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ACR Appropriateness Criteria® Acute Pancreatitis

Baker, Mark E. MD*; Nelson, Rendon C. MD; Rosen, Max P. MD, MPH; Blake, Michael A. MB, BCh§; Cash, Brooks D. MD; Hindman, Nicole M. MD; Kamel, Ihab R. MD, PhD#; Kaur, Harmeet MD**; Piorkowski, Robert J. MD††; Qayyum, Aliya MD**; Yarmish, Gail M. MD‡‡

doi: 10.1097/RUQ.0000000000000099
ACR Appropriateness Criteria

The American College of Radiology Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. The Atlanta Classification by the Acute Pancreatitis Classification Working Group recently modified the terminology for the clinical course and the morphologic changes identified on imaging, primarily contrast- enhanced multidetector computed tomography (MDCT). The two distinct clinical courses of the disease are classified as (1) early phase, which lasts approximately 1 week, and (2) late phase, which starts after the first week and can last for months after the initial episode. The two, primary, morphologic changes are acute, interstitial edematous and necrotizing pancreatitis. Timing of imaging, primarily MDCT, is based on the clinical phases and is, therefore, important for these imaging guidelines. Ultrasound’s role is to detect gallstones after the first episode. MDCT plays a primary role in the management of acutely ill patients, only after a minimum of 48–72 hours and generally after one week. MR plays a supplementary role to MDCT. Follow-up MDCT guides management and therapy: percutaneous aspiration of fluid collections and/or placement of large caliber catheters in infected necrosis.

*Cleveland Clinic, Cleveland, Ohio; †Duke University Medical Center, Durham, North Carolina; ‡University of Massachusetts Memorial Medical Center, Worcester, Massachusetts; §Massachusetts General Hospital, Boston, Massachusetts; ∥University of South Alabama, Mobile, Alabama, American Gastroenterological Association; ¶New York University Medical Center, New York, New York; #Johns Hopkins University School of Medicine, Baltimore, Maryland; **The University of Texas, MD Anderson Cancer Center, Houston, Texas; ††Hartford Hospital, Hartford, Connecticut, American College of Surgeons; and ‡‡ Staten Island University Hospital, Staten Island, New York.

Received for publication May 1, 2014; accepted May 2, 2014.

The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document.

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The authors declare no conflict of interest.

Mark E. Baker, MD reported “Research agreement with Siemens Healthcare (hardware; software) monetary support for research forthcoming (agreement, not signed).”

Rendon C. Nelson, MD reported “Consultant with GE Healthcare. Research support with Bracco, Wemoto International and Becton-Dickinson.”

Aliya Qayyum, MD reported “Spouse works for Philips Medical (PACS).”

Corresponding author information: Mark E. Baker, MD, Professor of Radiology, Cleveland Clinic Lerner College of Medicine of CWRU, Cleveland Clinic, 9500 Euclid Ave, Desk L10, Cleveland Ohio 44195 (e-mail:

© 2014 by Lippincott Williams & Wilkins