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Wang LL, Thompson TA, Shih RY, Ajam AA, Bulsara K, Burns J, Davis MA, Ivanidze J, Kalnins A, Kuo PH, Ledbetter LN, Pannell JS, Pollock JM, Shakkottai VG, Shih RD, Soares BP, Soderlund KA, Utukuri PS, Woolsey S, Policeni B. ACR Appropriateness Criteria® Dizziness and Ataxia: 2023 Update. J Am Coll Radiol 2024; 21:S100-S125. [PMID: 38823940 DOI: 10.1016/j.jacr.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 06/03/2024]
Abstract
Diagnostic evaluation of a patient with dizziness or vertigo is complicated by a lack of standardized nomenclature, significant overlap in symptom descriptions, and the subjective nature of the patient's symptoms. Although dizziness is an imprecise term often used by patients to describe a feeling of being off-balance, in many cases dizziness can be subcategorized based on symptomatology as vertigo (false sense of motion or spinning), disequilibrium (imbalance with gait instability), presyncope (nearly fainting or blacking out), or lightheadedness (nonspecific). As such, current diagnostic paradigms focus on timing, triggers, and associated symptoms rather than subjective descriptions of dizziness type. Regardless, these factors complicate the selection of appropriate diagnostic imaging in patients presenting with dizziness or vertigo. This document serves to aid providers in this selection by using a framework of definable clinical variants. 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 process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Lily L Wang
- University of Cincinnati Medical Center, Cincinnati, Ohio.
| | - Trevor A Thompson
- Research Author, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Robert Y Shih
- Panel Chair, Uniformed Services University, Bethesda, Maryland
| | | | - Ketan Bulsara
- UCONN Health, University of Connecticut, Farmington, Connecticut, Neurosurgery expert
| | | | - Melissa A Davis
- Yale University School of Medicine, New Haven, Connecticut; Committee on Emergency Radiology-GSER
| | | | | | - Phillip H Kuo
- University of Arizona, Tucson, Arizona; Commission on Nuclear Medicine and Molecular Imaging
| | | | | | | | - Vikram G Shakkottai
- University of Texas Southwestern Medical Center, Dallas, Texas; American Academy of Neurology
| | - Richard D Shih
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida; American College of Emergency Physicians
| | - Bruno P Soares
- The University of Vermont Medical Center, Burlington, Vermont
| | | | | | - Sarah Woolsey
- Association for Utah Community Health, Salt Lake City, Utah; American Academy of Family Physicians
| | - Bruno Policeni
- Specialty Chair, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Chen W, Xiao H, Zhang Y, Wang L, Li B, Sha Y. A 3-hour time interval may not be sufficient for delayed enhancement magnetic resonance imaging with intravenous gadoteridol injection based on 3d-real IR sequence of the inner ear in Meniere's disease patient. Acta Otolaryngol 2024; 144:1-6. [PMID: 38315462 DOI: 10.1080/00016489.2024.2311796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 01/22/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) can be applied to visualize endolymphatic hydrops (EH). AIMS/OBJECTIVES To explore whether a 3-h time interval was feasible for clinical practice. MATERIALS AND METHODS We prospectively enrolled 15 patients with unilateral Meniere's disease, each of whom underwent delayed enhancement MRI scan of the inner ear after intravenous gadoteridol injection at a 3-h interval. The ears of these patients were divided into two groups (group A: the affected ears; group B: the unaffected ears). Among the two groups, the signal intensity in perilymphatic area of the basal turn of cochlea, the results of visual evaluations in the vestibule, cochlea and semicircular canal and the detection results of EH were compared. RESULTS Regarding the signal intensity, a difference was found between group A and group B (p = .016). Besides, no difference was found between the visual evaluations in the vestibule, cochlea and semicircular canal of the two groups. Regarding the detection results of EH, group A (6 vestibules were undiagnosable; 8 cochleae were undiagnosable); group B (9 vestibules were undiagnosable; 10 cochleae were undiagnosable). CONCLUSIONS AND SIGNIFICANCE In the clinical application of gadoteridol for the inner ear, 3-h delayed MR imaging may not be sufficient.
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Affiliation(s)
- Wei Chen
- Department of Radiology, Eye & ENT Hospital of Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
| | - Hanyu Xiao
- Department of Radiology, Eye & ENT Hospital of Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
| | - Yiyin Zhang
- Department of Radiology, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Luxi Wang
- Department of Radiology, Eye & ENT Hospital of Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
| | - Bingrong Li
- Department of Radiology, Lishui Central Hospital, Lishui, China
| | - Yan Sha
- Department of Radiology, Eye & ENT Hospital of Fudan University, Shanghai, China
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Quint R, Vaussy A, Stemmer A, Hautefort C, Houdart E, Eliezer M. Iterative Denoising Accelerated 3D FLAIR Sequence for Hydrops MR Imaging at 3T. AJNR Am J Neuroradiol 2023; 44:1064-1069. [PMID: 37536733 PMCID: PMC10494947 DOI: 10.3174/ajnr.a7953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/27/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND AND PURPOSE 3D FLAIR sequences have become the criterion standard for identifying endolymphatic hydrops, but scan time remains an important limitation to their widespread use. Our purpose was to evaluate the diagnostic performance and image quality of an accelerated 3D FLAIR sequence combined with an iterative denoising algorithm. MATERIALS AND METHODS This was a retrospective study performed on 30 patients with clinical suspicion of endolymphatic hydrops who underwent 3T MR imaging 4 hours after gadolinium injection using two 3D FLAIR sequences. The first (conventional FLAIR) was accelerated with a conventional turbo factor of 187. The second was accelerated with an increased turbo factor of 263, resulting in a 33% scan time reduction (5 minutes 36 seconds versus 8 minutes 15 seconds, respectively). A sequence was reconstructed in-line immediately after the accelerated 3D FLAIR acquisition from the same raw data with iterative denoising (accelerated-FLAIR iterative denoising). The signal intensity ratio image quality score and endolymphatic hydrops diagnosis were evaluated. RESULTS The mean signal intensity ratio for symptomatic and asymptomatic ears of accelerated-FLAIR iterative denoising was significantly higher than the mean SNR of conventional FLAIR (29.5 versus 19 and 25.9 versus 16.3, P < .001). Compared with the conventional FLAIR sequence, the image-quality score was higher with accelerated-FLAIR iterative denoising (mean image-quality score, 3.8 [SD, 0.4] versus 3.3 [SD, 0.6] for accelerated-FLAIR iterative denoising and conventional FLAIR, respectively, P = .003). There was no significant difference in the diagnosis of endolymphatic hydrops between the 2 sequences. Interreader agreement was good-to-excellent. CONCLUSIONS The iterative denoising algorithm applied to an accelerated 3D FLAIR sequence for exploration of endolymphatic hydrops enabled significantly reducing the scan time without compromising image quality and diagnostic performance.
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Affiliation(s)
- R Quint
- From the Department of Neuroradiology (R.Q., E.H., M.E.), Lariboisière University Hospital, Paris, France
| | - A Vaussy
- Siemens Healthineers France (A.V.), Saint-Denis, France
| | - A Stemmer
- Siemens Healthineers (A.S.), Erlangen, Germany
| | - C Hautefort
- Department of Head and Neck Surgery (C.H.), Lariboisière University Hospital, Paris, France
| | - E Houdart
- From the Department of Neuroradiology (R.Q., E.H., M.E.), Lariboisière University Hospital, Paris, France
- Faculté de Médecine (E.H.), Université de Paris, Paris, France
| | - M Eliezer
- From the Department of Neuroradiology (R.Q., E.H., M.E.), Lariboisière University Hospital, Paris, France
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