ACR Appropriateness Criteria Dysphagia.
ACR Appropriateness Criteria Dysphagia.
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DOI：
10.1016/j.jacr.2019.02.007
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发表时间：
2019-05-01
期刊：
影响因子：
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通讯作者：
Kim, David H
中科院分区：
文献类型：
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作者：
Levy, Angela D;Carucci, Laura R;Kim, David H
这篇综述总结了吞咽困难患者的初始成像的相关文献。对于有潜在原因的口咽吞咽困难患者，改良的钡剂吞咽通常适用于初始成像，但对于不明原因的吞咽困难患者，荧光镜双相食管造影通常适用。对于免疫功能正常和免疫功能低下的胸骨后吞咽困难患者，荧光双相食管造影通常适用于初次成像。对于吞咽困难的术后患者，透视单对比食管造影和颈部和胸部CT静脉（IV）造影通常适用于术后早期发生的口咽或胸骨后吞咽困难，其中通常首选水溶性造影剂而不是硫酸钡。在术后后期（超过1个月），通常应使用IV造影剂进行颈部和胸部CT检查，并使用透视单对比食管造影剂。美国放射学会的适当性标准是针对特定临床条件的循证指南，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来自同行评审期刊的当前医学文献进行广泛分析，并应用成熟的方法（兰德/UCLA适当性方法和建议评估、制定和评价分级或GRADE）对特定临床场景的成像和治疗程序的适当性进行评级。在缺乏证据或证据不明确的情况下，专家意见可以补充现有证据，以推荐成像或治疗。
This review summarizes the relevant literature for the initial imaging of patients with symptoms of dysphagia. For patients with oropharyngeal dysphagia who have an underlying attributable cause, a modified barium swallow is usually appropriate for initial imaging but for those who have unexplained dysphagia a fluoroscopic biphasic esophagram is usually appropriate. Fluoroscopic biphasic esophagram is usually appropriate for initial imaging in both immunocompetent and immunocompromised patients whohave retrosternal dysphagia. For postoperative patients with dysphagia, fluoroscopic single-contrast esophagram and CT neck and chest with intravenous (IV) contrast are usually appropriate for oropharyngeal or retrosternal dysphagia occurring in the early postoperative period where water-soluble contrast is usually preferred rather than barium sulfate. In the later postoperative period(greater than 1 month), CT neck and chest with IV contrast and fluoroscopic single-contrast esophagram are usually appropriate. 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.