Torabi Maha, Lenchik Leon, Beaman Francesca D, Wessell Daniel E, Bussell Jennifer K, Cassidy R Carter, Czuczman Gregory J, Demertzis Jennifer L, Khurana Bharti, Klitzke Alan, Motamedi Kambiz, Pierce Jennifer L, Sharma Akash, Walker Eric A, Kransdorf Mark J
Research Author, Wake Forest University School of Medicine, Winston Salem, North Carolina.
Wake Forest University School of Medicine, Winston Salem, North Carolina.
J Am Coll Radiol. 2019 May;16(5S):S7-S17. doi: 10.1016/j.jacr.2019.02.029.
Hand and wrist injuries are common reasons for musculoskeletal-related emergency department visits. Imaging is essential for evaluating many of these injuries. In most cases, conventional radiographs provide sufficient information to guide the treating clinician. This review focuses on seven common variants to guide diagnosis of hand and wrist injuries. In addition to radiographs, appropriate use of CT, MRI, bone scan, and ultrasound are discussed. 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.
手部和腕部损伤是肌肉骨骼相关急诊就诊的常见原因。影像学检查对于评估其中许多损伤至关重要。在大多数情况下，传统X线片可提供足够信息以指导治疗医生。本综述聚焦于七种常见变异情况，以指导手部和腕部损伤的诊断。除了X线片外，还讨论了CT、MRI、骨扫描和超声的合理应用。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、制定和评价或GRADE）来评定特定临床场景下影像学检查和治疗程序的适宜性。在证据不足或不明确的情况下，专家意见可补充现有证据以推荐影像学检查或治疗。
