pathology) while 51 were managed conservatively with concordant follow up (4 SBO, 11 diverticulitis, 6 pelvic inflammatory disease, 7 inflammatory bowel disease, 7 colitis, 6 pyelonephritis, 2 cholecystitis, renal abscess, pseudomembranous colitis, splenic haematoma, mesenteric adenitis, 2 pancreatitis, lymphoma, epiploic appendagitis). 1 patient had an MR diagnosis of appendicitis but at laparoscopy a sigmoid diverticular perforation was diagnosed and the appendix was normal. In the MR negative group (n=349), 324 had uneventful follow-up, 22 had negative laparoscopies, while 3 had subsequent appendectomies, with appendicitis on histology (3 days, 10 days and 2 months post scan). In the MR indeterminate group (n=3), one was treated conservatively with uneventful follow up, one had laparoscopic appendectomy with normal appendix on histology, one had laparoscopic appendectomy with acute appendicitis on histology. When MR correlated with clinical follow up (n=468), overall diagnostic accuracy is 99% (463/468). When MR findings correlated with direct visualisation at surgery/endoscopy (n=90), sensitivity is 98% (95% CI) and specificity is 92% (95% CI). 3
40. Kaplan KR, Mitchell DG, Steiner RM, et al. Polycythemia vera and myelofibrosis: correlation of MR imaging, clinical, and laboratory findings. Radiology. 183(2):329-34, 1992 May. Observational-Dx 14 patients To determine whether MR imaging findings can be correlated with the clinicopathologic diagnosis and established clinical parameters of severity (serum lactate dehydrogenase [LDH] and cholesterol levels) and chronicity (spleen size). Magnetic resonance (MR) imaging was performed in 14 patients with biopsy-proved polycythemia vera (n = 4) or myelofibrosis (n = 10) to determine whether MR imaging findings can be correlated with the clinicopathologic diagnosis and established clinical parameters of severity (serum lactate dehydrogenase [LDH] and cholesterol levels) and chronicity (spleen size). Evaluation of marrow in the proximal femurs showed that patients could be categorized into three distinct groups based on anatomic patterns of normal fatty and abnormal low-signal-intensity (non-fatty) marrow in the femoral capital epiphysis (FCE) and greater trochanter (GT). Patients with nonfatty marrow in both the FCE and GT (n = 8) had significantly higher serum LDH (P less than .02) and lower serum cholesterol (P less than .02) levels than patients with fatty marrow in at least the GT (n = 6). Splenic volume, as measured from MR images, was significantly greater in the myelofibrosis group than in the polycythemia vera group (P less than .001). MR imaging provided a better understanding of these hematologic disorders and novel parameters for classification that are different from conventional histologic and laboratory data. 4
41. Zafar F, Lubert AM, Trout AT, et al. Abdominal CT and MRI Findings of Portal Hypertension in Children and Adults with Fontan Circulation. Radiology. 303(3):557-565, 2022 06. Observational-Dx 123 To quantify the prevalence of radiologic evidence of portal hypertension and elevated VAST score (one point each for varices, ascites, splenomegaly, and thrombocytopenia) of 2 or greater in children and adults with Fontan circulation and to determine the association with hemodynamics and adverse outcomes. A total of 123 patients (age range, 9–55 years; 32 children) were evaluated (median age, 23 years; IQR, 17–30 years; 63 male patients). Median time since diagnosis of Fontan circulation was 16 years (IQR, 12–23 years). Twenty-five of the 123 patients (20%)had radiologic evidence of portal hypertension, and 34 (28%) had a VAST score of 2 or greater. Fontan deterioration occurred in 25of the 123 patients (20%); median follow-up duration was 0.4 year (IQR, 0.1–3.1 years). Compared with patients who had Fontan circulation without deterioration, patients with Fontan deterioration were more likely to have moderate or severe ventricular systolicdys function (P , .01), moderate or severe atrioventricular valve regurgitation (P , .01), higher Fontan pressure (P = .01), radiologic evidence of portal hypertension (P , .01), and VAST score of 2 or greater (P , .01). 3
42. Ahn SH, Mayo-Smith WW, Murphy BL, Reinert SE, Cronan JJ. Acute nontraumatic abdominal pain in adult patients: abdominal radiography compared with CT evaluation. Radiology. 2002;225(1):159-164. Observational-Dx 871 patients had abdominal radiography, and 188 patients had abdominal CT Retrospective study to compare the diagnostic yield of abdominal radiography with that of CT in adult patients presenting to the emergency department with nontraumatic abdominal pain. Interpretation of abdominal radiographs was nonspecific in 588 (68%) of 871 patients, normal in 200 (23%), and abnormal in 83 (10%). The highest sensitivity of abdominal radiography was 90% for intra-abdominal foreign body and 49% for bowel obstruction. Abdominal radiography had 0% sensitivity for appendicitis, pyelonephritis, pancreatitis, and diverticulitis. Sensitivities of abdominal CT were highest for bowel obstruction and urolithiasis at 75% and 68%, respectively. Abdominal radiographs are not sensitive in the evaluation of adult patients presenting to the emergency department with nontraumatic abdominal pain. 3
43. Zambetti EF, Haramati LB, Jenny-Avital ER, Borczuk AC. Detection and significance of splenomegaly on chest radiographs of HIV-infected outpatients. Clinical Radiology. 54(1):34-7, 1999 Jan. Review/Other-Dx 337 The purpose of this study was to determine the prevalence of splenomegaly on chest radiographs of HIV-infected outpatients and to correlate with CD4 cell counts, opportunistic conditions, liver disease and the presence of intrathoracic disease on chest radiographs. Splenomegaly was present on chest radiographs in 82 (41%) HIV-infected patients including: 36/84 (43%) Group 1, 23/49 (47%) Group 2, 18/46 (39%) Group 3, and 5/21 (24%) Group 4 (P = NS). Splenomegaly was present in 30/97 (31%) patients with no evidence of liver disease or opportunistic conditions known to be associated with splenomegaly. Forty-nine HIV-infected patients had 63 opportunistic conditions known to be associated with splenomegaly (mycobacterial and fungal infections, Kaposi sarcoma and lymphoma), half of whom had splenomegaly. Splenomegaly was present on chest radiographs in 18/137 (13%) controls. The presence or absence of splenomegaly on CT or US agreed with chest radiography in 89%. Among the autopsied patients, 135/239 (56%) had splenomegaly (splenic weight > or = 240 g). No specific pathogen was present in 93/135 (69%) enlarged spleens. In contrast, one or more opportunistic conditions were present in 26/104 (25%) normal weight spleens. 4
44. Gale HI, Bobbitt CA, Setty BN, et al. Expected Sonographic Appearance of the Spleen in Children and Young Adults With Sickle Cell Disease: An Update. Journal of Ultrasound in Medicine. 35(8):1735-45, 2016 Aug. Review/Other-Dx 112 patients To update the imaging literature regarding spleen appearances in young patients with sickle cell disease (SCD). In our cohort, 35.7% of patients had autosplenectomy, and 8.0% had undergone surgical splenectomy. Only 5.0% of individuals age 0 to 5 years had autosplenectomy. In those who had not undergone surgical splenectomy or autosplenectomy, 76.2% had echogenic spleens, heterogeneous-appearing spleens, or both, and patients with the homozygous sickle cell anemia (HbSS) genotype were more likely to have an abnormal spleen echo texture. Patients treated with transfusions had echogenic spleens and had a higher frequency of splenic regeneration nodules. Most patients (80%) with splenomegaly did not require surgical splenectomy after 5.7 years of follow-up. 4
45. Walker TM, Hambleton IR, Mason KP, Serjeant G. Spleen size in homozygous sickle cell disease: trends in a birth cohort using ultrasound. British Journal of Radiology. 95(1140):20220634, 2022 Dec 01. Observational-Dx 557 To provide ultrasound baselines for spleen length in homozygous sickle cell disease (HbSS) and in normal controls with a HbAA genotype. The spleen was visualized in all HbAA controls but in only 1103/2138 (52%) scans in HbSS. Where available, mean splenic lengths were significantly lower in HbSS (77-103 mm in males, 70-83 mm in females) compared to normal controls (89-101 mm in males, 86-95 mm in females). Assessed by statistical modelling after adjusting for body height, the splenic ratio (splenic length/body height) declined over the age range 12-20 years in HbSS, consistent with progressive splenic fibrosis. Genetic factors known to inhibit sickling, a thalassemia and fetal hemoglobin level (HbF) significantly reduced the decline in splenic ratio. Clinical splenomegaly was an insensitive measure of splenic enlargement as only 50% of patients aged 18 years and above with spleens measuring =150 mm on ultrasonography had palpable spleens.Conclusions: An age-related decline in splenic length occurred in HbSS and occurred more slowly with genetic factors known to inhibit sickling. The standards provided may be of value in assessing minor degrees of subclinical acute splenic sequestration. 4
46. Hosey RG, Mattacola CG, Kriss V, Armsey T, Quarles JD, Jagger J. Ultrasound assessment of spleen size in collegiate athletes. British Journal of Sports Medicine. 40(3):251-4; discussion 251-4, 2006 Mar. Observational-Dx 631 To determine normal spleen dimensions in a healthy collegiate athletic population. Mean (SD) splenic length was 10.65 (1.55) cm and width, 5.16 (1.21) cm. Men had larger spleens than women (p<0.001). White subjects had larger spleens than African-American subjects (p<0.001). A previous history of infectious mononucleosis or the presence of recent cold symptoms had no significant affect on spleen size. In more than 7% of athletes, baseline spleen size met current criteria for splenomegaly. 4
47. McCorkle R, Thomas B, Suffaletto H, Jehle D. Normative spleen size in tall healthy athletes: implications for safe return to contact sports after infectious mononucleosis. Clinical Journal of Sport Medicine. 20(6):413-5, 2010 Nov. Observational-Dx 66 To establish normative parameters of the spleen by ultrasonography in tall athletes. Mean height was 192.26 cm (SD, ±6.52) for men and 176.54 cm (SD, ±5.19) for women. Mean splenic measurements for all subjects were 12.19 cm (SD, ±1.45) for spleen length, 8.88 cm (SD, ±0.96) for spleen width, and 5.55 cm (SD, ±0.76) for spleen thickness. The study mean for spleen length was 12.192 cm (95% confidence interval, 11.835-12.549) and population mean was 8.94 cm (2 tailed t test, P < 0.01). In this population of tall athletes, normal spleen size was significantly larger than the normal spleen size of an average individual. 3
48. Piscaglia F, Donati G, Cecilioni L, et al. Influence of the spleen on portal haemodynamics: a non-invasive study with Doppler ultrasound in chronic liver disease and haematological disorders. Scand J Gastroenterol. 37(10):1220-7, 2002 Oct. Review/Other-Dx 89 with cirrhosis, 35 with chronic hepatitis To assess splanchnic haemodynamics in chronic liver diseases and various other disorders with splenomegaly. Splenic artery resistance index was significantly and selectively increased in patients with cirrhosis (0.63, whereas all other group means ranged between 0.53 and 0.56; P < 0.01). Portal flow velocity was significantly decreased in cirrhosis (P < 0.01). The combination of these two parameters provided an accuracy of 87.5% in distinguishing portal hypertensive from haematological splenomegaly. In patients with cirrhosis, the degree of spleen enlargement was positively correlated with increasing portal flow volume, portal vein diameter and variceal size, whereas splenic resistance index and portal velocity did not differ in connection with spleen size. 4
49. Berzigotti A, Zappoli P, Magalotti D, Tiani C, Rossi V, Zoli M. Spleen enlargement on follow-up evaluation: a noninvasive predictor of complications of portal hypertension in cirrhosis. Clinical Gastroenterology & Hepatology. 6(10):1129-34, 2008 Oct. Review/Other-Dx 127 patients To test the hypotheses that spleen enlarges over time in cirrhosis, and that a progressive enlargement may be associated with portal hypertension-related events. At inclusion, spleen diameter was 14.9 +/- 3.1 cm; 83% of the patients had splenomegaly. Spleen was larger in patients with decompensated disease (n = 39) versus patients with compensated disease (n = 88) (16.1 +/- 3.5 vs 14.5 +/- 2.7; P = .012). The mean follow-up period was 53 +/- 37 months. Spleen progressively enlarged over time (analysis of variance, P < .0001). A total of 46.4% of patients showed a spleen enlargement of 1 cm or more at 1 year. Over 5 years of follow-up evaluation patients showing spleen enlargement showed a higher actuarial probability of esophageal varices formation (84.6% vs 16.6%; P = .001) and growth (63.3% vs 20.6%; P = .001). Among patients with compensated cirrhosis at inclusion, those showing a spleen enlargement had a higher actuarial probability of developing the first clinical decompensation of cirrhosis (51.1% vs 19.5%, P = .002). 4
50. Ferri PM, Ferreira AR, Fagundes ED, Liu SM, Roquete ML, Penna FJ. Portal vein thrombosis in children and adolescents: 20 years experience of a pediatric hepatology reference center. Arquivos de Gastroenterologia. 49(1):69-76, 2012 Jan-Mar.Arq Gastroenterol. 49(1):69-76, 2012 Jan-Mar. Review/Other-Dx 55 To describe a group of patients with portal vein thrombosis without associated hepatic disease of the Pediatric Hepatology Clinic of the Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil with emphasis on diagnosis, presentation form and clinical complications, and the treatment of portal hypertension. Of the 55 studied patients, 30 (54.5%) were male. In 29 patients (52.7%), none of the risk factors for portal vein thrombosis was observed. The predominant form of presentation was the upper gastrointestinal bleeding (52.7%). In 20 patients (36.4%), the initial manifestation was splenomegaly. During the whole following period of the study, 39 patients (70.9%) showed at least one episode of upper gastrointestinal bleeding. The mean age of patients in the first episode was 4.6 ± 3.4 years old. The endoscopic procedure carried out in the urgency or electively for search of esophageal varices showed its presence in 84.9% of the evaluated patients. The prophylactic endoscopic treatment was performed with endoscopic band ligation of varices in 31.3% of patients. Only one died due to refractory bleeding. 4
51. Abujudeh HH, Kaewlai R, McMahon PM, et al. Abdominopelvic CT increases diagnostic certainty and guides management decisions: a prospective investigation of 584 patients in a large academic medical center. AJR. 2011;196(2):238-243. Review/Other-Dx 584 patients To prospectively determine how CT affects physicians’ diagnostic certainty and management decisions in the setting of patients with nontraumatic abdominal complaints presenting to the emergency department. The most common diagnoses were renal colic (119/584, 20.4%) and intestinal obstruction (80/584, 13.7%). CT altered the leading diagnosis in 49% of the patients (284/584, P<0.00001) and increased mean physician diagnostic certainty from 70.5% (pre-CT) to 92.2% (post-CT) (P<0.001; log likelihood ratio, 2.48). The management plan was changed by CT in 42% (244/583) (P<0.0001). Physicians planned to admit 75.3% of the patients (440/584) to the hospital before CT; that plan was changed to hospital discharge with follow-up in 24.1% of patients (106/440) after CT. Surgery was planned for 79 patients before CT, whereas hospital discharge was planned for 25.3% of these patients (20/79) after CT. In the management of patients presenting to the emergency department with nontraumatic abdominal complaints, CT changes the leading diagnosis, increases diagnostic certainty, and changes potential patient management decisions. 4
52. Oto A, Schmid-Tannwald C, Agrawal G, et al. Diffusion-weighted MR imaging of abdominopelvic abscesses. Emerg Radiol 2011;18:515-24. Observational-Dx 58 patients To determine the incremental value of diffusion-weighted MR imaging (DW-MRI) over T2-weighted imaging diagnosing abdominopelvic abscesses and compare apparent diffusion coefficient (ADC) values of abscesses and non-infected ascites. Detection of abscesses and confidence improved significantly when T2-weighted images were combined with DW-MRI (sensitivity: observer 1-100%, observer 2-96.6%) or contrast enhanced images (sensitivity: both observers-100%) compared to T2-weighted images alone (sensitivity: observer 1-65.5%, observer 2-72.4%). All abscesses showed restricted diffusion. Mean ADC of abscesses (observer 1-1.17 +/- 0.42 x 10(-)(3) mm(2)/s, observer 2-1.43 +/- 0.48 x 10(-3) mm(2)/s) was lower than ascites (observer 1-3.57 +/- 0.68 x 10(-3) mm(2)/s, observer 2-3.42 +/- 0.67 x 10(-3) mm(2)/s) (p < 0.01). ROC analysis showed perfect discrimination of abscess from ascites with threshold ADC of 2.0 x 10(-3) mm(2)/s (Az value 1.0). 3
53. Guglielmo FF, Anupindi SA, Fletcher JG, et al. Small Bowel Crohn Disease at CT and MR Enterography: Imaging Atlas and Glossary of Terms. [Review]. Radiographics. 40(2):354-375, 2020 Mar-Apr. Review/Other-Dx NA This article, authored by the Society of Abdominal Radiology Crohn's Disease-Focused Panel, illustrates the imaging findings and recommended radiology report impression statements described in the consensus recommendations with examples of CT enterography and MR enterography images. No results stated in abstract. 4
54. Ripolles T, Sebastian-Tomas JC, Martinez-Perez MJ, Manrique A, Gomez-Abril SA, Torres-Sanchez T. Ultrasound can differentiate complicated and noncomplicated acute colonic diverticulitis: a prospective comparative study with computed tomography. Abdom Radiol (NY) 2021;46:3826-34. Observational-Dx 240 patients To prospectively assess the diagnostic value of intestinal ultrasound (US) compared to computerized tomography (CT) in differentiating uncomplicated and complicated acute colonic diverticulitis (ACD). Of the 240 patients included in our study, 71 (29.6%) were Stage 0, 127 (53%) Stage 1A, and 42 (17.5%) were moderate-severe ACD (stages 1B, 2A, 2B, 3 and 4). The sensitivity of US for diagnosing complicated ACD was 84% and specificity of 95.8%. Most patients (24 of 27) misclassified by US as uncomplicated diverticulitis were classified on CT as stage 1A. From the 148 cases in which the radiologist considered CT unnecessary, only 3 of these revealed signs of complicated ACD on CT; none of them required emergency surgery. 1
55. Go HL, Baarslag HJ, Vermeulen H, Lameris JS, Legemate DA. A comparative study to validate the use of ultrasonography and computed tomography in patients with post-operative intra-abdominal sepsis. Eur J Radiol 2005;54:383-7. Observational-Dx 85 To validate abdominal ultrasonography and helical computed tomography in detecting causes for sepsis in patients after abdominal surgery and to determine improved criteria for its use. The overall prevalence of an abdominal infection was 0.49. The likelihood ratio (LR) of a positive test-result for US was 1.33 (95% CI: 0.8-2.5) and for CT scan 2.53 (95% CI: 1.4-5.0); corresponding post-test probabilities for US 0.57 (95% CI: 0.42-0.70) and for CT 0.71 (95% CI: 0.57-0.83). The LR of a negative test-result was, respectively, 0.60 (95% CI: 0.3-1.3) and 0.18 (95% CI: 0.06-0.5); corresponding post-test probabilities for US 0.37 (95% CI: 0.20-0.57) and for CT 0.15 (95% CI: 0.06-0.32) were calculated. 2
56. Chang KJ, Marin D, Kim DH, et al. ACR Appropriateness Criteria® Suspected Small-Bowel Obstruction. J Am Coll Radiol 2020;17:S305-S14. 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 suspected small-bowel obstruction. No results stated in abstract. 4
57. Kellow ZS, MacInnes M, Kurzencwyg D, et al. The role of abdominal radiography in the evaluation of the nontrauma emergency patient. Radiology. 2008;248(3):887-893. Observational-Dx 874 patients interpretation of abdominal radiography was normal (n=300), nonspecific (n=406), and abnormal (n=168) Retrospective study to characterize the utility of abdominal radiography for nontrauma emergency patients in a single-institution setting. Of 300 patients whose abdominal radiography results were normal, 42% (n=125) had follow-up imaging; 72% (n=90) of these showed abnormal, 78% (165/212) showed nonspecific, and 87% (86/99) showed abnormal findings. Of 438 patients who did not undergo follow-up imaging, 75% (n=327) were discharged. For all indications other than catheter placement, abdominal radiography helped confirm the suspected diagnosis in 2%-8% of cases. In 37 (4%) of 874 patients, abdominal radiography was possibly helpful in changing patient treatment without a follow-up study. Abdominal radiography is often requested; however, its results contribute to patient treatment in a small percentage of cases. With the exception of catheter placement, if a patient requires investigation beyond clinical history, physical examination, and lab results, the emergency physician should be encouraged to request more definitive imaging. 2
58. Jarvis L, Cook PG, James CM, Rose M, Prentice AG, Dubbins PA. Duplex sonography in splenomegaly. British Journal of Radiology. 64(762):485-8, 1991 Jun. Observational-Dx 29 The purpose of this study is to assess the splenic artery and vein and the hepatic portal vein in patients with established splenomegaly, using duplex Doppler ultrasound to assess whether the time-velocity spectrum improves specificity of diagnosis.The aetiology of splenomegaly is seldom clear from either clinical or imaging assessment of the spleen. In the majority of cases sonographic assessment of the spleen produces a homogeneous enlargement of variable echodensity, but with very poor correlation with pathology. A study has been undertaken to assess the Doppler characteristics of the splenic artery in splenomegaly, excluding cases of portal hypertension in an attempt to provide further diagnostic information. Analysis of waveform, peak frequency and pulsatility index were compared and failed to demonstrate any significant change. In the normal subject there is a broad systolic spectrum related to the tortuosity of the splenic artery, with persistence of forward flow throughout diastole, a reflection of the low peripheral resistance of the spleen. In splenomegaly the broad systolic spectrum is unchanged, since vessel tortuosity persists. Pathological and physiological assessment of the spleen in splenomegaly shows that a low resistance circulation persists, explaining maintenance of the diastolic flow pattern in splenomegaly. Increased blood flow to the spleen in splenomegaly occurs either as a result of an increase in vessel diameter or an increase in flow velocity, or a variable combination of the two which does not seem to be governed by specific pathology. An increase in peak frequency in some cases reflected some increase in flow velocity but provided no useful correlation. Analysis of the pulsatility index supported the above findings without adding further information. 3
59. National Academies of Sciences, Engineering, and Medicine; Division of Behavioral and Social Sciences and Education; Committee on National Statistics; Committee on Measuring Sex, Gender Identity, and Sexual Orientation. Measuring Sex, Gender Identity, and Sexual Orientation. In: Becker T, Chin M, Bates N, eds. Measuring Sex, Gender Identity, and Sexual Orientation. Washington (DC): National Academies Press (US) Copyright 2022 by the National Academy of Sciences. All rights reserved.; 2022. Review/Other-Dx N/A Sex and gender are often conflated under the assumptions that they are mutually determined and do not differ from each other; however, the growing visibility of transgender and intersex populations, as well as efforts to improve the measurement of sex and gender across many scientific fields, has demonstrated the need to reconsider how sex, gender, and the relationship between them are conceptualized. No abstract available. 4
60. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://edge.sitecorecloud.io/americancoldf5f-acrorgf92a-productioncb02-3650/media/ACR/Files/Clinical/Appropriateness-Criteria/ACR-Appropriateness-Criteria-Radiation-Dose-Assessment-Introduction.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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