TY - JOUR
T1 - ACR Appropriateness Criteria® Stress (Fatigue-Insufficiency) Fracture Including Sacrum Excluding Other Vertebrae
T2 - 2024 Update
AU - Expert Panel on Musculoskeletal Imaging:
AU - Morrison, William B.
AU - Deely, Diane
AU - Fox, Michael G.
AU - Blankenbaker, Donna G.
AU - Dodds, Julie A.
AU - French, Cristy N.
AU - Frick, Matthew A.
AU - Jawetz, Shari T.
AU - Khurana, Bharti
AU - Kresin, Molly
AU - Nacey, Nicholas
AU - Reitman, Charles
AU - Said, Nicholas
AU - Stensby, J. Derek
AU - Walker, Eric A.
AU - Chang, Eric Y.
N1 - Publisher Copyright:
© 2024 American College of Radiology
PY - 2024/11
Y1 - 2024/11
N2 - Stress fractures, including both fatigue and insufficiency types, are frequently encountered in clinical practice as a source of pain in a variety of patients (athletes, older patients, and patients with predisposing conditions). Radiography is the imaging modality of choice for baseline diagnosis. MRI has greatly improved our ability to diagnose radiographically occult stress fractures. Nuclear medicine scintigraphy and CT may also be useful as diagnostic tools. Although fatigue and insufficiency fractures can be self-limited and go on to healing even without diagnosis, there is usually value in initiating prompt therapeutic measures as incomplete stress fractures have the potential to progress to completion, necessitating surgery. This is particularly important in the setting of stress fractures of the femoral neck. Accuracy in the identification of these injuries is also relevant because the differential diagnosis includes entities that would otherwise be treated differently (ie, metastatic disease). The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
AB - Stress fractures, including both fatigue and insufficiency types, are frequently encountered in clinical practice as a source of pain in a variety of patients (athletes, older patients, and patients with predisposing conditions). Radiography is the imaging modality of choice for baseline diagnosis. MRI has greatly improved our ability to diagnose radiographically occult stress fractures. Nuclear medicine scintigraphy and CT may also be useful as diagnostic tools. Although fatigue and insufficiency fractures can be self-limited and go on to healing even without diagnosis, there is usually value in initiating prompt therapeutic measures as incomplete stress fractures have the potential to progress to completion, necessitating surgery. This is particularly important in the setting of stress fractures of the femoral neck. Accuracy in the identification of these injuries is also relevant because the differential diagnosis includes entities that would otherwise be treated differently (ie, metastatic disease). The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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U2 - 10.1016/j.jacr.2024.08.019
DO - 10.1016/j.jacr.2024.08.019
M3 - Article
C2 - 39488356
AN - SCOPUS:85207260315
SN - 1546-1440
VL - 21
SP - S490-S503
JO - Journal of the American College of Radiology
JF - Journal of the American College of Radiology
IS - 11
ER -