lUniversity of Washington Medical Center, Seattle, Washington; Committee on Emergency Radiology-GSER. mMayo Clinic, Jacksonville, Florida; Commission on Nuclear Medicine and Molecular Imaging. nUniversity of Missouri Health Care, Columbia, Missouri. oPenn State Milton S. Hershey Medical Center, Hershey, Pennsylvania and Uniformed Services University of the Health Sciences, Bethesda, Maryland. pSpecialty Chair, VA San Diego Healthcare System, San Diego, California. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Chronic Extremity Joint Pain Special Imaging Considerations Image-guided aspiration may be helpful in confirming and characterizing crystal deposition disease and excluding infection. Image-guided aspiration may be challenging; however, depending on the amount of fluid present [6,7]. OR Discussion of Procedures by Variant Variant 1: Chronic extremity joint pain. Suspect inflammatory (seropositive or seronegative arthritis), crystalline (gout or pseudogout), or erosive osteoarthritis. Initial imaging. The area of interest for this variant include: the ankle, elbow, foot, hand, hip, knee, shoulder, and wrist. Bone Scan Whole Body There is no relevant literature supporting the use of bone scan whole body as the initial imaging modality in this clinical scenario. CT Area of Interest With IV Contrast There is no relevant literature supporting the use of CT area of interest with intravenous (IV) contrast as the initial imaging modality in this clinical scenario.
Chronic Extremity Joint Pain Suspected Inflammatory Arthritis Crystalline Arthritis or Erosive Osteoarthritis PCAs. lUniversity of Washington Medical Center, Seattle, Washington; Committee on Emergency Radiology-GSER. mMayo Clinic, Jacksonville, Florida; Commission on Nuclear Medicine and Molecular Imaging. nUniversity of Missouri Health Care, Columbia, Missouri. oPenn State Milton S. Hershey Medical Center, Hershey, Pennsylvania and Uniformed Services University of the Health Sciences, Bethesda, Maryland. pSpecialty Chair, VA San Diego Healthcare System, San Diego, California. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Chronic Extremity Joint Pain Special Imaging Considerations Image-guided aspiration may be helpful in confirming and characterizing crystal deposition disease and excluding infection. Image-guided aspiration may be challenging; however, depending on the amount of fluid present [6,7]. OR Discussion of Procedures by Variant Variant 1: Chronic extremity joint pain. Suspect inflammatory (seropositive or seronegative arthritis), crystalline (gout or pseudogout), or erosive osteoarthritis. Initial imaging. The area of interest for this variant include: the ankle, elbow, foot, hand, hip, knee, shoulder, and wrist. Bone Scan Whole Body There is no relevant literature supporting the use of bone scan whole body as the initial imaging modality in this clinical scenario. CT Area of Interest With IV Contrast There is no relevant literature supporting the use of CT area of interest with intravenous (IV) contrast as the initial imaging modality in this clinical scenario.