Cardiovasc Imaging Asia.  2017 Jul;1(3):156-165. 10.22468/cvia.2017.00066.

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, Korea
  • 2Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
  • 3Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
  • 4Department of Cardiology, Sarawak General Hospital Heart Centre, Sarawak, Malaysia
  • 5Department of Radiology, Mount Elizabeth Hospital, Singapore, Singapore
  • 6Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
  • 7Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
  • 8Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
  • 9Department of Diagnostic Radiology, Keio University, Tokyo, Japan
  • 10Department of Radiology, Kyungpook National University Hospital, Daegu, Korea
  • 11Department of Radiology, Hong Kong College of Radiologists, Hong Kong, China
  • 12Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • 13Department of Radiology, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
  • 14Department of Radiology, Myongji Hospital, Goyang, Korea
  • 15Department of Radiology, Mie University Hospital, Mie, Japan
  • 16Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
  • 17Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Institute for Radiological Research, College of Medicine, Chang Gung University, Taoyuan, Taiwan
  • 18Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
  • 19Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea

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
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