ACR Updates Appropriateness Criteria for Imaging Penetrating Abdominal and Pelvic Trauma (2026)

Updated ACR guidelines: CT abdomen/pelvis with IV contrast + CT urography are usually appropriate first-line for suspected penetrating upper urinary tract trauma; CT urography preferred when collecting system injury is suspected. Retrograde urethrography, CT cystography compleme…

• Evidence-based guideline update (2026) covering penetrating abdominal and pelvic trauma with focus on urinary tract injury; developed via GRADE methodology and RAND/UCLA Appropriateness Method by multidisciplinary expert panel.
• For penetrating lower urinary tract trauma, fluoroscopic retrograde urethrography, contrast-enhanced CT abdomen/pelvis, and CT cystography are usually appropriate and may be used in a complementary fashion.
• Ultrasound and MRI are rated usually NOT appropriate for initial evaluation of penetrating urinary tract trauma; CT protocols lacking dedicated urographic phases should not substitute for CT urography when ureteral/collecting system injury is suspected.

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