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

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.

Assessment of Left Ventricular Myocardial Diseases with Cardiac Computed Tomography

“…2). With the retrospective ECG-gated spiral scanning based on continuous data acquisition and table movement at low table feed (low spiral pitch) or ECG-gated volumetric acquisition with a static table (256- and 320-detector-row CT scanner), CT images are obtained at multiple phases of the cardiac cycle for the assessment of LV functional parameters including wall thickness, volume, and mass, and identification of LV regional wall motion abnormality (111213).…”

“…The measurement of LV functional parameters by CCT can be used as an alternative, particularly in cases of equivocal or suboptimal echocardiography or contraindications for CMR. However, there is not sufficient evidence to recommend CCT as a routine measurement of LV functional parameters (1112). A wide-detector CT scanner with single shot scanning or dual-source CT encompassing both cardiac cycles may be used routinely for simultaneous functional analyses.…”

Guideline for Cardiovascular Magnetic Resonance Imaging from the Korean Society of Cardiovascular Imaging—Part 1: Standardized Protocol

“…Herein, we offer a practical standard CMR protocol for beginners designed to be easy to follow and implement. This protocol guideline is based on previously reported CMR guidelines (123456789) and includes sequence terminology used by vendors, essential MR physics (1011121314151617), imaging planes (218), field strength considerations (19202122232425), MRI-conditional devices (10202627282930313233), drugs for stress tests (34), various CMR modules (16353637383940414243444546), and disease/symptom-based protocols (474849505152535455565758) based on a survey of cardiologists, and various appropriate use criteria. It will be of considerable help in planning and implementing tests.…”

Comparison of the Diagnostic Accuracies of 1.5T and 3T Stress Myocardial Perfusion Cardiovascular Magnetic Resonance for Detecting Significant Coronary Artery Disease

“…In the last 2 decades, 1.5-tesla (T) cardiac magnetic resonance (CMR) imaging with adenosine stress testing has become a well-established, noninvasive diagnostic modality with high accuracy for detecting inducible myocardial ischemia consistent with significant coronary artery stenosis, compared with that using fractional flow reserve (FFR) as the reference standard ( 1 2 3 4 ). Many medical institutions now have 3T MR systems.…”