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Acute Nonlocalized Abdominal Pain

Variant: 1   Acute nonlocalized abdominal pain and fever. No recent surgery. Initial imaging.
Procedure Appropriateness Category Relative Radiation Level
CT abdomen and pelvis with IV contrast Usually Appropriate ☢☢☢
US abdomen May Be Appropriate O
Radiography abdomen May Be Appropriate ☢☢
MRI abdomen and pelvis without and with IV contrast May Be Appropriate O
MRI abdomen and pelvis without IV contrast May Be Appropriate O
CT abdomen and pelvis without IV contrast May Be Appropriate ☢☢☢
CT abdomen and pelvis without and with IV contrast May Be Appropriate ☢☢☢☢
Fluoroscopy contrast enema Usually Not Appropriate ☢☢☢
Fluoroscopy upper GI series with small bowel follow-through Usually Not Appropriate ☢☢☢
Nuclear medicine scan gallbladder Usually Not Appropriate ☢☢
FDG-PET/CT skull base to mid-thigh Usually Not Appropriate ☢☢☢☢
WBC scan abdomen and pelvis Usually Not Appropriate ☢☢☢☢

Variant: 2   Acute nonlocalized abdominal pain and fever. Postoperative patient. Initial imaging.
Procedure Appropriateness Category Relative Radiation Level
CT abdomen and pelvis with IV contrast Usually Appropriate ☢☢☢
US abdomen May Be Appropriate O
Radiography abdomen May Be Appropriate ☢☢
Fluoroscopy contrast enema May Be Appropriate ☢☢☢
Fluoroscopy upper GI series with small bowel follow-through May Be Appropriate ☢☢☢
MRI abdomen and pelvis without and with IV contrast May Be Appropriate O
MRI abdomen and pelvis without IV contrast May Be Appropriate O
CT abdomen and pelvis without IV contrast May Be Appropriate ☢☢☢
CT abdomen and pelvis without and with IV contrast May Be Appropriate ☢☢☢☢
Nuclear medicine scan gallbladder Usually Not Appropriate ☢☢
FDG-PET/CT skull base to mid-thigh Usually Not Appropriate ☢☢☢☢
WBC scan abdomen and pelvis Usually Not Appropriate ☢☢☢☢

Variant: 3   Acute nonlocalized abdominal pain. Neutropenic patient. Initial imaging.
Procedure Appropriateness Category Relative Radiation Level
CT abdomen and pelvis with IV contrast Usually Appropriate ☢☢☢
US abdomen May Be Appropriate O
MRI abdomen and pelvis without and with IV contrast May Be Appropriate O
MRI abdomen and pelvis without IV contrast May Be Appropriate O
CT abdomen and pelvis without IV contrast May Be Appropriate ☢☢☢
CT abdomen and pelvis without and with IV contrast May Be Appropriate ☢☢☢☢
Radiography abdomen Usually Not Appropriate ☢☢
Fluoroscopy contrast enema Usually Not Appropriate ☢☢☢
Fluoroscopy upper GI series with small bowel follow-through Usually Not Appropriate ☢☢☢
Nuclear medicine scan gallbladder Usually Not Appropriate ☢☢
FDG-PET/CT skull base to mid-thigh Usually Not Appropriate ☢☢☢☢
WBC scan abdomen and pelvis Usually Not Appropriate ☢☢☢☢

Variant: 4   Acute nonlocalized abdominal pain. Not otherwise specified. Initial imaging.
Procedure Appropriateness Category Relative Radiation Level
MRI abdomen and pelvis without and with IV contrast Usually Appropriate O
CT abdomen and pelvis with IV contrast Usually Appropriate ☢☢☢
CT abdomen and pelvis without IV contrast Usually Appropriate ☢☢☢
US abdomen May Be Appropriate O
Radiography abdomen May Be Appropriate ☢☢
MRI abdomen and pelvis without IV contrast May Be Appropriate O
CT abdomen and pelvis without and with IV contrast May Be Appropriate ☢☢☢☢
Fluoroscopy contrast enema Usually Not Appropriate ☢☢☢
Fluoroscopy upper GI series with small bowel follow-through Usually Not Appropriate ☢☢☢
Nuclear medicine scan gallbladder Usually Not Appropriate ☢☢
FDG-PET/CT skull base to mid-thigh Usually Not Appropriate ☢☢☢☢
WBC scan abdomen and pelvis Usually Not Appropriate ☢☢☢☢

Panel Members
Summary of Literature Review
Introduction/Background
Discussion of Procedures by Variant
Variant 1: Acute nonlocalized abdominal pain and fever. No recent surgery. Initial imaging.
Variant 1: Acute nonlocalized abdominal pain and fever. No recent surgery. Initial imaging.
A. Radiography Abdomen
Variant 1: Acute nonlocalized abdominal pain and fever. No recent surgery. Initial imaging.
B. Fluoroscopy Contrast Enema
Variant 1: Acute nonlocalized abdominal pain and fever. No recent surgery. Initial imaging.
C. Fluoroscopy Upper GI with SBFT
Variant 1: Acute nonlocalized abdominal pain and fever. No recent surgery. Initial imaging.
D. CT Abdomen and Pelvis
Variant 1: Acute nonlocalized abdominal pain and fever. No recent surgery. Initial imaging.
E. MRI Abdomen and Pelvis
Variant 1: Acute nonlocalized abdominal pain and fever. No recent surgery. Initial imaging.
F. US Abdomen
Variant 1: Acute nonlocalized abdominal pain and fever. No recent surgery. Initial imaging.
G. FDG-PET/CT Skull Base to Mid-Thigh
Variant 1: Acute nonlocalized abdominal pain and fever. No recent surgery. Initial imaging.
H. Nuclear Medicine
Variant 2: Acute nonlocalized abdominal pain and fever. Postoperative patient. Initial imaging.
Variant 2: Acute nonlocalized abdominal pain and fever. Postoperative patient. Initial imaging.
A. Radiography Abdomen
Variant 2: Acute nonlocalized abdominal pain and fever. Postoperative patient. Initial imaging.
B. Fluoroscopy
Variant 2: Acute nonlocalized abdominal pain and fever. Postoperative patient. Initial imaging.
C. Fluoroscopy Contrast Enema
Variant 2: Acute nonlocalized abdominal pain and fever. Postoperative patient. Initial imaging.
D. Fluoroscopy Upper GI with SBFT
Variant 2: Acute nonlocalized abdominal pain and fever. Postoperative patient. Initial imaging.
E. CT Abdomen and Pelvis
Variant 2: Acute nonlocalized abdominal pain and fever. Postoperative patient. Initial imaging.
F. MRI Abdomen and Pelvis
Variant 2: Acute nonlocalized abdominal pain and fever. Postoperative patient. Initial imaging.
G. US Abdomen
Variant 2: Acute nonlocalized abdominal pain and fever. Postoperative patient. Initial imaging.
H. FDG-PET/CT Skull Base to Mid-Thigh
Variant 2: Acute nonlocalized abdominal pain and fever. Postoperative patient. Initial imaging.
I. Nuclear Medicine
Variant 3: Acute nonlocalized abdominal pain. Neutropenic patient. Initial imaging.
Variant 3: Acute nonlocalized abdominal pain. Neutropenic patient. Initial imaging.
A. Radiography Abdomen
Variant 3: Acute nonlocalized abdominal pain. Neutropenic patient. Initial imaging.
B. Fluoroscopy Contrast Enema
Variant 3: Acute nonlocalized abdominal pain. Neutropenic patient. Initial imaging.
C. Fluoroscopy Upper GI with SBFT
Variant 3: Acute nonlocalized abdominal pain. Neutropenic patient. Initial imaging.
D. CT Abdomen and Pelvis
Variant 3: Acute nonlocalized abdominal pain. Neutropenic patient. Initial imaging.
E. MRI Abdomen and Pelvis
Variant 3: Acute nonlocalized abdominal pain. Neutropenic patient. Initial imaging.
F. US Abdomen
Variant 3: Acute nonlocalized abdominal pain. Neutropenic patient. Initial imaging.
G. Nuclear Medicine and FDG-PET/CT Skull Base to Mid-Thigh
Variant 4: Acute nonlocalized abdominal pain. Not otherwise specified. Initial imaging.
Variant 4: Acute nonlocalized abdominal pain. Not otherwise specified. Initial imaging.
A. Radiography Abdomen
Variant 4: Acute nonlocalized abdominal pain. Not otherwise specified. Initial imaging.
B. Fluoroscopy Contrast Enema
Variant 4: Acute nonlocalized abdominal pain. Not otherwise specified. Initial imaging.
C. Fluoroscopy Upper GI with SBFT
Variant 4: Acute nonlocalized abdominal pain. Not otherwise specified. Initial imaging.
D. CT Abdomen and Pelvis
Variant 4: Acute nonlocalized abdominal pain. Not otherwise specified. Initial imaging.
E. MRI Abdomen and Pelvis
Variant 4: Acute nonlocalized abdominal pain. Not otherwise specified. Initial imaging.
F. US Abdomen
Variant 4: Acute nonlocalized abdominal pain. Not otherwise specified. Initial imaging.
G. Nuclear Medicine
Summary of Recommendations
Summary of Evidence
Supporting Documents

The evidence table, literature search, and appendix for this topic are available at https://acsearch.acr.org/list. The appendix includes the strength of evidence assessment and the final rating round tabulations for each recommendation.

For additional information on the Appropriateness Criteria methodology and other supporting documents, please go to the ACR website at https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Appropriateness-Criteria.

Appropriateness Category Names and Definitions

Appropriateness Category Name

Appropriateness Rating

Appropriateness Category Definition

Usually Appropriate

7, 8, or 9

The imaging procedure or treatment is indicated in the specified clinical scenarios at a favorable risk-benefit ratio for patients.

May Be Appropriate

4, 5, or 6

The imaging procedure or treatment may be indicated in the specified clinical scenarios as an alternative to imaging procedures or treatments with a more favorable risk-benefit ratio, or the risk-benefit ratio for patients is equivocal.

May Be Appropriate (Disagreement)

5

The individual ratings are too dispersed from the panel median. The different label provides transparency regarding the panel’s recommendation. “May be appropriate” is the rating category and a rating of 5 is assigned.

Usually Not Appropriate

1, 2, or 3

The imaging procedure or treatment is unlikely to be indicated in the specified clinical scenarios, or the risk-benefit ratio for patients is likely to be unfavorable.
Relative Radiation Level Information
References
Disclaimer
The ACR Committee on Appropriateness Criteria and its expert panels have developed criteria for determining appropriate imaging examinations for diagnosis and treatment of specified medical condition(s). These criteria are intended to guide radiologists, radiation oncologists and referring physicians in making decisions regarding radiologic imaging and treatment. Generally, the complexity and severity of a patient’s clinical condition should dictate the selection of appropriate imaging procedures or treatments. Only those examinations generally used for evaluation of the patient’s condition are ranked.  Other imaging studies necessary to evaluate other co-existent diseases or other medical consequences of this condition are not considered in this document.  The availability of equipment or personnel may influence the selection of appropriate imaging procedures or treatments. Imaging techniques classified as investigational by the FDA have not been considered in developing these criteria; however, study of new equipment and applications should be encouraged.  The ultimate decision regarding the appropriateness of any specific radiologic examination or treatment must be made by the referring physician and radiologist in light of all the circumstances presented in an individual examination