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American College of Radiology updates Appropriateness Criteria for cranial neuropathy

American College of Radiology updates Appropriateness Criteria for cranial neuropathy

In August 2017, American College of Radiology has updated the guidelines on ACR Appropriateness Criteria® cranial neuropathy. Following are the major recommendations:
   
Variant 1: Anosmia and abnormalities of the sense of smell. (Olfactory nerve, CN I.)

Radiologic Procedure Rating Comments RRL*
MRI head without and with IV contrast 8 This procedure is performed in conjunction with MRI of the orbit, face, and neck. O
MRI orbit face neck without and with IV contrast 8 This procedure is performed in conjunction with MRI of the head. O
MRI head without IV contrast 6 O
MRI orbit face neck without IV contrast 6 O
CT maxillofacial with IV contrast 6 radioactive radioactive
CT head with IV contrast 5 radioactive radioactive radioactive
CT head without IV contrast 5 radioactive radioactive radioactive
CT head without and with IV contrast 5 radioactive radioactive radioactive
CT maxillofacial without IV contrast 5 radioactive radioactive
CT maxillofacial without and with IV contrast 4 radioactive radioactive radioactive
FDG-PET/CT whole body 2 radioactive radioactive radioactive radioactive
Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate *Relative Radiation Level

Variant 2: Weakness or paralysis of the mastication muscles. Sensory abnormalities of the head and neck. Trigeminal neuralgia. (Trigeminal nerve, CN V.)

Radiologic Procedure Rating Comments RRL*
MRI head without and with IV contrast 8 This procedure is performed in conjunction with MRI of the orbit, face, and neck. O
MRI orbit face neck without and with IV contrast 8 This procedure is performed in conjunction with MRI of the head. O
MRI head without IV contrast 6 O
MRI orbit face neck without IV contrast 6 O
MRA head without IV contrast 6 O
CTA head with IV contrast 5 radioactive radioactive radioactive
CT head with IV contrast 5 radioactive radioactive radioactive
CT maxillofacial with IV contrast 5 radioactive radioactive
CT maxillofacial without IV contrast 5 radioactive radioactive
CT head without IV contrast 4 radioactive radioactive radioactive
CT head without and with IV contrast 4 radioactive radioactive radioactive
CT neck with IV contrast 4 radioactive radioactive radioactive
CT neck without IV contrast 4 Contrast-enhanced imaging is preferred. radioactive radioactive radioactive
CT maxillofacial without and with IV contrast 4 radioactive radioactive radioactive
CT neck without and with IV contrast 3 radioactive radioactive radioactive
FDG-PET/CT whole body 2 radioactive radioactive radioactive radioactive
US neck 2 O
Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate *Relative Radiation Level

Variant 3: Weakness or paralysis of facial expression. Hemifacial spasm. Bell palsy. (Facial nerve, CN VII.)

Radiologic Procedure Rating Comments RRL*
MRI orbit face neck without and with IV contrast 9 This procedure is performed in conjunction with MRI of the head. O
MRI head without and with IV contrast 8 This procedure is performed in conjunction with MRI of the orbit, face, and neck. O
MRI head without IV contrast 5 O
MRI orbit face neck without IV contrast 5 O
CT head with IV contrast 5 radioactive radioactive radioactive
CT head without IV contrast 5 radioactive radioactive radioactive
CT head without and with IV contrast 4 radioactive radioactive radioactive
CT neck with IV contrast 4 radioactive radioactive radioactive
CT neck without IV contrast 3 radioactive radioactive radioactive
CT neck without and with IV contrast 3 radioactive radioactive radioactive
FDG-PET/CT whole body 2 radioactive radioactive radioactive radioactive
US neck 2 O
Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate *Relative Radiation Level

Variant 4: Palate weakness. Oropharyngeal pain. (Glossopharyngeal nerve, CN IX.)

Radiologic Procedure Rating Comments RRL*
MRI head without and with IV contrast 8 This procedure is performed in conjunction with MRI of the orbit, face, and neck. O
MRI orbit face neck without and with IV contrast 8 This procedure is performed in conjunction with MRI of the head. O
MRI head without IV contrast 6 O
MRI orbit face neck without IV contrast 6 O
CT neck with IV contrast 6 radioactive radioactive radioactive
CT head with IV contrast 5 radioactive radioactive radioactive
CT head without IV contrast 5 Contrast-enhanced imaging is preferred. radioactive radioactive radioactive
CT neck without IV contrast 5 Contrast-enhanced imaging is preferred. radioactive radioactive radioactive
CT head without and with IV contrast 4 radioactive radioactive radioactive
CT neck without and with IV contrast 4 radioactive radioactive radioactive
FDG-PET/CT whole body 2 radioactive radioactive radioactive radioactive
US neck 2 O
Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate *Relative Radiation Level

Variant 5: Vocal cord paralysis. (Vagal nerve, CN X.)

Radiologic Procedure Rating Comments RRL*
MRI orbit face neck without and with IV contrast 8 This procedure is performed in conjunction with MRI of the head. CT of the neck is an alternative examination and in some instances can be complementary. O
CT neck with IV contrast 8 MRI of the orbit, face, and neck can be an alternative examination and in some instances can be complementary. radioactive radioactive radioactive
MRI head without and with IV contrast 7 This procedure is performed in conjunction with MRI of the orbit, face, and neck. CT of the neck can be useful to assess the extracranial course of CN X. O
MRI head without IV contrast 6 O
MRI orbit face neck without IV contrast 6 O
CT chest with IV contrast 6 radioactive radioactive radioactive
MRI chest without and with IV contrast 5 O
CT head with IV contrast 5 radioactive radioactive radioactive
CT neck without IV contrast 5 Contrast-enhanced imaging is preferred. radioactive radioactive radioactive
CT chest without IV contrast 5 radioactive radioactive radioactive
MRI chest without IV contrast 4 O
CT head without IV contrast 4 radioactive radioactive radioactive
CT head without and with IV contrast 4 radioactive radioactive radioactive
CT neck without and with IV contrast 4 radioactive radioactive radioactive
X-ray chest 4 radioactive
FDG-PET/CT whole body 4 This procedure is not a first-line examination. radioactive radioactive radioactive radioactive
US neck 4 O
CT chest without and with IV contrast 3 radioactive radioactive radioactive
Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate *Relative Radiation Level

Variant 6: Weakness or paralysis of the sternocleidomastoid and trapezius muscles. (Accessory nerve, CN XI.)

Radiologic Procedure Rating Comments RRL*
MRI head without and with IV contrast 8 This procedure is performed in conjunction with MRI of the orbit, face, and neck. O
MRI orbit face neck without and with IV contrast 8 This procedure is performed in conjunction with MRI of the head. CT neck imaging can be complementary. O
MRI orbit face neck without IV contrast 7 Contrast-enhanced imaging is preferred. O
CT neck with IV contrast 7 MRI of the orbit, face, and neck can be an alternative examination and in some instances can be complementary. radioactive radioactive radioactive
MRI head without IV contrast 6 O
CT head with IV contrast 6 radioactive radioactive radioactive
CT head without IV contrast 5 radioactive radioactive radioactive
CT head without and with IV contrast 5 radioactive radioactive radioactive
CT neck without IV contrast 5 radioactive radioactive radioactive
CT neck without and with IV contrast 5 The panel did not agree on a recommendation. radioactive radioactive radioactive
FDG-PET/CT whole body 3 radioactive radioactive radioactive radioactive
US neck 2 O
Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate *Relative Radiation Level

Note: Abbreviations used in the tables are listed at the end of the “Major Recommendations” field.

Variant 7: Weakness or paralysis of the tongue. (Hypoglossal nerve, CN XII.)

Radiologic Procedure Rating Comments RRL*
MRI head without and with IV contrast 8 This procedure is performed in conjunction with MRI of the orbit, face, and neck. O
MRI orbit face neck without and with IV contrast 8 This procedure is performed in conjunction with MRI of the head. O
CT neck with IV contrast 7 MRI of the orbit, face, and neck is preferred, but in some instances CT neck can be complementary. radioactive radioactive radioactive
MRI head without IV contrast 6 O
MRI orbit face neck without IV contrast 6 O
CT head with IV contrast 5 radioactive radioactive radioactive
CT head without IV contrast 5 radioactive radioactive radioactive
CT head without and with IV contrast 4 radioactive radioactive radioactive
CT neck without IV contrast 4 radioactive radioactive radioactive
CT neck without and with IV contrast 4 radioactive radioactive radioactive
FDG-PET/CT whole body 2 radioactive radioactive radioactive radioactive
US neck 2 O
Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate *Relative Radiation Level

 

Variant 8: Perineural spread of tumor. (Most commonly trigeminal nerve [CN V], facial nerve [CN VII].)

Radiologic Procedure Rating Comments RRL*
MRI head without and with IV contrast 9 This procedure is performed in conjunction with MRI of the orbit, face, and neck. O
MRI orbit face neck without and with IV contrast 9 This procedure is performed in conjunction with MRI of the head. O
MRI orbit face neck without IV contrast 7 Addition of contrast-enhanced imaging is preferred. O
CT neck with IV contrast 6 radioactive radioactive radioactive
MRI head without IV contrast 5 O
CT head with IV contrast 5 radioactive radioactive radioactive
CT head without IV contrast 5 radioactive radioactive radioactive
CT neck without IV contrast 5 radioactive radioactive radioactive
CT head without and with IV contrast 4 radioactive radioactive radioactive
CT neck without and with IV contrast 4 radioactive radioactive radioactive
FDG-PET/CT whole body 4 This procedure is not a first-line examination. radioactive radioactive radioactive radioactive
US neck 2 O
Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate *Relative Radiation Level
Policeni B, Burns J, Conley DB, Crowley RW, Harvey HB, Hoang J, Hunt CH, Jagadeesan BD, Juliano AF, Kennedy TA, Moonis G, Pannell JS, Patel ND, Perlmutter JS, Rosenow JM, Schroeder JW, Whitehead MT, Cornelius RS, Corey AS, Expert Panel on Neurologic Imaging. ACR Appropriateness Criteria® cranial neuropathy. Reston (VA): American College of Radiology (ACR); 2017. 22 p. [136 references]

https://acsearch.acr.org/docs/69509/Narrative/

https://acsearch.acr.org/docs/69509/EvidenceTable/

Source: American College of Radiology

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