Policeni Bruno, Corey Amanda S, Burns Judah, Conley David B, Crowley R Webster, Harvey H Benjamin, Hoang Jenny, Hunt Christopher H, Jagadeesan Bharathi D, Juliano Amy F, Kennedy Tabassum A, Moonis Gul, Pannell Jeffrey S, Patel Nandini D, Perlmutter Joel S, Rosenow Joshua M, Schroeder Jason W, Whitehead Mathew T, Cornelius Rebecca S
Principal Author and Panel Vice Chair, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
Panel Chair, Emory University, Atlanta, Georgia.
J Am Coll Radiol. 2017 Nov;14(11S):S406-S420. doi: 10.1016/j.jacr.2017.08.035.
Evaluation of cranial neuropathy can be complex given the different pathway of each cranial nerve as well as the associated anatomic landmarks. Radiological evaluation requires imaging of the entire course of the nerve from its nucleus to the end organ. MRI is the modality of choice with CT playing a complementary role, particularly in the evaluation of the bone anatomy. Since neoplastic and inflammatory lesions are prevalent on the differential diagnosis, contrast enhanced studies are preferred when possible. The American College of Radiology Appropriateness Criteria are evidencebased 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.
鉴于各颅神经的不同走行路径以及相关的解剖标志,颅神经病变的评估可能会很复杂。放射学评估需要对神经从其核团到终末器官的整个行程进行成像。MRI是首选的检查方式,CT起辅助作用,尤其是在评估骨解剖结构时。由于肿瘤性和炎性病变在鉴别诊断中较为常见,因此在可能的情况下,首选增强检查。美国放射学会适宜性标准是针对特定临床情况的循证指南,每年由多学科专家小组进行审查。指南的制定和修订包括对同行评审期刊上的当前医学文献进行广泛分析,并应用成熟的方法(兰德/加州大学洛杉矶分校适宜性方法以及推荐分级评估、制定与评价或GRADE)来评估特定临床场景下成像和治疗程序的适宜性。在缺乏证据或证据不明确的情况下,专家意见可补充现有证据以推荐成像或治疗。