ACR Appropriateness Criteria® Anorectal Disease

Expert Panel on Gastrointestinal Imaging; Angela D Levy; Peter S Liu; David H Kim; Kathryn J Fowler; Adil E Bharucha; Kevin J Chang; Elizabeth Cilenti; Kenneth L Gage; Evelyn M Garcia; Avinash R Kambadakone; Elena K Korngold; Daniele Marin; Courtney Moreno; Jason A Pietryga; Cynthia S Santillan; Stefanie Weinstein; Steven D Wexner; Laura R Carucci

doi:10.1016/j.jacr.2021.08.009

ACR Appropriateness Criteria® Anorectal Disease

J Am Coll Radiol. 2021 Nov;18(11S):S268-S282. doi: 10.1016/j.jacr.2021.08.009.

Authors

Expert Panel on Gastrointestinal Imaging; Angela D Levy¹, Peter S Liu², David H Kim³, Kathryn J Fowler⁴, Adil E Bharucha⁵, Kevin J Chang⁶, Elizabeth Cilenti⁷, Kenneth L Gage⁸, Evelyn M Garcia⁹, Avinash R Kambadakone¹⁰, Elena K Korngold¹¹, Daniele Marin¹², Courtney Moreno¹³, Jason A Pietryga¹⁴, Cynthia S Santillan¹⁵, Stefanie Weinstein¹⁶, Steven D Wexner¹⁷, Laura R Carucci¹⁸

Affiliations

¹ Medstar Georgetown University Hospital, Washington, District of Columbia. Electronic address: [email protected].
² Section Head, Abdominal Imaging, Cleveland Clinic, Cleveland, Ohio.
³ Panel Chair, University of Wisconsin Hospital & Clinics, Madison, Wisconsin.
⁴ Panel Vice-Chair, University of California San Diego, San Diego, California; and Founder, Advisory Board Quantix Bio.
⁵ Chair of the Neurogastroenterology Section, Chair of Research Compliance Subcommittee, and Medical Director, Office of Clinical Trials, Mayo Clinic Rochester, Minnesota; and American Gastroenterological Association.
⁶ Boston University Medical Center, Boston, Massachusetts.
⁷ Medstar Georgetown University Hospital, Washington, District of Columbia, Primary care physician.
⁸ H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida; SECJNMMI Member-at-Large.
⁹ Virginia Tech Carilion School of Medicine, Roanoke, Virginia.
¹⁰ Massachusetts General Hospital, Boston, Massachusetts; Taubman Museum of Art Board Member; and Past-President VA Rad Society.
¹¹ Section Chief, Abdominal Imaging, Oregon Health and Science University, Portland, Oregon.
¹² Duke University Medical Center, Durham, North Carolina.
¹³ Emory University, Atlanta, Georgia; Chair ACR CTC Registry Committee; and Executive Council American Roentgen Ray Society.
¹⁴ University of Alabama at Birmingham, Birmingham, Alabama; Associate Editor Hollow Organ GI.
¹⁵ Chief, Body Imaging Division and Vice-Chair, Clinical Operations for Radiology, University of California San Diego, San Diego, California.
¹⁶ University of California San Francisco, San Francisco, California.
¹⁷ Cleveland Clinic Florida, Weston, Florida; Editor-in-Chief, Surgery Journal; American College of Surgeons PAC Board; and Managing Member, Unique Surgical Innovations.
¹⁸ Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia; Director of CT and MRI at VCU, Section Chief, Abdominal Imaging at VCU.

PMID: 34794588
DOI: 10.1016/j.jacr.2021.08.009

Abstract

This review summarizes the relevant literature for the selection of the initial imaging in 4 clinical scenarios in patients with suspected inflammatory disease or postoperative complication of the anorectum. These clinical scenarios include suspected perianal fistula or abscess; rectovesicular or rectovaginal fistula; proctitis or pouchitis; and suspected complication following proctectomy, coloproctectomy, or colectomy with a pouch or other anastomosis. The appropriateness of imaging modalities as they apply to each clinical scenario is rated as usually appropriate, may be appropriate, and usually not appropriate to assist the selection of the most appropriate imaging modality in the corresponding clinical scenarios of anorectal 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 include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Keywords: AUC; Anorectal fistula/abscess; Appropriate Use Criteria; Appropriateness Criteria; Ileal pouch anal anastomosis (IPAA); Pouchitis/proctitis; Rectal fistula; Rectovaginal; Rectovescicular.

Publication types

Practice Guideline
Review

MeSH terms

Diagnostic Imaging
Humans
Rectal Diseases*
Societies, Medical*
United States