ACR Updates Appropriateness Criteria for Imaging of Myelopathy (2026)

The ACR has issued its 2026 update to Appropriateness Criteria for myelopathy, providing evidence-based imaging guidance for acute, chronic, and vascular causes of spinal cord dysfunction to help differentiate extrinsic from intrinsic pathology.

• Guideline covers three clinical scenarios: acute, chronic, and vascular myelopathy; recommendations developed via GRADE methodology and RAND/UCLA Appropriateness Method by a multidisciplinary expert panel.
• Framework is designed to guide triage toward surgical or medical intervention — specific imaging modality recommendations and appropriateness ratings not detailed in the available abstract.
• Where peer-reviewed evidence is lacking or equivocal, expert consensus serves as the primary evidentiary source, a recognized limitation of appropriateness criteria methodology.

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