Harvey H Benjamin, Watson Laura C, Subramaniam Rathan M, Burns Judah, Bykowski Julie, Chakraborty Santanu, Ledbetter Luke N, Lee Ryan K, Pannell Jeffrey S, Pollock Jeffrey M, Powers William J, Rosenow Joshua M, Shih Robert Y, Slavin Konstantin, Utukuri Pallavi S, Corey Amanda S
Massachusetts General Hospital, Boston, Massachusetts.
Research Author, Massachusetts General Hospital, Boston, Massachusetts.
J Am Coll Radiol. 2020 May;17(5S):S175-S187. doi: 10.1016/j.jacr.2020.01.042.
Movement disorders and neurodegenerative diseases are a variety of conditions that involve progressive neuronal degeneration, injury, or death. Establishing the correct diagnosis of a movement disorder or neurodegenerative process can be difficult due to the variable features of these conditions, unusual clinical presentations, and overlapping symptoms and characteristics. MRI has an important role in the initial assessment of these patients, although a combination of imaging and laboratory and genetic tests is often needed for complete evaluation and management. This document summarizes the imaging appropriateness data for rapidly progressive dementia, chorea, Parkinsonian syndromes, suspected neurodegeneration with brain iron accumulation, and suspected motor neuron 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.
运动障碍和神经退行性疾病是一系列涉及神经元进行性变性、损伤或死亡的病症。由于这些病症的特征多变、临床表现不寻常以及症状和特征重叠,因此准确诊断运动障碍或神经退行性病变可能具有挑战性。MRI在这些患者的初始评估中起着重要作用,不过通常需要结合影像学检查、实验室检查和基因检测才能进行全面评估和管理。本文总结了快速进展性痴呆、舞蹈症、帕金森综合征、疑似脑铁沉积性神经退行性病变以及疑似运动神经元病的影像学适宜性数据。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评估、制定和评价分级系统或GRADE)来评估特定临床场景下影像学检查和治疗程序的适宜性。在缺乏证据或证据不明确的情况下,专家意见可能会补充现有证据以推荐影像学检查或治疗方法。