Panel Chair, University of Wisconsin, Madison, Wisconsin.
Panel Chair, Massachusetts General Hospital, Boston, Massachusetts, Chief, Division of Interventional Radiology, Massachusetts General Hospital.
J Am Coll Radiol. 2021 May;18(5S):S153-S173. doi: 10.1016/j.jacr.2021.02.013.
Cirrhosis is a heterogeneous disease that cannot be studied as a single entity and is classified in two main prognostic stages: compensated and decompensated cirrhosis. Portal hypertension, characterized by a pathological increase of the portal pressure and by the formation of portal-systemic collaterals that bypass the liver, is the initial and main consequence of cirrhosis and is responsible for the majority of its complications. A myriad of treatment options exists for appropriately managing the most common complications of portal hypertension, including acute variceal bleeding and refractory ascites. 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.
肝硬化是一种异质性疾病，不能作为单一实体进行研究，分为代偿期和失代偿期两个主要预后阶段。门静脉高压症的特征是门静脉压力病理性升高，并形成绕过肝脏的门体侧支循环，这是肝硬化的最初和主要后果，也是其大多数并发症的原因。存在许多治疗选择可用于适当治疗门静脉高压症的最常见并发症，包括急性静脉曲张出血和难治性腹水。美国放射学院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议期刊上的现有医学文献进行广泛分析，并应用成熟的方法（RAND/UCLA 适宜性方法和推荐评估、制定和评估分级或 GRADE）来评估特定临床情况下影像学和治疗程序的适宜性。在缺乏证据或证据不确定的情况下，专家意见可以补充现有证据，以推荐影像学或治疗。
