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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Bhatia V, Lodha R. Upper gastrointestinal bleeding. Indian J Pediatr. 78(2):227-33, 2011 Feb. Review/Other-Dx N/A Upper gastrointestinal bleeding is a life threatening condition in children. No results stated in abstract. 4
3. Piccirillo M, Pucinischi V, Mennini M, et al. Gastrointestinal bleeding in children: diagnostic approach. Ital J Pediatr. 2024 Jan 23;50(1):13. Review/Other-Dx N/A To describe the variety of conditions responsible for GIB in pediatric patients and to outline diagnostic pathways according to patients' age, suspected site of bleeding and type of bleeding which can help pediatricians in clinical practice. No results stated in abstract. 4
6. Aboughalia HA, Cheeney SHE, Elojeimy S, Blacklock LC, Parisi MT. Meckel diverticulum scintigraphy: technique, findings and diagnostic pitfalls. Pediatr Radiol. 2023 Mar;53(3):493-508. Review/Other-Dx N/A To review the embryological origin and anatomical features of Meckel diverticulum, highlight the role of scintigraphy in evaluating Meckel diverticulum, and discuss the proper imaging technique when performing this test. No results stated in abstract. 4
8. Garcia-Blazquez V, Vicente-Bartulos A, Olavarria-Delgado A, Plana MN, van der Winden D, Zamora J. Accuracy of CT angiography in the diagnosis of acute gastrointestinal bleeding: systematic review and meta-analysis. Eur Radiol. 2013;23(5):1181-1190. Meta-analysis 22 studies; 672 patients To assess the diagnostic accuracy of CTA in the evaluation of patients with an episode of acute GI hemorrhage. 22 studies were included and provided data on 672 patients (range of age 5–74) with a mean age of 65 years. The overall sensitivity of CTA for detecting active acute GI hemorrhage was 85.2% (95% CI, 75.5% to 91.5%). The overall specificity of CTA was 92.1% (95% CI, 76.7% to 97.7%). The likelihood ratios for positive and negative test results were 10.8 (95% CI, 3.4 to 34.4) and 0.16 (95% CI, 0.1 to 0.27) respectively, with an area under the curve of 0.935 (95% CI, 0.693 to 0.989). The sources of heterogeneity explored had no significant impact on diagnostic performance. Inadequate
10. Wells ML, Hansel SL, Bruining DH, et al. CT for Evaluation of Acute Gastrointestinal Bleeding. Radiographics. 2018;38(4):1089-1107. Review/Other-Dx N/A To discuss the use of CT during evaluation of acute GI bleeding. No results in abstract. 4
16. Parra DA, Chavhan GB, Shammas A, John PR. Computed tomography angiography in acute gastrointestinal and intra-abdominal bleeding in children: preliminary experience. Can Assoc Radiol J. 2013 Nov;64(4):S0846-5371(12)00120-9. Review/Other-Dx N/A To illustrate our experience with CTA in the diagnosis and management of patients who presented with acute bleed. No abstract avaiable. 4
17. Williams J, Vasanawala SS. Active gastrointestinal hemorrhage identification by blood pool contrast-enhanced magnetic resonance angiography. Pediatr Radiol. 2011 Sep;41(9):1198-200. Review/Other-Dx N/A To describe an analogous method of detecting acute gastrointestinal hemorrhage by enhanced MRI with blood pool contrast agent. No results stated in abstract. 4
18. Chavhan GB, Babyn PS, John P, Yoo SJ, Rigsby CK. Pediatric Body MR Angiography: Principles, Techniques, and Current Status in Body Imaging. AJR Am J Roentgenol. 2015 Jul;205(1):173-84. Review/Other-Dx N/A To describe the principles and various techniques of MR angiography (MRA) that can be applied to pediatric body imaging and the current noncardiac, nonneurologic applications of MRA of children. The choice between CT angiography and MRA for body imaging should depend on the clinical query, ROI, and vessel size. MRA is useful for assessment of stenosis of the main renal artery, portal hypertension, tumor vascularity, vascular malformations, generalized vasculopathy in vasculitis and syndromes, and thoracic outlet syndrome. 4
19. Jacovides CL, Nadolski G, Allen SR, et al. Arteriography for Lower Gastrointestinal Hemorrhage: Role of Preceding Abdominal Computed Tomographic Angiogram in Diagnosis and Localization. JAMA Surg. 150(7):650-6, 2015 Jul. Observational-Dx 161 angiographic procedures To determine if preceding visceral arteriography with computed tomographic angiography (CTA) in acute lower gastrointestinal hemorrhage increases hemorrhage identification and localization and to determine if CTA was superior to nuclear scintigraphy when used as a pre-angiogram test. A total of 161 angiographic procedures were performed during the study period (78 before and 83 after protocol implementation). Use of CTA increased from 3.8% to 56.6%, and use of nuclear scintigraphy decreased from 83.3% to 50.6% following protocol implementation (P?<?.001). Preceding angiography with CTA resulted in similar angiography contrast administration (mean [SD] amount for CTA prior to visceral arteriogram (VA), 135 [63] vs 160 [77] mL; P?=?.18) and fluoroscopy time (mean [SD], 26.3 [16.8] vs 32.2 [34.9] minutes; P?=?.34). Although nuclear scintigraphy and CTA had similar sensitivity and specificity, localization of hemorrhage site by CTA was more precise and consistent with angiography findings. As a pre-angiography test, compared with nuclear scintigraphy, CTA reduced overall the number of imaging studies required (mean [SD] number per patient admission, 2.1 [0.3] vs 2.5 [0.8]; P?=?.005) and resulted in administration of more overall contrast (mean [SD], 220 [80] vs 130 [70] mL; P?<?.001) without worsening renal function. 4
20. Clerc D, Grass F, Schäfer M, Denys A, Demartines N, Hübner M. Lower gastrointestinal bleeding-Computed Tomographic Angiography, Colonoscopy or both?. World J Emerg Surg. 2017;12():1. Review/Other-Dx 183 patients To compare lower endoscopy and computed tomographic angiography (CTA) modalities with regards to diagnostic value and bleeding control. Final analysis included 183 patients; 122 (66.7%) had LE first, while 32 (17.5%) had CTA; 29 (15.8%) had neither of both exams. Median time to CTA was shorter compared to LE (3 (IQR = 8.2) vs. 22 (IQR = 36.9) hours, P < 0.001). Active bleeding was identified in 31% with CTA vs. 15% with LE (P = 0.031); a non-actively bleeding source was found by CTA and LE in 22 vs. 31%, respectively (P = 0.305). Bleeding control required endoscopy in 19%, surgery in 14% and embolization in 1.6%, while 66% were treated conservatively. Post-interventional bleeding was mostly controlled by endoscopic therapy (57%). 80% of patients with active bleeding on CTA required surgery. 4
21. Lee J, Lai MW, Chen CC, et al. Red blood cell scintigraphy in children with acute massive gastrointestinal bleeding. Pediatr Int. 50(2):199-203, 2008 Apr. Review/Other-Dx 22 patients To review the usefulness of technetium-99m-labeled red blood cell scintigraphy ((99m)Tc RBC scan) in children with acute massive gastrointestinal (GI) bleeding. The study included 22 patients who underwent 23 (99m)Tc RBC scans. The scans were usually performed after other diagnostic tests failed to locate the bleeding. The diagnostic sensitivity of the scans was nine out of 23 (39.1%). The test demonstrated a positive scan within the first 2 h in six patients, and three patients had positive results at 24 h. The locations of the lesions identified on scanning and surgical investigation were highly correlated in patients with a positive scan within 2 h. 4
22. Dam HQ, Brandon DC, Grantham VV, et al. The SNMMI procedure standard/EANM practice guideline for gastrointestinal bleeding scintigraphy 2.0. J Nucl Med Technol. 2014 Dec;42(4):308-17. Review/Other-Dx N/A The SNMMI and EANM have written and approved these standards/guidelines to promote the use of nuclear medicine procedures with high quality. No abstract available. 4
23. Yan Y, Liu Q, Liu X, et al. Sonographic diagnosis of an ileal adenomyoma in a neonate. J Clin Ultrasound. 47(2):97-99, 2019 Feb. Review/Other-Dx N/A Sonography is the preferred modality to diagnose an ileal adenomyoma. No results stated in abstract. 4
24. Parra DA, Navarro OM. Sonographic diagnosis of intestinal polyps in children. Pediatr Radiol. 2008 Jun;38(6):680-4. Review/Other-Dx N/A Although colonoscopy is the modality of choice for the diagnosis of intestinal polyps, sonography may be the first diagnostic modality in the evaluation of children with this pathology. No results stated in abstract. 4
25. Nguyen HN, Navarro OM, Bloom DA, et al. Ultrasound for Midgut Malrotation and Midgut Volvulus: AJR Expert Panel Narrative Review. AJR Am J Roentgenol. 2022 Jun;218(6):931-939. Review/Other-Dx N/A To describe the findings of midgut malrotation and volvulus on US, including practical tips for acquisition and interpretation; discuss the advantages and challenges of both imaging modalities; and propose a path and safeguards for possible transition to the use of US as the first-line modality for diagnosis based on our experience in imaging children with midgut malrotation and volvulus. No results stated in abstract. 4
26. Irvine I, Doherty A, Hayes R. Bleeding meckel's diverticulum: A study of the accuracy of pertechnetate scintigraphy as a diagnostic tool. Eur J Radiol. 96:27-30, 2017 Nov. Review/Other-Dx 144 scans to assess the accuracy of pertechnetate scintigraphy performed at Our Lady's Hospital for Sick Children, Crumlin (OLCHC) on children with clinical suspicion of a bleeding MD. Of the total 144 scans performed, 22 were considered to be positive, and all patients were found to have a MD at surgery. 122 were negative, and in 53 of these patients, an alternative cause for symptoms was found, often at endoscopy. In the remaining 69 patients, no cause was found, despite full medical work-up. In all of these cases, symptoms resolved, and have not yet recurred, making MD very unlikely. 4
27. Vali R, Daneman A, McQuattie S, Shammas A. The value of repeat scintigraphy in patients with a high clinical suspicion for Meckel diverticulum after a negative or equivocal first Meckel scan. Pediatr Radiol. 2015 Sep;45(10):1506-14. Review/Other-Dx 33 cases The purpose of this retrospective study is to evaluate the value of repeat scintigraphy for these patients. Seven out of 12 (58%) equivocal studies were positive on the second study. Six of them were proven to be positive at operation (confirmed by pathology) while one of them was negative on laparoscopy. From 21 negative first scans with a high suspicion for Meckel diverticulum, three (14%) were positive on the second study. All three were proven to be Meckel diverticulum on pathology. 4
28. Warrington JC, Charron M. Pediatric gastrointestinal nuclear medicine. Semin Nucl Med. 2007 Jul;37(4):269-85. Review/Other-Dx N/A The scintigraphic method is safe, accurate, well-tolerated by children and complementary to endoscopy in most patients. No results stated in abstract. 4
29. Krasaelap A, Lerner DG, Oliva S. The Role of Endoscopy in the Diagnosis and Management of Small Bowel Pathology in Children. Gastrointest Endosc Clin N Am. 2023 Apr;33(2):S1052-5157(22)00110-6. Review/Other-Dx N/A To provide a comprehensive overview of the indications, techniques, and clinical applications of capsule endoscopy; device-assisted enteroscopy; and imaging studies for small bowel evaluation in children. No results stated in abstract. 4
30. Romberg EK, Tang ER, Chandra T, Podberesky DJ, Epelman M, Iyer RS. Applications of Pediatric Body CT Angiography: What Radiologists Need to Know. AJR Am J Roentgenol. 2020 May;214(5):1019-1030. Review/Other-Dx N/A To discuss common pediatric applications of thoracoabdominal CTA, including for congenital pulmonary airway malformation, sequestration, vascular rings, aortic coarctation, pulmonary embolism, nontraumatic hemorrhage, abdominal transplant evaluation, and several vascular disorders, and highlights key clinical and imaging features. No results stated in abstract. 4
31. Fidler JL, Gunn ML, Soto JA, et al. Society of abdominal radiology gastrointestinal bleeding disease-focused panel consensus recommendations for CTA technical parameters in the evaluation of acute overt gastrointestinal bleeding. Abdom Radiol (NY). 2019 Sep;44(9):2957-2962. Review/Other-Dx N/A To formulate consensus recommendations for CT angiography technical parameters used to evaluate overt gastrointestinal (GI) bleeding. Consensus agreement was reached in 15/17 (89%) of the questions including the technique for the administration of IV contrast, the number of phases, scan timing, and image reconstruction. 4
32. Casciani E, Nardo GD, Chin S, et al. MR Enterography in paediatric patients with obscure gastrointestinal bleeding. Eur J Radiol. 93:209-216, 2017 Aug. Observational-Dx 25 patients To evaluate the performance of Magnetic Resonance enterography (MRE) in the diagnostic work-up of children presenting with obscure gastrointestinal bleeding (OGIB). 25 patients (mean age 10.8±4.5 years, range 4 months to 16 years) were included. MRE was diagnostic in 76% (19 of 25). The most frequent diagnoses were intestinal polyp (28%) and Meckel's diverticulum (16%). Sensitivity and specificity of MRE were 86% and 100% respectively. There were no reported complications during any of the examinations. 2
33. Dubois J, Rypens F, Garel L, Yazbeck S, Therasse E, Soulez G. Pediatric gastrointestinal vascular anomalies: imaging and therapeutic issues. [Review] [14 refs]. Pediatr Radiol. 37(6):566-74, 2007 Jun. Review/Other-Dx N/A To review the classification, imaging characteristics and treatment of gastrointestinal vascular anomalies. No results stated in abstract. 4
34. Racadio JM, Agha AK, Johnson ND, Warner BW. Imaging and radiological interventional techniques for gastrointestinal bleeding in children. Semin Pediatr Surg. 1999 Nov;8(4):181-92. Review/Other-Dx N/A The role of radiology in defining associated pathology, pinpointing the bleeding site, and intervening to control hemorrhage is discussed. No results stated in abstract. 4
35. Meyerovitz MF, Fellows KE. Angiography in gastrointestinal bleeding in children. AJR Am J Roentgenol. 1984 Oct;143(4):837-40. Review/Other-Dx 27 patients To define the diagnostic effectiveness of arterigraphy in gastrointestinal bleeding of obscure origin in children. Final diagnoses were made in 25 patients by means of surgery, endoscopy, biopsy, laboratory data, and clinical follow-up. Of these 25 cases, arteriography gave a correct diagnosis in 64% and was falsely negative in 36%. In acute gastrointestinal bleeding, arteriographic diagnosis was correct in 71% and falsely negative in 29%. In chronic or recurrent gastrointestinal bleeding, arteriographic diagnosis was correct in 55% and falsely negative in 45%. 4
36. Moore MM, Gee MS, Iyer RS, et al. ACR Appropriateness Criteria® Crohn Disease-Child. J Am Coll Radiol 2022;19:S19-S36. 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 Crohn disease in a child. No results stated in abstract. 4
37. Davis JS, Ryan ML, Fields JM, Neville HL, Perez EA, Sola JE. Use of CT enterography for the diagnosis of lower gastrointestinal bleeding in pediatric patients. J Pediatr Surg. 2013 Mar;48(3):S0022-3468(13)00007-9. Review/Other-Dx 6 patients Diagnosis of lower gastrointestinal bleeding (LGIB) represents a significant diagnostic and therapeutic challenge for any physician. We reviewed 6 patients ages 4-15 who underwent CTE for LGIB at a tertiary pediatric institution. In sum, CTE appears to be a valuable tool for localizing the source of LGIB prior to surgical or endoscopic intervention. 4
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