Korean J Radiol.  2017 Dec;18(6):871-880. 10.3348/kjr.2017.18.6.871.

2017 Multimodality Appropriate Use Criteria for Noninvasive Cardiac Imaging: Expert Consensus of the Asian Society of Cardiovascular Imaging

Affiliations
  • 1Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.
  • 2Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang 10380, Korea.
  • 3Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
  • 4Department of Cardiology, Sarawak General Hospital Heart Centre, Sarawak 93586, Malaysia.
  • 5Department of Radiology, Mount Elizabeth Hospital, Singapore 228510, Singapore.
  • 6Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea.
  • 7Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea.
  • 8Department of Radiology, Chonnam National University Hospital, Gwangju 61469, Korea.
  • 9Department of Diagnostic Radiology, Keio University, Tokyo 9608582, Japan.
  • 10Department of Radiology, Kyungpook National University Hospital, Daegu 41944, Korea.
  • 11Department of Radiology, Hong Kong College of Radiologists, Hong Kong 251114, China.
  • 12Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea.
  • 13Department of Radiology, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing 100037, China.
  • 14Department of Radiology, Myongji Hospital, Goyang 10475, Korea.
  • 15Department of Radiology, Mie University Hospital, Mie 5148507, Japan.
  • 16Department of Cardiology, National Heart Centre Singapore, Singapore 169609, Singapore.
  • 17Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Institute for Radiological Research, College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan.
  • 18Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
  • 19Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 08308, Korea. yhwanseok@naver.com

Abstract

In 2010, the Asian Society of Cardiovascular Imaging (ASCI) provided recommendations for cardiac CT and MRI, and this document reflects an update of the 2010 ASCI appropriate use criteria (AUC). In 2016, the ASCI formed a new working group for revision of AUC for noninvasive cardiac imaging. A major change that we made in this document is the rating of various noninvasive tests (exercise electrocardiogram, echocardiography, positron emission tomography, single-photon emission computed tomography, radionuclide imaging, cardiac magnetic resonance, and cardiac computed tomography/angiography), compared side by side for their applications in various clinical scenarios. Ninety-five clinical scenarios were developed from eight selected pre-existing guidelines and classified into four sections as follows: 1) detection of coronary artery disease, symptomatic or asymptomatic; 2) cardiac evaluation in various clinical scenarios; 3) use of imaging modality according to prior testing; and 4) evaluation of cardiac structure and function. The clinical scenarios were scored by a separate rating committee on a scale of 1-9 to designate appropriate use, uncertain use, or inappropriate use according to a modified Delphi method. Overall, the AUC ratings for CT were higher than those of previous guidelines. These new AUC provide guidance for clinicians choosing among available testing modalities for various cardiac diseases and are also unique, given that most previous AUC for noninvasive imaging include only one imaging technique. As cardiac imaging is multimodal in nature, we believe that these AUC will be more useful for clinical decision making.

Keyword

Appropriate use criteria; Multimodality; Noninvasive cardiac imaging

MeSH Terms

Area Under Curve
Asian Continental Ancestry Group
Cardiac Imaging Techniques/*standards
Consensus
Echocardiography
Guidelines as Topic
Heart Diseases/*diagnosis/diagnostic imaging
Humans
Magnetic Resonance Imaging/standards
Positron-Emission Tomography/standards
ROC Curve
Tomography, X-Ray Computed/standards

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