• Gay SB, Bree RL, Foley WD, Glick SN, Heiken JP, Huprich JE, Levine MS, Ros PR, Rosen MP, Shuman WP, Greene FL, Rockey DC, Expert Panel on Gastrointestinal Imaging. Palpable abdominal mass. [online publication]. Reston (VA): American College of Radiology (ACR); 2006. 3 p. [7 references]

This is the current release of the guideline.

This guideline updates a previous version: American College of Radiology (ACR), Expert panel on Gastrointestinal Imaging. Imaging evaluation of the palpable abdominal mass. Reston (VA): American College of Radiology (ACR); 2001. 2 p. (ACR appropriateness criteria).

The appropriateness criteria are reviewed annually and updated by the panels as needed, depending on introduction of new and highly significant scientific evidence.

ACR Appropriateness Criteria®

Clinical Condition: Palpable Abdominal Mass

Note: Abbreviations used in the table are listed at the end of the "Major Recommendations" field.

There has been little written about the generic use of imaging in evaluating palpable abdominal masses since the 1980s. Rather, newer research has been both scant and focused on evaluation of specific masses using CT, US, and MRI.

Investigators have found both US and CT excellent for affirming or excluding a clinically suspected abdominal mass, with sensitivity and specificity values in excess of 95%. This is particularly noteworthy since as few as 16%-38% of patients referred for suspected abdominal mass will have that diagnosis corroborated by an imaging study.

Both US and CT can visualize the organ from which a mass arises. The success of US in determining organ of origin has been 88%-91%, while CT has fared slightly better at 93%. US is limited by bowel gas in cases of dilated bowel. As one might expect, attempts to predict the pathologic diagnosis of masses based on imaging findings are less successful. US studies correctly predicted the pathologic diagnosis in 77%-81% of cases, while CT suggested the diagnosis in 88% of cases.

Investigators have stressed the ability of CT and US to image masses no matter what their organ of origin and have touted them as first-line procedures for evaluation of palpable masses. While certain combinations of clinical findings could lend themselves to a more targeted approach (for example, hematemesis plus a palpable gastric-region mass might merit endoscopy as the first study), cross-sectional imaging in general is well suited to initial evaluation of abdominal masses. One study in 1981 showed that, compared with strategies not using CT, the use of CT can result in savings in time for diagnosis and overall cost of hospitalization.

At the time of this writing, no comparative studies evaluating MRI are available. From an intuitive standpoint, however, the nonorgan-specific nature and multiplanar imaging capabilities of MRI seem quite suitable for evaluating an abdominal mass. In the absence of data, the usefulness of MRI in evaluating palpable masses is unknown. It is likely comparable to CT and US.

Abbreviations

• CT, computed tomography
• GI, gastrointestinal
• IVP, intravenous pyelogram
• MRI, magnetic resonance imaging
• US, ultrasound

Algorithms were not developed from criteria guidelines.

The recommendations are based on analysis of the current literature and expert panel consensus.

• Gay SB, Bree RL, Foley WD, Glick SN, Heiken JP, Huprich JE, Levine MS, Ros PR, Rosen MP, Shuman WP, Greene FL, Rockey DC, Expert Panel on Gastrointestinal Imaging. Palpable abdominal mass. [online publication]. Reston (VA): American College of Radiology (ACR); 2006. 3 p. [7 references]

Not applicable: The guideline was not adapted from another source.

1998 (revised 2006)

American College of Radiology - Medical Specialty Society

The American College of Radiology (ACR) provided the funding and the resources for these ACR Appropriateness Criteria®.

Committee on Appropriateness Criteria, Expert Panel on Gastrointestinal Imaging

Panel Members: Spencer B. Gay, MD; Robert L. Bree, MD, MHSA; W. Dennis Foley, MD; Seth N. Glick, MD; Jay P. Heiken, MD; James E. Huprich, MD; Marc S. Levine, MD; Pablo R. Ros, MD, MPH; Max Paul Rosen, MD, MPH; William P. Shuman, MD; Frederick L. Greene, MD; Don C. Rockey, MD

Not stated

This is the current release of the guideline.

This guideline updates a previous version: American College of Radiology (ACR), Expert panel on Gastrointestinal Imaging. Imaging evaluation of the palpable abdominal mass. Reston (VA): American College of Radiology (ACR); 2001. 2 p. (ACR appropriateness criteria).

The appropriateness criteria are reviewed annually and updated by the panels as needed, depending on introduction of new and highly significant scientific evidence.

None available

This summary was completed by ECRI on March 19, 2001. The information was verified by the guideline developer on March 29, 2001. This summary was updated by ECRI on July 31, 2002. The updated information was verified by the guideline developer on October 1, 2002. The summary was updated on August 11, 2006.