ACR Appropriateness Criteria® Cranial Neuropathy: 2022 Update


Tanya J. Rath, Division Chair of Neuroradiology, Mayo Clinic Arizona, Phoenix, Arizona. Electronic address:
Bruno Policeni, Panel Chair; Department of Radiology Vice-Chair, University of Iowa Hospitals and Clinics, Iowa City, Iowa; President Iowa Radiological Society and ACR Councilor.
Amy F. Juliano, Panel Vice-Chair, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts; NI-RADS committee chair.
Mohit Agarwal, Froedtert Memorial Lutheran Hospital Medical College of Wisconsin, Milwaukee, Wisconsin; Fellowship Program Director.
Alec M. Block, Stritch School of Medicine Loyola University Chicago, Maywood, Illinois.
Judah Burns, Montefiore Medical Center, Bronx, New York; Vice-Chair for Education & Residency Program Director, Montefiore Medical Center; Vice-Chair, Subcommittee on Methodology.
David B. Conley, Practice Director, Northwestern ENT and Rhinology Fellowship Director, Northwestern University Feinberg School of Medicine, Chicago, Illinois; and Member, American Academy of Otolaryngology-Head and Neck Surgery.
R Webster Crowley, Rush University Medical Center, Chicago, Illinois; Neurosurgery expert; Chief, Cerebrovascular and Endovascular Neurosurgery; Medical Director, Department of Neurosurgery; Surgical Director, Rush Comprehensive Stroke Center; Program Director, Endovascular Neurosurgery.
Prachi Dubey, Houston Methodist Hospital, Houston, Texas.
Elliott R. Friedman, University of Texas Health Science Center, Houston, Texas; Diagnostic Radiology Residency Program Director.
Maria K. Gule-Monroe, The University of Texas MD Anderson Cancer Center, Houston, Texas; Medical Director of Diagnostic Imaging at Houston Area Location Woodlands.
Mari Hagiwara, Neuroradiology Fellowship Program Director and Head and Neck Imaging Director, New York University Langone Medical Center, New York, New York.
Christopher H. Hunt, Mayo Clinic, Rochester, Minnesota.
Vikas Jain, MetroHealth Medical Center, Cleveland, Ohio; Medical Director, Lumina Imaging.
William J. Powers, University of North Carolina School of Medicine, Chapel Hill, North Carolina; American Academy of Neurology.
Joshua M. Rosenow, Neuroradiology Fellowship Program Director and Head and Neck Imaging Director, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
M Reza Taheri, George Washington University Hospital, Washington, District of Columbia; Director of Neuroradiology.
Kate DuChene Thoma, Director of Faculty Development Fellowship, University of Iowa Hospital, Iowa City, Iowa; Primary care physician.
David Zander, Chief of Head and Neck Radiology, University of Colorado Denver, Denver, Colorado.
Amanda S. Corey, Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia.

Document Type

Journal Article

Publication Date



Journal of the American College of Radiology : JACR








AUC; Appropriate Use Criteria; Appropriateness Criteria; Cranial nerves; Cranial neuropathy; Hemifacial spasm; Perineural tumor spread; Trigeminal neuralgia


Cranial neuropathy can result from pathology affecting the nerve fibers at any point and requires imaging of the entire course of the nerve from its nucleus to the end organ in order to identify a cause. MRI with and without intravenous contrast is often the modality of choice with CT playing a complementary role. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.