ACR Updates Appropriateness Criteria for Imaging Hydrocephalus in Children

ACR guideline: cranial ultrasound first in infants with open fontanelles; MRI preferred for defining obstruction; abbreviated/rapid MRI may avoid sedation; noncontrast CT reserved for urgent or MRI-inaccessible situations.

• Evidence-based ACR guideline covering two key scenarios: newly suspected hydrocephalus and suspected CSF-diversion (shunt) malfunction in pediatric patients, developed using GRADE methodology and RAND/UCLA Appropriateness Method.
• Abbreviated/rapid MRI protocols are highlighted as a strategy to reduce exam time and potentially eliminate the need for sedation — a clinically meaningful operational point for pediatric imaging.
• Where peer-reviewed evidence is lacking or equivocal, expert consensus serves as the primary evidentiary source, which limits the strength of recommendations in some clinical scenarios.

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