115

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Special Report

New Indications Computed Body Tomography . ,

Society for Computed Body Tomography

‘:“

The Society of indications

‘:

.

‘;

for Computed for computed

guidelines are intended in the April 1 977 policy consensus

opinion

which CT Society.

body

The and,

Society by

Society’s various bers

of the

has

to examine

‘ ‘.‘

on three

“

‘

and

judged

separate

prepared the applications.

select

include

as a group

the

following

At

the

scientific

for

Society. for their

meeting

new

uses

indicated

for

by the

to formulate,

debate, During

the

in the spring of 1 978, members were divided into with a chairman and several subcommittee mem-

indications

of the Society

list new

published reflect the

indications.

computed

tomography

related

organ system. During the ensuing months the chairman after discussion with members of the subcommittee, was indications related to that organ system. Once completed, to the president members of the

following These

many

to be clinically

occasions

to

meeting each

Society

been

concensus,

first annual subcommittees,

‘

update, and augment the indications of the Institute of Medicine. They

of members

met

‘,:

Body Tomography has tomography in extracranial

to clarify, statement

scanning

general

for

of

They were reorganized, comment and study. the

Society

in August

to

a particular

of each subcommittee, able to compile a list of these were submitted edited, 1 978,

and the

sent

drafts

to all of

the

subcommittees were presented to the Society members, where again indications were discussed and selections made by concensus. Between August 1 978 and February 1 979 additional details were added, and again recirculated to the members. They were again discussed at the annual meeting of the Society, February 1 979. Final publication. Prior to submission President Education Radiologic

Health,

with

for

drafts

through American

AJR 133:115-119, 1 979 American 0361-803X/79/1331-01

©

July Roentgen

1979 Ray Society 15 $00.00

of the National and Welfare, their

and

decisions for

were

made

publication,

the

and American

Blue Cross, the Secretary the Office of Technologic the

suggestions

Institute and

of Medicine comment.

six drafts, including preliminary Journal of Roentgenology.

the

study

document College

submitted of Radiology,

of the Department Assessment, the were In all, by

contacted the the

for

manuscript editorial

the

of Health, Bureau of

and

supplied has

staff

gone of

the

INDICATIONS

116

Indications

.

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.

Determination neoplasms

C

Evaluation including

of the extent of the neck. of bony neoplasms,

of

abnormalities fractures,

primary

and

secondary

of the dislocations,

cervical spine and congen-

in the

tissues,

Chest

Localization

of foreign

.

or

larynx

bodies and

soft

assessment

after trauma. Evaluation of retropharyngeal

of

airway

hypo-

.

of problems

Wall

Determination

abscesses.

by chest

among

radiograph.

Assist

Mediastinal

Assessment

-

anatomic Distinction

to other

of whether

or solid

biopsy

mediastinal

aneurysm,

from

mass

when

for occult

Detection

anomaly,

or

pulmonary

conventional

thymic

artery

this

distinction.

Extensive

surgery

neoplasm

metastases tasis. Detection

in selected

gravis when or suspicious.

plain

.

nodule

when

metastases

is planned with

a high

or for apparent

of primary

chest

masses.

angle

or obscured

by

physiology.

Detection of aortacoronary with intravenous contrast

tumor

Major

of cardiac (e.g. (e.g. , mediastinal

ventricular aneurysm) or pulmonary lesion)

,

vein graft occlusion medium bolus with

from mass.

is possible thirdand

scanners.

for a known propensity

solitary in patient chest

pri-

with

tomography

Vessels

Evaluation and detection of thoracic aortic aneurysms. Screening and measurement of abdominal aortic aneurysms when ultrasound fails or is unavailable.

.

Detection of intraluminal clots, ture of thoracic and abdominal

.

Evaluation Evaluation the major

.

for lung

lung metas-

Blood

. .

when:

Delineation tumors,

.

of aortoprosthetic of suspected vessels. of relation infections,

Demonstration

chronic leakage, aneurysms.

disruption. infection of synthetic

of major or other

of invasion

vessels

and

rup-

grafts

of

to retroperitoneal

abnormalities. of vena

cava

by tumor.

positive

radiography

of lung and mediastinum for underlyeffusion and the postpneumonectomy for recurrent disease. or central calcification in a pulmonary

conventional

in-

Examinations of intracardiac anatomy are not indicated at this time. Future advances in CT equipment may allow more clinically useful demonstration of cardiac anatomy

.

.

sputum cytology and negative and fiberoptic bronchoscopy.

Assessment ing pleural fibrothorax Search for diffuse

guidance

bone.

fourth-generation

or hyperplasia

for pulmonary lesions. Detection of occult pulmonary mary

mediastinal

Distinction pericardiac

node enlargement, variant.

Lung

-

fluoroscopic

lesion.

of thymoma

patients with myasthenia radiography is negative

Search

when

low in costovertebral

C

tomography

of making

among lymph cause, or anatomic

cavity

Heart

fat deposition.

enlarged

or is not capable line widening.

Distinction vascular

or

and of

or spinal

thoracic

struc-

is pathologic

vascular

and physiologic

solid

fails Paraspinal

cause

mass,

tissues.

into

Biopsy

of lesions

Mass

na-

.

variation. of solid

Hilum. Differentiation

Search

fatty,

widening.

-

-

cystic,

relative

disease.

and subcutaneous

adequate.

overlying

Localization tures.

-

of intrusion

Needle

Certain

Differentiation ture.

-

of neoplastic

muscle,

canal.

Mass.

S

of extent

bone,

Detection

presented

spread in selected including medias-

invasion.

Assess

.

.

of extent of intrathoracic bronchogenic carcinoma

Percutaneous

Evaluation

July 1979

CT

or pleural

integrity

Mediastinum C

AJR:133,

Determination patients with tinal

ital anomalies. pharynx,

CT

for Body

Neck

.

FOR

is indeterminate.

Spine S

Type I examination: No contrast nation: Dilute metrizamide. Type trated metrizamide myelography with hours

after

metrizamide

instilled subsequent

medium. Type III examination:

originally

instillation.

CT,

for

performed

II examiConcen-

conventional

within

4

AJR:133,

C

INDICATIONS

July 1979

Evaluation

(type

and specific ment.

I) of spinal

causes

stenosis

of bony

and

to determine soft

tissue

extent

FOR

CT

Liver

encroach-

. Evaluation

of space-occupying lesions. Primary and secondary malignant neoplasms and clinically significant benign lesions, such as adenomas, cavernous hemangiomas, and abscesses. Initial detection; whether liver is primary organ of interest or examined as part of CT evaluation

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Diffuse spinal stenosis, congenital or acquired. Localized spinal stenosis, associated with degenerative disease Posttraumatic

or malalignment. stenosis: detection

ments or hematoma. Postspinal fusion growth. Detection of midline plain films. Combined causes genic,

traumatic,

niations S

C

nature

or foramenal including

nucleus

bone

spurs

of other

over-

not seen on

degenerative,

infection/tumor,

of the

and

. Localization

C

fusion

-

frag-

-

iatro-

as well

as her-

extent

(type

I) for CT-guided

biopsy

(type I) of nature and tumors and inflammatory nondiagnostic conventional

I or II procedure) using myelogram and/or clinical findings to specify CT level(s). . Alternative procedure (type I) in situations precluding standard myelography as primary examination (allergic history, mechanical difficulties, emotional factors).

of primary

enchymal,

neural,

malignancies lymphatic,

such

and

as those

embryonic

of mes-

rest

origin,

melanomas, and benign conditions, such as cysts that may mimic malignancies. . Staging of nodal and extranodal extension of lymphomas and ious

other types of retroperitoneal primary sites (e.g. , initial

recurrent

metastatic

testicular

metastases from staging or detection

varof

of retroperitoneal abscess or hemorrhage (hematoma); localization for needle aspiration. Further evaluation when other radiologic studies unexpectedly suggest abnormality, such as deviated ureter by normal

retroperitoneal

. Guidance

C

.

Detection

and

esses. . Detection (neoplasms .

Guidance

tions

differential fluid

for the

diagnosis

collections

aspiration

masses.

of

imporof or

cystic,

of location,

when

such

extent,

information

as an scan.

inflammatory, and

number

of

is of clinical

Evaluation

Guidance for hepatic biopsy and aspiration. Assessment of response to nonoperative therapy. of trauma.

Detection of hepatic laceration and intrahepatic and subcapsular hematoma, and determination of extent of injury in cases of blunt or penetrating trauma. Evaluation of diffuse liver disease. CT currently of limited value, but may be useful in specific circumstances, such as detection of fatty infiltration of the liver and conditions of excessive iron deposition (hemochromatosis) and glycogen storage disease in children.

of age

of subcapsular

mass and differentiation lesions.

hemaof solid,

Pancreas

. Evaluation

biopsy.

and

primary or secondary and abscesses, etc.)

and peritoneal

of solid, lesions.

Detection and estimation toma. . Detection of intrasplenic cystic, and inflammatory

of free

or loculated

inflammatory

proc-

. of

is of clinical

of the presence or clarification of hepatic lesion(s) suspected

S

fat.

for retroperitoneal

intraperitoneal

as

Spleen

Peritoneum S

lesions

such

knowledge

tumor).

. Detection S

disease,

in which

importance. -

Retroperitoneum

. Detection

hepatic

lesions,

or

extent of boney or masses. myelography (type

associated tance. Confirmation the nature

Assessment

-

of lesion.

procedure

abdominal

carcinoma,

Differentiation and vascular

-

-

aspiration. Evaluation paraspinal Following

suspected

pancreatic

found on other imaging procedure, such inconclusive or nonspecific radionuclide

pulposus.

Evaluation (types I and II) of congenital dysraphic abnormalities (spina bifida, meningomyelocele, meningocele, diastematomyelia). Evaluation (type I or II) of spinal cord and/or nerve root masses, usually as secondary procedure to further determine

.

stenosis:

of fracture

117

peritoneal

of intraperitoneal

masses fluid

collec-

for possible

Distinction S

mass

lesion.

Detection of primary tumor and its extent. Search for primary lesion in patient with distant metastases. Evaluation of jaundiced patient. Evaluation of suspected pancreatitis. Evaluation of patient with possible upper abdominal masses. Serial assessment of regression or persistence of tumor during and after therapy. Differentiation of pancreatic from parapancreatic mass. among

solid,

cystic,

vascular,

matory, calcified, and fatty lesions. Detection of complications of acute or subacute titis.

inflam-

pancrea-

118

INDICATIONS

Detection extent.

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Serial

of pseudocysts,

assessment

or surgical Detection extent. .

their

number,

of pseudocyst

management. of abscess:

Guidance of percutaneous ration procedures.

size,

following

determination pancreatic

and

and

CT

AJR:133,

Gastrointestinal S

medical

of size biopsy

FOR

cent

and

in the assessment

or tumorlike organs.

renal

.

Evaluation of kidneys when excretory urography or angiography is contraindicated by risk of serious reaction to contrast medium. . Evaluation of renal mass or suspected mass detected on another imaging procedure. Differentiation of an anatomic variant from a pathologic process. Differentiation of a benign fluid-filled cyst from a cyst and/or solid renal mass. Determination of the extent of renal neoplasm be-

renal

.

.

and

after

treatment.

of selected

neoplasm,

when

patients, excretory

suspected urogram

clinically

of

is negative.

Evaluation of juxtarenal (para- or perirenal) lesions seen or suspected on excretory urography. Differentiation of anatomic variant from pathologic process. Determination of the cause, location, and extent of a lesion. Evaluation of urographic Assessment ness.

nonfunctioning

of size,

outline,

kidney(s).

and

parenchymal

thick-

Detection of obstruction, determination of site, cause, and extent of disease process. Documentation of congenital absence. Detection of minimally calcified renal calculi not demonstrated by conventional techniques. . Determination of cause of renal and perirenal calcification. . Assessment of extent of renal trauma. . Guidance for antegrade nephrostomy, renal biopsy, or mass

the

or recurrence

mesentery

indicated

of

or adja-

for the detection

lesions.

Gland

. Evaluation

fore

into

aspi-

Kidneys

Evaluation

of extent

condition

CT is not currently

of mucosal

Adrenal

.

1979

Tract

CT is useful tumor

July

aspiration.

of patients hyperfunction.

with

biochemical

evidence

of ad-

.

Evaluation of patients with suspicion of adrenal found on conventional radiographic examination. . Guidance for adrenal biopsy.

Uterus

mass

and Ovaries

.

Evaluation of mass detected by clinical examination, after positive biopsy, after failure of ultrasound examination, or when strong clinical suspicion exists for a mass lesion. . Evaluation of primary tumor and its extent of spread; and evaluation

.

fatty S

of secondary

Differentiation

Bladder,

for uterine

inflammatory,

Ureters,

and ovarian

Prostate,

. Evaluation of primary extent of tumor. . Differentiation of solid, fatty tumors. . Detection of obstructing, not

detected

. Guidance

Pelvic

cystic,

vascular,

or

masses.

Guidance

culi

tumor.

of solid,

biopsy.

and Seminal and

secondary

cystic,

tumor,

inflammatory,

minimally

by conventional

Vesicles

calcified

including vascular, ureteral

or cal-

studies.

for biopsy.

Bones

. Evaluation extent. S Guidance

of bone

lesions

and accompanying

soft tissue

for biopsy.

Gallbladder .

CT is not indicated cholecystography

at this time unless and ultrasonography

oral

and intravenous are indeterminate

Musculoskeletal .

or unobtainable. .

Biliary

. . .

.

Tree

Differentiation dice. Determination

of obstructive

from

of site and etiology

Determination

of etiology

nonobstructive

jaun.

of obstruction.

of obstruction.

.

System

Evaluation of selected patients with known or suspected primary bone tumors. Evaluation of patients with suspected recurrence of bone tumors. Evaluation of patients with suspected but indefinite signs of skeletal metastases when conventional studies fail to clarify. Evaluation of joint abnormalities difficult to detect by conventional methods. Evaluation of patients with soft tissue tumors, either

AJR:133,

July

known

or suspected

extent. #{149} Guidance

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INDICATIONS

1979

Therapy

for

of

coefficients for the

purpose

and

baseline from can

#{149} Conformance

as

Members

1 19

follow-up

Foreign anatomy

soft tissue

of planning

of

J. Alfidi, Western

determine

and Followup

chemotherapy ment modalities

Ralph Case

and

CT

protocol.

#{149} Evaluation of signs and symptoms suggesting sion, recurrence, or failure of therapy.

cross-sectional

of bone

#{149} Provision

presence

biopsy.

Planning

#{149} Definition

to confirm

FOR

to

of an established

and Officers M.D. Reserve

University

areas

Body

#{149} In chest

Localization

and

techniques

abdomen

provide

when

insufficient

therapy of these and

and treat-

acceptable

of the Society School

of Medicine

assistance

in manuscript

for Computed

preparation.

Body

Stuart S. Sagel, M.D. Mallinckrodt Institute

Dieter Schellinger, M.D. Georgetown University School

Hospital

John Haaga, M.D. Cleveland Clinic

Robert R. Hattery, Mayo Clinic

Patrick Mayo

Melvyn Korobkin, Duke University

M.D. School

David Mayo Medical of Medicine

M.D. Center

II, M.D.

Robert J. Stanley, M.D. Mallinckrodt Institute of Radiology

Center

M.D.

Elias Kazam, M.D. New York Hospital-Cornell

F. Sheedy, Clinic

Tomography

of Radiology

William Glenn, M.D. Long Beach Memorial

M.D. Medical

imaging

ACKNOWLEDGMENT

W. Frederick Sample, University of California

S. Harell, University

traditional

The Society is greatly indebted to Dr. Peter Livingston, Hollywood Memorial Hospital, Florida for his input and Joan Collie for her

Ronald G. Evens, M.D. Mallinckrodt Institute of Radiology

George Stanford

other

information.

therapy.

radiation

which effectiveness be judged.

part

attenuation

in tumor-bearing

radiation

prior

and

progres-

Center

Stephens, Clinic

Jack Wittenberg, Massachusetts

M.D. M.D. General

Hospital

for Health

of Medicine

Sciences