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 Acute Onset Flank Pain-Suspicion of Stone Disease scan range. Dual-energy CT allows for the characterization of stone composition (ie, uric acid, cystine, and calcium) and the generation of virtual unenhanced images simulating noncontrast CT images [6-8]. MR urography (MRU) is also tailored to improve visualization of the urinary system. Unenhanced MRU relies upon the intrinsic high signal intensity from urine on heavily T2-weighted imaging for the evaluation of the urinary tract. IV contrast is administered to provide additional information regarding obstruction, urothelial thickening, focal lesions, and stones. Contrast-enhanced T1-weighted series should include corticomedullary, nephrographic, and excretory phases. Thin-slice acquisition and multiplanar imaging should be obtained. For the purposes of this document, we make a distinction between MRU and MRI abdomen and pelvis without and with IV contrast. MRI abdomen and pelvis without and with IV contrast is defined as any MRI protocol not specifically tailored for evaluation of the upper and lower urinary tracts, without both the precontrast and excretory phases, and without heavily T2-weighted images of the urinary tract. The addition of digital tomosynthesis (DT) to standard digital radiography allows for additional radiographic projections at multiple angles, thus removing overlying structures and providing depth information about stones compared with 2-D radiographs.
Acute Onset Flank Pain Suspicion of Stone Disease Urolithiasis . 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 Acute Onset Flank Pain-Suspicion of Stone Disease scan range. Dual-energy CT allows for the characterization of stone composition (ie, uric acid, cystine, and calcium) and the generation of virtual unenhanced images simulating noncontrast CT images [6-8]. MR urography (MRU) is also tailored to improve visualization of the urinary system. Unenhanced MRU relies upon the intrinsic high signal intensity from urine on heavily T2-weighted imaging for the evaluation of the urinary tract. IV contrast is administered to provide additional information regarding obstruction, urothelial thickening, focal lesions, and stones. Contrast-enhanced T1-weighted series should include corticomedullary, nephrographic, and excretory phases. Thin-slice acquisition and multiplanar imaging should be obtained. For the purposes of this document, we make a distinction between MRU and MRI abdomen and pelvis without and with IV contrast. MRI abdomen and pelvis without and with IV contrast is defined as any MRI protocol not specifically tailored for evaluation of the upper and lower urinary tracts, without both the precontrast and excretory phases, and without heavily T2-weighted images of the urinary tract. The addition of digital tomosynthesis (DT) to standard digital radiography allows for additional radiographic projections at multiple angles, thus removing overlying structures and providing depth information about stones compared with 2-D radiographs.