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.)
Variant 2: Weakness or paralysis of the mastication muscles. Sensory abnormalities of the head and neck. Trigeminal neuralgia. (Trigeminal nerve, CN V.)
Variant 3: Weakness or paralysis of facial expression. Hemifacial spasm. Bell palsy. (Facial nerve, CN VII.)
Variant 4: Palate weakness. Oropharyngeal pain. (Glossopharyngeal nerve, CN IX.)
Variant 5: Vocal cord paralysis. (Vagal nerve, CN X.)
Variant 6: Weakness or paralysis of the sternocleidomastoid and trapezius muscles. (Accessory nerve, CN XI.)
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.)
Variant 8: Perineural spread of tumor. (Most commonly trigeminal nerve [CN V], facial nerve [CN VII].)
https://acsearch.acr.org/docs/69509/Narrative/
https://acsearch.acr.org/docs/69509/EvidenceTable/
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 | ||
| CT head with IV contrast | 5 | ||
| CT head without IV contrast | 5 | ||
| CT head without and with IV contrast | 5 | ||
| CT maxillofacial without IV contrast | 5 | ||
| CT maxillofacial without and with IV contrast | 4 | ||
| FDG-PET/CT whole body | 2 | ||
| 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 | ||
| CT head with IV contrast | 5 | ||
| CT maxillofacial with IV contrast | 5 | ||
| CT maxillofacial without IV contrast | 5 | ||
| CT head without IV contrast | 4 | ||
| CT head without and with IV contrast | 4 | ||
| CT neck with IV contrast | 4 | ||
| CT neck without IV contrast | 4 | Contrast-enhanced imaging is preferred. | |
| CT maxillofacial without and with IV contrast | 4 | ||
| CT neck without and with IV contrast | 3 | ||
| FDG-PET/CT whole body | 2 | ||
| 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 | ||
| CT head without IV contrast | 5 | ||
| CT head without and with IV contrast | 4 | ||
| CT neck with IV contrast | 4 | ||
| CT neck without IV contrast | 3 | ||
| CT neck without and with IV contrast | 3 | ||
| FDG-PET/CT whole body | 2 | ||
| 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 | ||
| CT head with IV contrast | 5 | | |
| CT head without IV contrast | 5 | Contrast-enhanced imaging is preferred. | |
| CT neck without IV contrast | 5 | Contrast-enhanced imaging is preferred. | |
| CT head without and with IV contrast | 4 | ||
| CT neck without and with IV contrast | 4 | ||
| FDG-PET/CT whole body | 2 | ||
| 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. | |
| 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 | ||
| MRI chest without and with IV contrast | 5 | O | |
| CT head with IV contrast | 5 | ||
| CT neck without IV contrast | 5 | Contrast-enhanced imaging is preferred. | |
| CT chest without IV contrast | 5 | ||
| MRI chest without IV contrast | 4 | O | |
| CT head without IV contrast | 4 | ||
| CT head without and with IV contrast | 4 | ||
| CT neck without and with IV contrast | 4 | ||
| X-ray chest | 4 | ||
| FDG-PET/CT whole body | 4 | This procedure is not a first-line examination. | |
| US neck | 4 | O | |
| CT chest without and with IV contrast | 3 | ||
| 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. | |
| MRI head without IV contrast | 6 | O | |
| CT head with IV contrast | 6 | ||
| CT head without IV contrast | 5 | ||
| CT head without and with IV contrast | 5 | ||
| CT neck without IV contrast | 5 | ||
| CT neck without and with IV contrast | 5 | The panel did not agree on a recommendation. | |
| FDG-PET/CT whole body | 3 | ||
| 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. | |
| MRI head without IV contrast | 6 | O | |
| MRI orbit face neck without IV contrast | 6 | O | |
| CT head with IV contrast | 5 | ||
| CT head without IV contrast | 5 | ||
| CT head without and with IV contrast | 4 | ||
| CT neck without IV contrast | 4 | ||
| CT neck without and with IV contrast | 4 | ||
| FDG-PET/CT whole body | 2 | ||
| 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 | ||
| MRI head without IV contrast | 5 | O | |
| CT head with IV contrast | 5 | ||
| CT head without IV contrast | 5 | ||
| CT neck without IV contrast | 5 | ||
| CT head without and with IV contrast | 4 | ||
| CT neck without and with IV contrast | 4 | ||
| FDG-PET/CT whole body | 4 | This procedure is not a first-line examination. | |
| 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/
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