ACR Appropriateness Criteria® Brain Tumors.

in Journal of the American College of Radiology : JACR by , Jana Ivanidze, Robert Y Shih, Pallavi S Utukuri, Amna A Ajam, Moises Auron, Susan M Chang, Justin T Jordan, Aleks Kalnins, Phillip H Kuo, Luke N Ledbetter, Jeffrey S Pannell, Jeffrey M Pollock, Jason Sheehan, Bruno P Soares, Karl A Soderlund, Lily L Wang, Judah Burns

TLDR

  • The study provides evidence-based guidelines for managing brain tumors in various clinical scenarios, highlighting the importance of advanced brain imaging tools and modalities.
  • The guidelines are based on a systematic analysis of the medical literature and expert input from a multidisciplinary panel.
  • The study has practical implications for treating physicians, providing clear guidelines for imaging recommendations and workup.

Abstract

Brain tumors represent a complex and clinically diverse disease group, whose management is particularly dependent on neuroimaging given the wide range of differential diagnostic considerations and clinical scenarios. The introduction of advanced brain imaging tools into clinical practice makes it paramount for all treating physicians to recognize the range and understand the appropriate application of various conventional and advanced imaging modalities. The imaging recommendations for neuro-oncologic clinical scenarios involving screening in patients with increased genetic risk, screening in patients with systemic malignancy, pretreatment evaluation in patients with intra- and extraaxial brain tumors, posttreatment-surveillance in patients with known brain tumors after completion of therapy, and subsequent workup in the context of suspected radiographic progression are encompassed by this document. 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.

Overview

  • The study focuses on brain tumors and their management in various clinical scenarios, highlighting the importance of advanced brain imaging tools to recognize and apply imaging modalities.
  • The study aims to provide evidence-based guidelines for specific clinical conditions, including screening, pre- and post-treatment evaluation, and workup for suspected progression.
  • The study uses a multidisciplinary expert panel to review and develop guidelines annually, with a systematic analysis of the medical literature from peer-reviewed journals.

Comparative Analysis & Findings

  • The study provides guidelines for various clinical scenarios, including increased genetic risk, systemic malignancy, intra- and extraaxial brain tumors, and known brain tumors after completion of therapy.
  • The guidelines are based on evidence-based principles such as Grading of Recommendations Assessment, Development, and Evaluation (GRADE) and the RAND/UCLA Appropriateness Method.
  • The study highlights the importance of recognizing the range of conventional and advanced imaging modalities in clinical practice, with a focus on the appropriate application of imaging for specific clinical scenarios.

Implications and Future Directions

  • The study has practical implications for treating physicians, providing clear guidelines for imaging recommendations and workup for patients with brain tumors.
  • Future research directions could explore the use of artificial intelligence and machine learning algorithms to aid in diagnosis and treatment planning for brain tumors.
  • Further studies could investigate the use of advanced imaging modalities, such as functional MRI and magnetic resonance spectroscopy, to better understand the biology of brain tumors.
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