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: Dyspnea due to suspected valvular heart disease. Ischemia excluded. Initial imaging. Arteriography Coronary with Ventriculography There is no relevant literature to support the use of arteriography coronary with ventriculography for the evaluation of dyspnea due to suspected VHD, ischemia excluded. CT Coronary Calcium There is scant literature regarding the use of CT coronary calcium scans in the evaluation of dyspnea due to suspected VHD, ischemia excluded. Presence of mitral annular calcification on CT coronary calcium scans has shown correlation with cardiovascular risk [20]. Coronary artery calcium scanning for the detection and quantification of aortic valve calcium burden may be useful in some instances, for example, in patients with low- gradient aortic stenosis, but is not a first-line imaging examination. CT Heart Function and Morphology CT plays a predominantly supportive role to echocardiography in the assessment of suspected VHD, utilized when echocardiographic images are suboptimal, or to provide complementary information [21]. CT can aid in differentiating aortic leaflet morphologies, with leaflet fusion length, uneven cusp area, and midline calcification all showing strong association with bicuspid valve (P < .
Dyspnea Suspected Cardiac Origin Ischemia Already Excluded . 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: Dyspnea due to suspected valvular heart disease. Ischemia excluded. Initial imaging. Arteriography Coronary with Ventriculography There is no relevant literature to support the use of arteriography coronary with ventriculography for the evaluation of dyspnea due to suspected VHD, ischemia excluded. CT Coronary Calcium There is scant literature regarding the use of CT coronary calcium scans in the evaluation of dyspnea due to suspected VHD, ischemia excluded. Presence of mitral annular calcification on CT coronary calcium scans has shown correlation with cardiovascular risk [20]. Coronary artery calcium scanning for the detection and quantification of aortic valve calcium burden may be useful in some instances, for example, in patients with low- gradient aortic stenosis, but is not a first-line imaging examination. CT Heart Function and Morphology CT plays a predominantly supportive role to echocardiography in the assessment of suspected VHD, utilized when echocardiographic images are suboptimal, or to provide complementary information [21]. CT can aid in differentiating aortic leaflet morphologies, with leaflet fusion length, uneven cusp area, and midline calcification all showing strong association with bicuspid valve (P < .