qSpecialty Chair, Emory University Hospital, Atlanta, Georgia. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org All elements are essential: 1) timing, 2) reconstructions/reformats, and 3) 3-D renderings. Standard CTs with contrast also include timing issues and reconstructions/reformats. Only in CTA, however, is 3-D rendering a required element. This corresponds to the definitions that the CMS has applied to the Current Procedural Terminology codes. OR Discussion of Procedures by Variant Variant 1: Known upper extremity arterial occlusion. Suspected embolic etiology. Next imaging study to determine source. The variant assumes that an upper extremity arterial occlusion has already been established. Typically, this diagnosis is made by CTA, arteriography, or MRA, although the clinical examination or another imaging study could also be used. Aortography Chest Conventional catheter aortography has largely been replaced by noninvasive imaging modalities such as CTA and MRA given their high sensitivity/specificity for detecting aortic pathologies such as mural thrombus [16,17]. Aortography is typically used as an alternative diagnostic strategy following initial noninvasive imaging and when therapeutic interventions are being considered [11,17]. CT Heart Function and Morphology With IV Contrast The primary role of cardiac CT in the initial evaluation of upper extremity arterial embolic occlusion is in the workup of cardiac thrombus as a source. Multiple studies have established high rates of atrial thrombus detection by cardiac CT compared to transesophageal echocardiography (TEE) [18-27].
Workup of Noncerebral Systemic Arterial Embolic Source. qSpecialty Chair, Emory University Hospital, Atlanta, Georgia. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org All elements are essential: 1) timing, 2) reconstructions/reformats, and 3) 3-D renderings. Standard CTs with contrast also include timing issues and reconstructions/reformats. Only in CTA, however, is 3-D rendering a required element. This corresponds to the definitions that the CMS has applied to the Current Procedural Terminology codes. OR Discussion of Procedures by Variant Variant 1: Known upper extremity arterial occlusion. Suspected embolic etiology. Next imaging study to determine source. The variant assumes that an upper extremity arterial occlusion has already been established. Typically, this diagnosis is made by CTA, arteriography, or MRA, although the clinical examination or another imaging study could also be used. Aortography Chest Conventional catheter aortography has largely been replaced by noninvasive imaging modalities such as CTA and MRA given their high sensitivity/specificity for detecting aortic pathologies such as mural thrombus [16,17]. Aortography is typically used as an alternative diagnostic strategy following initial noninvasive imaging and when therapeutic interventions are being considered [11,17]. CT Heart Function and Morphology With IV Contrast The primary role of cardiac CT in the initial evaluation of upper extremity arterial embolic occlusion is in the workup of cardiac thrombus as a source. Multiple studies have established high rates of atrial thrombus detection by cardiac CT compared to transesophageal echocardiography (TEE) [18-27].