Tufts Medical Center, Boston, Massachusetts.
Brigham & Women's Hospital, Boston, Massachusetts.
J Am Coll Radiol. 2014 Feb;11(2):114-20. doi: 10.1016/j.jacr.2013.10.023. Epub 2013 Dec 22.
Substantial cost, morbidity, and mortality are associated with acute proximal femoral fracture and may be reduced through an optimized diagnostic imaging workup. Radiography represents the primary diagnostic test of choice for the evaluation of acute hip pain. In middle aged and elderly patients with negative radiographs, the evidence indicates MRI to be the next diagnostic imaging study to exclude a proximal femoral fracture. CT, because of its relative decreased sensitivity, is only indicated in patients with MRI contraindications. Bone densitometry (DXA) should be obtained in patients with fragility fractures. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 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.
大量的成本、发病率和死亡率与急性股骨近端骨折有关，通过优化的诊断影像学检查可以降低这些风险。放射摄影术是评估急性髋部疼痛的主要诊断测试选择。对于影像学检查结果为阴性的中年和老年患者，证据表明 MRI 是排除股骨近端骨折的下一个诊断影像学研究。由于其相对较低的敏感性，CT 仅在存在 MRI 禁忌症的患者中使用。脆性骨折患者应进行骨密度（DXA）检测。ACR 适宜性标准是针对特定临床情况的基于证据的指南，由多学科专家小组每两年审查一次。指南的制定和审查包括对同行评议期刊上的现有医学文献进行广泛分析，并应用成熟的共识方法（改良 Delphi 法）对专家组评估影像学和治疗程序的适宜性进行评分。在缺乏证据或证据不明确的情况下，可以使用专家意见来推荐影像学或治疗方法。
