ACR Appropriateness Criteria(®) myelopathy

Journal of the American College of Radiology : JACR
David J SeidenwurmAlan D Waxman

Abstract

Myelopathy is a problem that requires imaging to distinguish among numerous specifically treatable causes. The first priority is to determine mechanical stability after trauma. Next, it is crucial to distinguish intrinsic disease from extrinsic compression-for example, by epidural abscess. Osteophytes or disc extrusions and metastatic compression are the most common causes of extrinsic lesions. Imaging approaches rely on clinical features such as pain, fever, trauma, and pattern of progression. CT is preferred initially in acute trauma and MRI in all other circumstances. Contrast-enhanced MRI is added when tumor or infection is suspected or with slow or stepwise progression, especially when pain is not prominent. Vascular imaging is used when arteriovenous malformation, fistula, or occlusive disease is suspected. Because the treatment of myelopathy is often complex, treatment planning may require more than one imaging study or sequential examination to assess interval change. The ACR Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical li...Continue Reading

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Citations

Jul 29, 2015·Journal of General Internal Medicine·Alai TanJames S Goodwin
Aug 10, 2018·Internal Medicine Journal·Leo KyiLynden J Roberts
Jun 24, 2016·European Radiology·Ajay MalhotraHoward P Forman

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