Arthur E. Stillman, MD-PhD, FACR, FAHA
Emory University Department of Radiology & Imaging Sciences
9/18/11
!   None
1

9/18/11
Journal of the American College of Cardiology
© 2006 by the American College of Cardiology Foundation
Published by Elsevier Inc.
Vol. 48, No. 7, 2006
ISSN 0735-1097/06/$32.00
doi:10.1016/j.jacc.2006.07.003
ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR APPROPRIATENESS CRITERIA
ACCF/ACR/SCCT/SCMR/
ASNC/NASCI/SCAI/SIR 2006 Appropriateness
Criteria for Cardiac Computed Tomography and Cardiac Magnetic Resonance Imaging*
A Report of the American College of Cardiology Foundation Quality
Strategic Directions Committee Appropriateness Criteria Working Group,
American College of Radiology, Society of Cardiovascular Computed
Tomography, Society for Cardiovascular Magnetic Resonance, American
Society of Nuclear Cardiology, North American Society for Cardiac
Imaging, Society for Cardiovascular Angiography and Interventions, and
Society of Interventional Radiology
Robert C. Hendel, MD, FACC
Manesh R. Patel, MD
CCT/CMR WRITING GROUP
Christopher M. Kramer, MD, FACC†
Michael Poon, MD, FACC‡
TECHNICAL PANEL MEMBERS
Robert C. Hendel, MD, FACC, Moderator §
James C. Carr, MD, BC
H
, BAO !
Nancy A. Gerstad, MD
Linda D. Gillam, MD, FACC
John McB. Hodgson, MD, FSCAI, FACC¶
Raymond J. Kim, MD, FACC
Christopher M. Kramer, MD, FACC†
John R. Lesser, MD, FACC
Edward T. Martin, MD, FACC, FACP
Joseph V. Messer, MD, MACC, FSCAI
Rita F. Redberg, MD, MS
C
, FACC**
Geoffrey D. Rubin, MD, FSCBTMR††
John S. Rumsfeld, MD, P
H
D, FACC
Allen J. Taylor, MD, FACC
Wm. Guy Weigold, MD, FACC‡
Pamela K. Woodard, MD‡‡
†Society for Cardiovascular Magnetic Resonance Official Representative; ‡Society of Cardiovascular Computed Tomography Official Representative; §American Society of
Nuclear Cardiology Official Representative; !
Society of Interventional Radiology Official Representative; ¶Society for Cardiovascular Angiography and Interventions Official
Representative; **American Heart Association Official Representative; ††American College of Radiology Official Representative; ‡‡North American Society for Cardiac Imaging
Official Representative.
JACC Vol. 48, No. 7, 2006
October 3, 2006:1475–97
Hendel et al.
Appropriateness Criteria for CCT/CMR
ACCF APPROPRIATENESS CRITERIA WORKING GROUP
1485
Eric D. Peterson, MD, FACC
AND
Michael J. Wolk, MD, MACC
Joseph M. Allen, MA
Manesh R. Patel, MD unless otherwise noted
No ECG changes and serial enzymes negative).
Table 12.
Detection of CAD: Symptomatic
Allen JM, Raskin IE. ACCF proposed method for evaluating the appropriateness of cardiovascular imaging. J Am Coll Cardiol 2005;46:1606–13.
Appropriateness
Indication
Criteria
(Median Score)
Evaluation of Chest Pain Syndrome (Use of Vasodilator Perfusion CMR or Dobutamine Stress Function CMR)
1.
2.
3.
4.
●
●
Low pre-test probability of CAD
ECG interpretable AND able to exercise
●
●
Intermediate pre-test probability of CAD
ECG interpretable AND able to exercise
●
●
Intermediate pre-test probability of CAD
ECG uninterpretable OR unable to exercise
I (2)
U (4)
A (7)
●
High pre-test probability of CAD
Evaluation of Chest Pain Syndrome (Use of MR Coronary Angiography)
U (5)
5.
6.
7.
I (1)
Evaluation of Intra-Cardiac Structures (Use of MR Coronary Angiography)
8.
●
Evaluation of suspected coronary anomalies A (8)
Acute Chest Pain (Use of Vasodilator Perfusion CMR or Dobutamine Stress Function CMR)
9.
U (6)
10.
●
●
Intermediate pre-test probability of CAD
ECG interpretable AND able to exercise
●
●
Intermediate pre-test probability of CAD
ECG uninterpretable OR unable to exercise
●
High pre-test probability of CAD
●
●
Intermediate pre-test probability of CAD
No ECG changes and serial cardiac enzymes negative
●
●
High pre-test probability of CAD
ECG—ST-segment elevation and/or positive cardiac enzymes
I (2)
I (2)
I (1)
Table 13.
Risk Assessment With Prior Test Results (Use of Vasodilator Perfusion CMR or
Dobutamine Stress Function CMR)
Indication
Appropriateness
Criteria
(Median Score)
11.
I (2)
12.
13.
●
●
●
Normal prior stress test (exercise, nuclear, echo, MRI)
High CHD risk (Framingham)
Within 1 year of prior stress test
●
●
Equivocal stress test (exercise, stress SPECT, or stress echo)
Intermediate CHD risk (Framingham)
●
●
Coronary angiography (catheterization or CT)
Stenosis of unclear significance
U (6)
A (7)
2

JACC Vol. 48, No. 7, 2006
October 3, 2006:1475–97
Hendel et al.
Appropriateness Criteria for CCT/CMR
CMR APPROPRIATENESS CRITERIA (BY INDICATION)
Assume the logical operator between each variable listed for an indication is “AND” unless otherwise noted
(e.g., Low pre-test probability of CAD AND No ECG changes and serial enzymes negative).
1485
Table 12.
Detection of CAD: Symptomatic
Indication
Appropriateness
Criteria
(Median Score)
Evaluation of Chest Pain Syndrome (Use of Vasodilator Perfusion CMR or Dobutamine Stress Function CMR)
1.
2.
3.
4.
●
●
Low pre-test probability of CAD
ECG interpretable AND able to exercise
●
●
Intermediate pre-test probability of CAD
ECG interpretable AND able to exercise
●
●
Intermediate pre-test probability of CAD
ECG uninterpretable OR unable to exercise
●
High pre-test probability of CAD
Evaluation of Chest Pain Syndrome (Use of MR Coronary Angiography)
I (2)
U (4)
A (7)
U (5)
5.
6.
7.
●
●
Intermediate pre-test probability of CAD
ECG interpretable AND able to exercise
●
●
Intermediate pre-test probability of CAD
ECG uninterpretable OR unable to exercise
I (2)
I (2)
●
High pre-test probability of CAD
Evaluation of Intra-Cardiac Structures (Use of MR Coronary Angiography)
I (1)
8.
●
Evaluation of suspected coronary anomalies A (8)
Acute Chest Pain (Use of Vasodilator Perfusion CMR or Dobutamine Stress Function CMR)
9.
U (6)
10.
●
●
Intermediate pre-test probability of CAD
No ECG changes and serial cardiac enzymes negative
●
●
High pre-test probability of CAD
ECG—ST-segment elevation and/or positive cardiac enzymes
I (1)
9/18/11
Table 13.
Risk Assessment With Prior Test Results (Use of Vasodilator Perfusion CMR or
Dobutamine Stress Function CMR)
Indication
Appropriateness
Criteria
(Median Score)
11.
●
●
●
Normal prior stress test (exercise, nuclear, echo, MRI)
High CHD risk (Framingham)
Within 1 year of prior stress test
I (2)
12.
●
●
Equivocal stress test (exercise, stress SPECT, or stress echo)
Intermediate CHD risk (Framingham)
U (6)
13.
●
●
Coronary angiography (catheterization or CT)
Stenosis of unclear significance
A (7)
1486 Hendel et al.
Appropriateness Criteria for CCT/CMR
Table 14.
Risk Assessment: Preoperative Evaluation for Non-Cardiac Surgery
Indication
Appropriateness
Criteria
(Median Score)
Low-Risk Surgery (Use of Vasodilator Perfusion CMR or Dobutamine Stress Function CMR)
14.
●
Intermediate perioperative risk predictor I (2)
15.
Intermediate- or High-Risk Surgery (Use of Vasodilator Perfusion CMR or Dobutamine Stress Function CMR)
●
Intermediate perioperative risk predictor U (6)
JACC Vol. 48, No. 7, 2006
October 3, 2006:1475–97
Table 15.
Detection of CAD: Post-Revascularization (PCI or CABG)
Indication
Appropriateness
Criteria
(Median Score)
Evaluation of Chest Pain Syndrome (Use of MR Coronary Angiography)
16.
17.
●
Evaluation of bypass grafts
●
History of percutaneous revascularization with stents
I (2)
I (1)
Table 16.
Structure and Function
Indication
Appropriateness
Criteria
(Median Score)
Evaluation of Ventricular and Valvular Function
Procedures may include LV/RV mass and volumes, MR angiography, quantification of valvular disease, and delayed contrast enhancement
18.
A (9)
●
●
Assessment of complex congenital heart disease including anomalies of coronary circulation, great vessels, and cardiac chambers and valves
Procedures may include LV/RV mass and volumes, MR angiography, quantification of valvular disease, and contrast enhancement
19.
20.
U (6)
A (8)
21.
22.
23.
24.
25.
●
Evaluation of LV function following myocardial infarction OR in heart failure patients
●
●
Evaluation of LV function following myocardial infarction OR in heart failure patients
Patients with technically limited images from echocardiogram
●
●
Quantification of LV function
Discordant information that is clinically significant from prior tests
●
●
Evaluation of specific cardiomyopathies (infiltrative [amyloid, sarcoid], HCM, or due to cardiotoxic therapies)
Use of delayed enhancement
●
●
Characterization of native and prosthetic cardiac valves—including planimetry of stenotic disease and quantification of regurgitant disease
Patients with technically limited images from echocardiogram or TEE
●
●
Evaluation for arrythmogenic right ventricular cardiomyopathy (ARVC)
Patients presenting with syncope or ventricular arrhythmia
●
●
Evaluation of myocarditis or myocardial infarction with normal coronary arteries
Positive cardiac enzymes without obstructive atherosclerosis on angiography
Evaluation of Intra- and Extra-Cardiac Structures
A (8)
A (8)
A (8)
A (9)
A (8)
26.
●
●
Evaluation of cardiac mass (suspected tumor or thrombus)
Use of contrast for perfusion and enhancement
A (9)
27.
28.
29.
●
Evaluation of pericardial conditions (pericardial mass, constrictive pericarditis)
●
Evaluation for aortic dissection
●
●
Evaluation of pulmonary veins prior to radiofrequency ablation for atrial fibrillation
Left atrial and pulmonary venous anatomy including dimensions of veins for mapping purposes
A (8)
A (8)
A (8)
3

1486 Hendel et al.
Appropriateness Criteria for CCT/CMR
Table 14.
Risk Assessment: Preoperative Evaluation for Non-Cardiac Surgery
Indication
●
Intermediate perioperative risk predictor
Appropriateness
Criteria
(Median Score)
Low-Risk Surgery (Use of Vasodilator Perfusion CMR or Dobutamine Stress Function CMR)
14.
●
Intermediate perioperative risk predictor
Intermediate- or High-Risk Surgery (Use of Vasodilator Perfusion CMR or Dobutamine Stress Function CMR)
I (2)
15.
U (6)
JACC Vol. 48, No. 7, 2006
October 3, 2006:1475–97
Table 15.
Detection of CAD: Post-Revascularization (PCI or CABG)
Indication
Appropriateness
Criteria
(Median Score)
Evaluation of Chest Pain Syndrome (Use of MR Coronary Angiography)
16.
17.
●
Evaluation of bypass grafts
●
History of percutaneous revascularization with stents
I (2)
I (1)
Table 16.
Structure and Function
Indication
18.
Appropriateness
Criteria
(Median Score)
Evaluation of Ventricular and Valvular Function
Procedures may include LV/RV mass and volumes, MR angiography, quantification of valvular disease, and delayed contrast enhancement
A (9)
●
●
Assessment of complex congenital heart disease including anomalies of coronary circulation, great vessels, and cardiac chambers and valves
Procedures may include LV/RV mass and volumes, MR angiography, quantification of valvular disease, and contrast enhancement
19.
20.
U (6)
A (8)
21.
22.
23.
24.
25.
26.
27.
28.
29.
●
Evaluation of LV function following myocardial infarction OR in heart failure patients
●
●
Evaluation of LV function following myocardial infarction OR in heart failure patients
Patients with technically limited images from echocardiogram
●
●
Quantification of LV function
Discordant information that is clinically significant from prior tests
●
●
Evaluation of specific cardiomyopathies (infiltrative [amyloid, sarcoid], HCM, or due to cardiotoxic therapies)
Use of delayed enhancement
●
●
Characterization of native and prosthetic cardiac valves—including planimetry of stenotic disease and quantification of regurgitant disease
Patients with technically limited images from echocardiogram or TEE
●
●
Evaluation for arrythmogenic right ventricular cardiomyopathy (ARVC)
Patients presenting with syncope or ventricular arrhythmia
●
●
Evaluation of myocarditis or myocardial infarction with normal coronary arteries
Positive cardiac enzymes without obstructive atherosclerosis on angiography
Evaluation of Intra- and Extra-Cardiac Structures
●
●
Evaluation of cardiac mass (suspected tumor or thrombus)
Use of contrast for perfusion and enhancement
●
Evaluation of pericardial conditions (pericardial mass, constrictive pericarditis)
●
Evaluation for aortic dissection
●
●
Evaluation of pulmonary veins prior to radiofrequency ablation for atrial fibrillation
Left atrial and pulmonary venous anatomy including dimensions of veins for mapping purposes
A (8)
A (8)
A (8)
A (9)
A (8)
A (9)
A (8)
A (8)
A (8)
9/18/11
JACC Vol. 48, No. 7, 2006
October 3, 2006:1475–97
Table 17.
Detection of Myocardial Scar and Viability
Hendel et al.
Appropriateness Criteria for CCT/CMR
1487
Indication
30.
31.
32.
33.
Evaluation of Myocardial Scar (Use of Late Gadolinium Enhancement)
●
●
To determine the location and extent of myocardial necrosis including ‘no reflow’ regions
Post-acute myocardial infarction
●
To detect post PCI myocardial necrosis
●
●
To determine viability prior to revascularization
Establish likelihood of recovery of function with revascularization (PCI or CABG) or medical therapy
●
●
To determine viability prior to revascularization
Viability assessment by SPECT or dobutamine echo has provided “equivocal or indeterminate” results
Appropriateness
Criteria
(Median Score)
A (7)
U (4)
A (9)
A (9)
CMR APPROPRIATENESS CRITERIA (BY APPROPRIATENESS CATEGORY)
Table 18.
Inappropriate Indications (Median Score 1–3)
Indication
1.
Detection of CAD: Symptomatic—Evaluation of Chest Pain Syndrome (Use of Vasodilator Perfusion CMR or Dobutamine Stress Function CMR)
●
●
Low pre-test probability of CAD
ECG interpretable AND able to exercise
Detection of CAD: Symptomatic—Evaluation of Chest Pain Syndrome (Use of MR Coronary Angiography)
Appropriateness
Criteria
(Median Score)
I (2)
5.
6.
●
●
Intermediate pre-test probability of CAD
ECG interpretable AND able to exercise
●
●
Intermediate pre-test probability of CAD
ECG uninterpretable OR unable to exercise
I (2)
I (2)
7.
●
High pre-test probability of CAD I (1)
Detection of CAD: Symptomatic—Acute Chest Pain (Use of Vasodilator Perfusion CMR or Dobutamine Stress Function CMR)
10.
●
●
High pre-test probability of CAD
ECG—ST-segment elevation and/or positive cardiac enzymes
Risk Assessment With Prior Test Results (Use of Vasodilator Perfusion CMR or Dobutamine Stress Function CMR)
I (1)
11.
I (2)
14.
●
●
●
Normal prior stress test (exercise, nuclear, echo, MRI)
High CHD risk (Framingham)
Within 1 year of prior stress test
Risk Assessment: Preoperative Evaluation for Non-Cardiac Surgery—Low Risk Surgery
(Use of Vasodilator Perfusion CMR or Dobutamine Stress Function CMR)
●
Intermediate perioperative risk predictor
Detection of CAD: Post-Revascularization (PCI or CABG)—Evaluation of Chest Pain Syndrome
(Use of MR Coronary Angiography)
I (2)
16.
17.
●
Evaluation of bypass grafts
●
History of percutaneous revascularization with stents
I (2)
I (1)
4

9/18/11
Int J Cardiovasc Imaging (2010) 26:173–186
DOI 10.1007/s10554-010-9687-z
O R I G I N A L P A P E R
ASCI CCT and CMR Guideline Working Group
•
Kakuya Kitagawa
•
Byoung Wook Choi
•
Carmen Chan
•
Masahiro Jinzaki
•
I-Chen Tsai
•
Hwan Seok Yong
•
Wei Yu
Received: 10 August 2010 / Accepted: 11 August 2010 / Published online: 24 August 2010
!
The Author(s) 2010. This article is published with open access at Springerlink.com
Abstract There has been a growing need for standard Asian population guidelines for cardiac CT and cardiac MR due to differences in culture, healthcare system, ethnicity and disease prevalence.
The Asian Society of Cardiovascular Imaging, as the establish cardiac CT and cardiac MR services. In this
ASCI cardiac MR appropriateness criteria report, 23
Technical Panel members representing various Asian countries were invited to rate 50 indications that can frequently be encountered in clinical practice in only society dedicated to cardiovascular imaging in Asia. Indications were rated on a scale of 1–9 to
Technical Panel Members of ASCI 2010 Cardiac MR scores of the 23 members, the final ratings for indi-
Appropriateness Criteria have been processed in Appendix .
and 3 inappropriate) indications. This report is
Electronic supplementary material The online version of this article (doi: 10.1007/s10554-010-9687-z ) contains supplementary material, which is available to authorized users.
expected to have a significant impact on the cardiac
!
K. Kitagawa (
Department of Diagnostic Radiology, Mie University
I.-C. Tsai
Department of Radiology, Taichung Veterans General
School of Medicine, Tsu, Japan e-mail: kakuya@clin.medic.mie-u.ac.jp
!
B. W. Choi
H. S. Yong
Department of Radiology, Korea University Guro
Department of Radiology, Research Institute
Hospital, Taichung, Taiwan
Hospital, Seoul, Korea of Radiological Science, Severance Hospital, !
W. Yu
Department of Radiology, Beijing Anzhen Hospital,
C. Chan
Capital Medical University, Beijing, China
Division of Cardiology, Department of Medicine,
Queen Mary Hospital, Hong Kong, China
M. Jinzaki
Department of Diagnostic Radiology,
Keio University School of Medicine, Tokyo, Japan
123
5

ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 Appropriate
Use Criteria for Cardiac Computed Tomography: A Report of the American
College of Cardiology Foundation Appropriate Use Criteria Task Force, the
Society of Cardiovascular Computed Tomography, the American College of
Radiology, the American Heart Association, the American Society of
Echocardiography, the American Society of Nuclear Cardiology, the North
American Society for Cardiovascular Imaging, the Society for Cardiovascular
Angiography and Interventions, and the Society for Cardiovascular Magnetic
Resonance
Cardiac Computed Tomography Writing Group, Allen J. Taylor, Manuel Cerqueira,
John McB. Hodgson, Daniel Mark, James Min, Patrick O'Gara, Geoffrey D. Rubin,
Circulation
Christopher M. Kramer and Michael J. Wolk
2010;122;e525-e555; originally published online Oct 25, 2010;
DOI: 10.1161/CIR.0b013e3181fcae66
Circulation is published by the American Heart Association. 7272 Greenville Avenue, Dallas, TX
72514
Copyright © 2010 American Heart Association. All rights reserved. Print ISSN: 0009-7322. Online
ISSN: 1524-4539
The online version of this article, along with updated information and services, is located on the World Wide Web at: http://circ.ahajournals.org/cgi/content/full/122/21/e525
Data Supplement (unedited) at: http://circ.ahajournals.org/cgi/content/full/CIR.0b013e3181fcae66/DC1 http://circ.ahajournals.org/cgi/content/full/CIR.0b013e3181fcae66/DC2
http://circ.ahajournals.org/subscriptions/
Permissions: Permissions & Rights Desk, Lippincott Williams & Wilkins, a division of Wolters
Fax: Kluwer Health, 351 West Camden Street, Baltimore, MD 21202-2436. Phone: 410-528-4050.
410-528-8550. E-mail: journalpermissions@lww.com
Reprints: Information about reprints can be found online at http://www.lww.com/reprints
Downloaded from circ.ahajournals.org
by ARTHUR STILLMAN on November 23, 2010
9/18/11
6

9/18/11
7

9/18/11
8

9/18/11
9

9/18/11
10

9/18/11
ACCF/ACR/AHA/NASCI/SCMR 2010 Expert Consensus Document on
Cardiovascular Magnetic Resonance: A Report of the American College of
Cardiology Foundation Task Force on Expert Consensus Documents
W. Gregory Hundley, David A. Bluemke, J. Paul Finn, Scott D. Flamm, Mark A.
Fogel, Matthias G. Friedrich, Vincent B. Ho, Michael Jerosch-Herold, Christopher
M. Kramer, Warren J. Manning, Manesh Patel, Gerald M. Pohost, Arthur E.
Stillman, Richard D. White, and Pamela K. Woodard
J. Am. Coll. Cardiol.
2010;55;2614-2662; originally published online May 17, 2010; doi:10.1016/j.jacc.2009.11.011
This information is current as of September 6, 2011
The online version of this article, along with updated information and services, is located on the World Wide Web at: http://content.onlinejacc.org/cgi/content/full/55/23/2614
ACCF/ACR/AHA/NASCI/SAIP/SCAI/SCCT 2010 Expert Consensus
Document on Coronary Computed Tomographic Angiography: A Report of the
American College of Cardiology Foundation Task Force on Expert Consensus
Documents
Daniel B. Mark, Daniel S. Berman, Matthew J. Budoff, J. Jeffrey Carr, Thomas C.
Gerber, Harvey S. Hecht, Mark A. Hlatky, John McB. Hodgson, Michael S. Lauer,
Julie M. Miller, Richard L. Morin, Debabrata Mukherjee, Michael Poon, Geoffrey
D. Rubin, and Robert S. Schwartz
J. Am. Coll. Cardiol.
2010;55;2663-2699; originally published online May 17, 2010; doi:10.1016/j.jacc.2009.11.013
This information is current as of September 6, 2011
Downloaded from content.onlinejacc.org
by on September 6, 2011
The online version of this article, along with updated information and services, is located on the World Wide Web at: http://content.onlinejacc.org/cgi/content/full/55/23/2663
11
Downloaded from content.onlinejacc.org
by on September 6, 2011