Lee Ryan K, Burns Judah, Ajam Amna A, Broder Joshua S, Chakraborty Santanu, Chong Suzanne T, Kendi A Tuba, Ledbetter Luke N, Liebeskind David S, Pannell Jeffrey S, Pollock Jeffrey M, Rosenow Joshua M, Shaines Matthew D, Shih Robert Y, Slavin Konstantin, Utukuri Pallavi S, Corey Amanda S
Einstein Healthcare Network, Philadelphia, Pennsylvania.
Panel Chair, Montefiore Medical Center, Bronx, New York.
J Am Coll Radiol. 2020 May;17(5S):S293-S304. doi: 10.1016/j.jacr.2020.01.037.
Seizures and epilepsy are a set of conditions that can be challenging to diagnose, treat, and manage. This document summarizes recommendations for imaging in different clinical scenarios for a patient presenting with seizures and epilepsy. MRI of the brain is usually appropriate for each clinical scenario described with the exception of known seizures and unchanged semiology (Variant 3). In this scenario, it is unclear if any imaging would provide a benefit to patients. In the emergent situation, a noncontrast CT of the head is also usually appropriate as it can diagnose or exclude emergent findings quickly and is an alternative to MRI of the brain in these clinical scenarios. 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.
癫痫发作和癫痫是一组在诊断、治疗和管理方面可能具有挑战性的病症。本文总结了针对癫痫发作和癫痫患者在不同临床场景下进行影像学检查的建议。除了已知癫痫发作且症状未变的情况（变体3）外，脑部MRI通常适用于所描述的每种临床场景。在这种情况下，尚不清楚任何影像学检查是否会对患者有益。在紧急情况下，头部非增强CT通常也适用，因为它可以快速诊断或排除紧急发现，并且在这些临床场景中是脑部MRI的替代方法。美国放射学会适宜性标准是针对特定临床病症的循证指南，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当前医学文献的广泛分析，以及应用成熟的方法（兰德/加州大学洛杉矶分校适宜性方法和推荐评估、制定与评价分级或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。
