TABLE 7.
Appropriate indications for coronary and chest CTA and cardiac CT
| Type of examination | Scorea |
|---|---|
| Coronary CTA | |
| Evaluation of suspected coronary anomalies | A (9) |
| Chest pain syndrome in patients with uninterpretable or equivocal stress test (exercise, perfusion, or stress echo) | A (8) |
| Chest pain syndrome in patients with intermediate pretest probability of CAD where ECG uninterpretable OR who are unable to exercise | A (7) |
| Acute chest pain in patients with intermediate pretest probability of CAD but no ECG changes and negative serial enzymes | A (7) |
| Assessment of complex congenital heart disease including anomalies of coronary circulation, great vessels, and cardiac chambers and valves | A (7) |
| Evaluation of coronary arteries in patients with new onset heart failure to assess etiology | A (7) |
| Vascular CTA | |
| Evaluation of suspected aortic dissection or thoracic aortic aneurysm | A (9) |
| Evaluation of suspected pulmonary embolism | A (9) |
| Cardiac CT | |
| Evaluation of cardiac mass (suspected tumor or thrombus) in patients with technically limited images from echocardiogram, MRI, or TEE | A (8) |
| Evaluation of pericardial conditions (pericardial mass, constrictive pericarditis, or complications of cardiac surgery) in patients with technically limited images from echocardiogram, MRI, or TEE | A (8) |
| Evaluation of pulmonary vein anatomy before invasive radiofrequency ablation for atrialfibrillation | A (8) |
| Noninvasive coronary vein mapping before placement of biventricular pacemaker | A (8) |
| Noninvasive coronary arterial mapping, including internal mammary artery before repeat cardiac surgical revascularization | A (8) |
CAD, coronary artery disease; CT, computed tomography; CTA, CT angiography; ECG, electrocardiogram; MRI, magnetic resonance imaging; TEE, transesophageal echocardiogram.
(Modified with permission from Hendel RC, Patel MR, Kramer CM, et al. 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. J Am Coll Cardiol 2006;48:1475–97.)
Median score assigned by panel members.