CHOOSING THE CORRECT RADIOLOGIC TEST RECOMMENDATIONS FROM THE ACR APPROPRIATENESS CRITERIA

Transcription

1 CHOOSING THE CORRECT RADIOLOGIC TEST RECOMMENDATIONS FROM THE ACR APPROPRIATENESS CRITERIA Susanna I. Lee MD, PhD, FACR, and James H. Thrall, MD, FACR DEPARTMENT OF RADIOLOGY MASSACHUSETTS GENERAL HOSPITAL HARVARD MEDICAL SCHOOL

2 Musculoskeletal Imaging Advanced Imaging for Low Back Pain Don t perform advanced imaging (e.g. MRI) of the spine within the first 6 weeks in patients with nonspecific acute low back pain in the absence of red flags. 23

3 A 40-year-old man presents with low back pain of <6 weeks duration. He is otherwise asymptomatic with no significant medical history. Which of the following is the most appropriate imaging exam? a. X-ray of the lumbar spine b. CT of the lumbar spine without contrast c. MRI of the lumbar spine without contrast d. Myelography and postmyelography CT of the lumbar spine e. No ideal imaging exam 24

4 Given that the patient has uncomplicated acute low back pain and/or radiculopathy, nonsurgical presentation, and no red flags, the following applies: a. X-ray of the lumbar spine is usually not appropriate. (2) b. CT of the lumbar spine without contrast is usually not appropriate. (2) c. MRI of the lumbar spine without contrast is usually not appropriate. (2) d. Myelography and postmyelography CT of the lumbar spine is usually not appropriate. (2) e. No ideal imaging exam is the correct answer. 25

5 An 89-year-old woman with known osteoporosis presents with low back pain. Which of the following is the most appropriate imaging exam? a. X-ray of the lumbar spine b. CT of the lumbar spine without contrast c. MRI of the lumbar spine without contrast d. Myelography and postmyelography CT of the lumbar spine e. No ideal imaging exam 26

6 For a patient with history of low velocity trauma or osteoporosis, or who is older than age 70, the following applies: a. X-ray of the lumbar spine may sometimes be appropriate. (6) b. CT of the lumbar spine without contrast may sometimes be appropriate. MRI is preferred. CT is useful if MRI is contraindicated or unavailable and/or for problem solving. (6) c. MRI lumbar spine without contrast is the most appropriate. (8) d. Myelography and postmyelography CT of the lumbar spine is usually not appropriate. (1) Lumbar spine fractures from osteoporosis. Lumbar spine MR sagittal T2- weighted image shows compression fractures of the L1 and L3 vertebrae (stars). 27

7 A 75-year-old man, chronically immunosuppressed, presents with low back pain. Which of the following is the most appropriate imaging exam? a. X-ray of the lumbar spine b. CT of the lumbar spine without contrast c. MRI of the lumbar spine without and with contrast d. Myelography and postmyelography CT of the lumbar spine e. No ideal imaging exam 28

8 For a patient in whom there is suspicion of cancer, infection, or immunosuppression, the following applies: a. X-ray of the lumbar spine may sometimes be appropriate. (5) b. CT of the lumbar spine without contrast may sometimes be appropriate. MRI is preferred. CT is useful if MRI is contraindicated or unavailable and/or for problem solving. (6) c. MRI of the lumbar spine without and with contrast is the most appropriate. (8) d. Myelography and postmyelography CT of the lumbar spine is usually not appropriate. (2) Cervical spine osteomyelitis. Cervical spine MR sagittal postcontrast image shows abnormal enhancement of the C6-7 vertebrae and disc collapse (arrow). 29