The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org Vascular Malformation of the Extremities transarterial or transvenous embolization, and surgical resection. Sclerotherapy is often used for low-flow lesions, whereas high-flow lesions are most effectively treated with embolization [8,10]. All elements are essential: 1) timing, 2) reconstructions/reformats, and 3) 3-D renderings. Standard CTs with contrast also include timing issues and recons/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. Discussion of Procedures by Variant Variant 1: Upper or lower extremity. Suspected vascular malformation presenting with pain or findings of physical deformity including soft-tissue mass, diffuse or focal enlargement, discoloration, or ulceration. Initial imaging. The body regions covered in this clinical scenario are shoulder, humerus, elbow, forearm, wrist, hand, hip, femur, knee, tibia/fibula, ankle, and foot. Radiography Extremity Radiographs are often used as the initial imaging modality in the workup of a patient presenting with nonspecific extremity complaints and may be useful for the exclusion of more common causes of extremity pain and deformity. However, radiographs are of limited utility for the specific purpose of vascular malformation imaging. In the setting of a vascular malformation, radiographs may be normal or show a soft-tissue mass [5,12].
Clinically Suspected Vascular Malformation of the Extremities. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org Vascular Malformation of the Extremities transarterial or transvenous embolization, and surgical resection. Sclerotherapy is often used for low-flow lesions, whereas high-flow lesions are most effectively treated with embolization [8,10]. All elements are essential: 1) timing, 2) reconstructions/reformats, and 3) 3-D renderings. Standard CTs with contrast also include timing issues and recons/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. Discussion of Procedures by Variant Variant 1: Upper or lower extremity. Suspected vascular malformation presenting with pain or findings of physical deformity including soft-tissue mass, diffuse or focal enlargement, discoloration, or ulceration. Initial imaging. The body regions covered in this clinical scenario are shoulder, humerus, elbow, forearm, wrist, hand, hip, femur, knee, tibia/fibula, ankle, and foot. Radiography Extremity Radiographs are often used as the initial imaging modality in the workup of a patient presenting with nonspecific extremity complaints and may be useful for the exclusion of more common causes of extremity pain and deformity. However, radiographs are of limited utility for the specific purpose of vascular malformation imaging. In the setting of a vascular malformation, radiographs may be normal or show a soft-tissue mass [5,12].