ACR Appropriateness Criteria® Preprocedural Planning for Transcatheter Aortic Valve Replacement: 2023 Update.

This document discusses preprocedural planning for transcatheter aortic valve replacement, evaluating the imaging modalities used in initial imaging for preprocedure planning under two variants 1) Preintervention planning for transcatheter aortic valve replacement: assessment of aortic root; and 2) Preintervention planning for transcatheter aortic valve replacement: assessment of supravalvular aorta and vascular access. US echocardiography transesophageal, MRI heart function and morphology without and with IV contrast, MRI heart function and morphology without IV contrast and CT heart function and morphology with IV contrast are usually appropriate for assessment of aortic root. CTA chest with IV contrast, CTA abdomen and pelvis with IV contrast, CTA chest abdomen pelvis with IV contrast are usually appropriate for assessment of supravalvular aorta and vascular access.

ACR Appropriateness Criteria® Congenital or Acquired Heart Disease.

Pediatric heart disease is a large and diverse field with an overall prevalence estimated at 6 to 13 per 1,000 live births. This document discusses appropriateness of advanced imaging for a broad range of variants. Diseases covered include tetralogy of Fallot, transposition of great arteries, congenital or acquired pediatric coronary artery abnormality, single ventricle, aortopathy, anomalous pulmonary venous return, aortopathy and aortic coarctation, with indications for advanced imaging spanning the entire natural history of the disease in children and adults, including initial diagnosis, treatment planning, treatment monitoring, and early detection of complications.

Attention U-net for automated pulmonary fissure integrity analysis in lung computed tomography images.

Computed Tomography (CT) imaging is routinely used for imaging of the lungs. Deep learning can effectively automate complex and laborious tasks in medical imaging. In this work, a deep learning technique is utilized to assess lobar fissure completeness (also known as fissure integrity) from pulmonary CT images.

A low-rank deep image prior reconstruction for free-breathing ungated spiral functional CMR at 0.55 T and 1.5 T.

Objective: This study combines a deep image prior with low-rank subspace modeling to enable real-time (free-breathing and ungated) functional cardiac imaging on a commercial 0.55 T scanner.

Materials And Methods: The proposed low-rank deep image prior (LR-DIP) uses two u-nets to generate spatial and temporal basis functions that are combined to yield dynamic images, with no need for additional training data.

ACR Appropriateness Criteria® Suspected Pulmonary Embolism: 2022 Update.

Pulmonary embolism (PE) remains a common and important clinical condition that cannot be accurately diagnosed on the basis of signs, symptoms, and history alone. The diagnosis of PE has been facilitated by technical advancements and multidetector CT pulmonary angiography, which is the major diagnostic modality currently used. Ventilation and perfusion scans remain largely accurate and useful in certain settings.

ACR Appropriateness Criteria® Dyspnea-Suspected Cardiac Origin (Ischemia Already Excluded): 2021 Update.

Dyspnea is the symptom of perceived breathing discomfort and is commonly encountered in a variety of clinical settings. Cardiac etiologies of dyspnea are an important consideration; among these, valvular heart disease (Variant 1), arrhythmia (Variant 2), and pericardial disease (Variant 3) are reviewed in this document. Imaging plays an important role in the clinical assessment of these suspected abnormalities, with usually appropriate procedures including resting transthoracic echocardiography in all three variants, radiography for Variants 1 and 3, MRI heart function and morphology in Variants 2 and 3, and CT heart function and morphology with intravenous contrast for Variant 3.

Artificial Intelligence to Assist in Exclusion of Coronary Atherosclerosis During CCTA Evaluation of Chest Pain in the Emergency Department: Preparing an Application for Real-world Use.

Coronary computed tomography angiography (CCTA) evaluation of chest pain patients in an emergency department (ED) is considered appropriate. While a "negative" CCTA interpretation supports direct patient discharge from an ED, labor-intensive analyses are required, with accuracy in jeopardy from distractions. We describe the development of an artificial intelligence (AI) algorithm and workflow for assisting qualified interpreting physicians in CCTA screening for total absence of coronary atherosclerosis.

ACR Appropriateness Criteria® Nonischemic Myocardial Disease with Clinical Manifestations (Ischemic Cardiomyopathy Already Excluded).

Nonischemic cardiomyopathies encompass a broad spectrum of myocardial disorders with mechanical or electrical dysfunction without evidence of ischemia. There are five broad variants of nonischemic cardiomyopathies; hypertrophic cardiomyopathy (Variant 1), restrictive or infiltrative cardiomyopathy (Variant 2), dilated or unclassified cardiomyopathy (Variant 3), arrhythmogenic cardiomyopathy (Variant 4), and inflammatory cardiomyopathy (Variant 5). For variants 1, 3, and 4, resting transthoracic echocardiography, MRI heart function and morphology without and with contrast, and MRI heart function and morphology without contrast are the usually appropriate imaging modalities.

ACR Appropriateness Criteria® Chest Pain-Possible Acute Coronary Syndrome.

Chest pain is a frequent cause for emergency department visits and inpatient evaluation, with particular concern for acute coronary syndrome as an etiology, since cardiovascular disease is the leading cause of death in the United States. Although history-based, electrocardiographic, and laboratory evaluations have shown promise in identifying coronary artery disease, early accurate diagnosis is paramount and there is an important role for imaging examinations to determine the presence and extent of anatomic coronary abnormality and ischemic physiology, to guide management with regard to optimal medical therapy or revascularization, and ultimately to thereby improve patient outcomes. A summary of the various methods for initial imaging evaluation of suspected acute coronary syndrome is outlined in this document.

Imaging Evaluation of Lung Transplantation Patients: A Time and Etiology-based Approach to High-resolution Computed Tomography Interpretation.

Lung transplantation is an established therapeutic option for patients with irreversible end-stage pulmonary disease limiting life expectancy and quality of life. Common indications for lung transplantation include chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, cystic fibrosis, pulmonary arterial hypertension, and alpha-1 antitrypsin deficiency. Complications of lung transplantation can be broadly divided etiologically into surgical, infectious, immunologic, or neoplastic.

Radiologic review of acquired pulmonary vein stenosis in adults.

Acquired pulmonary vein stenosis (PVS) is an uncommon occurrence in adults, but one that carries significant morbidity/mortality. PVS can be secondary to neoplastic infiltration/extrinsic compression, non-neoplastic infiltration/extrinsic compression, or iatrogenic intervention. This article: (I) reviews the common causes of acquired PVS; (II) illustrates direct and indirect cross-sectional imaging findings in acquired PVS (in order to avoid misinterpretation of these imaging findings); and (III) details the role of imaging before and after the treatment of acquired PVS.

Congenital heart disease in adults: Quantitative and qualitative evaluation of IR FLASH and IR SSFP MRA techniques using a blood pool contrast agent in the steady state and comparison to first pass MRA.

Objectives: To evaluate magnetic resonance angiography sequences during the contrast steady-state (SS-MRA) using inversion recovery (IR) with fast low-angle shot (IR-FLASH) or steady-state free precession (IR-SSFP) read-outs, following the injection of a blood-pool contrast agent, and compare them to first-pass MR angiography (FP-MRA) in adults with congenital heart disease (CHD).

Materials And Methods: Twenty-three adult patients with CHD who underwent both SS-MRA and FP-MRA using a 1.5-T scanner were retrospectively identified.

Steady-state MRA techniques with a blood pool contrast agent improve visualization of pulmonary venous anatomy and left atrial patency compared with time-resolved MRA pre- and postcatheter ablation in atrial fibrillation.

Purpose: To compare steady-state magnetic resonance angiography (SS-MRA), using a blood pool contrast agent, with the established technique of time-resolved MRA (TR-MRA), in pulmonary vein mapping and left atrial patency.

Materials And Methods: Twenty-one patients (12 males, age 58.3 ± 8.

The combined effect of multidetector-row computed tomographic tube voltage, tube current, and image reconstruction algorithm on the detection of pneumothorax after intervention.

Objectives: The objective of the study was to determine the lowest multidetector-row computed tomographic radiation dose parameters for the detection of pneumothorax after thoracic intervention.

Materials And Methods: An anthropomorphic chest phantom containing pneumothoraces was imaged with different tube voltages (80, 100, and 120 kV[p]) and tube currents (10, 20, 40, 75, and 110 mAs). The images were reconstructed with both filtered back projection (FBP) and iterative reconstruction (IR) algorithms.

Evaluation of the tarsometatarsal joint using conventional radiography, CT, and MR imaging.

The tarsometatarsal, or Lisfranc, joint complex provides stability to the midfoot and forefoot through intricate osseous relationships between the distal tarsal bones and metatarsal bases and their connections with stabilizing ligamentous support structures. Lisfranc joint injuries are relatively uncommon, and their imaging findings can be subtle. These injuries have typically been divided into high-impact fracture-displacements, which are often seen after motor vehicle collisions, and low-impact midfoot sprains, which are more commonly seen in athletes.

Wall morphology, blood flow and wall shear stress: MR findings in patients with peripheral artery disease.

Objectives: To investigate the influence of atherosclerotic plaques on femoral haemodynamics assessed by two-dimensional (2D) phase-contrast (PC) magnetic resonance imaging (MRI) with three-directional velocity encoding.

Methods: During 1 year, patients with peripheral artery disease and an ankle brachial index <1.00 were enrolled.

Analysis of the thoracic aorta using a semi-automated post processing tool.

Objective: To evaluates a semi-automated method for Thoracic Aortic Aneurysm (TAA) measurement using ECG-gated Dual Source CT Angiogram (DSCTA).

Methods: This retrospective HIPAA compliant study was approved by our IRB. Transaxial maximum diameters of outer wall to outer wall were studied in fifty patients at seven anatomic locations of the thoracic aorta: annulus, sinus, sinotubular junction (STJ), mid ascending aorta (MAA) at the level of right pulmonary artery, proximal aortic arch (PROX) immediately proximal to innominate artery, distal aortic arch (DIST) immediately distal to left subclavian artery, and descending aorta (DESC) at the level of diaphragm.

Improved characterization of popliteal aneurysms using gadofosveset-enhanced equilibrium phase magnetic resonance angiography.

Although standard magnetic resonance angiography (MRA) has many advantages in the evaluation of peripheral artery disease, it has poorer spatial resolution compared with computed tomographic angiography and digital subtraction angiography. The MRA blood pool contrast agents have an extended half-life. By allowing longer imaging times, MRA enables the acquisition of high-resolution images as well as providing simultaneous visualization of both arteries and veins.

Myocardial T2-mapping and velocity mapping: changes in regional left ventricular structure and function after heart transplantation.

Monitoring post cardiac transplant (TX) status relies on frequent invasive techniques such as endomyocardial biopsies and right heart cardiac catheterization. The aim of this study was to noninvasively evaluate regional myocardial structure, function, and dyssynchrony in TX patients. Myocardial T2-mapping and myocardial velocity mapping of the left ventricle (basal, midventricular, and apical short-axis locations) was applied in 10 patients after cardiac transplantation (49 ± 13 years, n = 2 with signs of mild rejection, time between TX and MRI = 1-64 months) and compared to healthy controls (n = 20 for myocardial velocity mapping and n = 14 for T2).

Optimization of single shot 3D breath-hold non-enhanced MR angiography of the renal arteries.

Background: Cardiac and navigator-gated, inversion-prepared non-enhanced magnetic resonance angiography techniques can accurately depict the renal arteries without the need for contrast administration. However, the scan time and effectiveness of navigator-gated techniques depend on the subject respiratory pattern, which at times results in excessively prolonged scan times or suboptimal image quality. A single-shot 3D magnetization-prepared steady-state free precession technique was implemented to allow the full extent of the renal arteries to be depicted within a single breath-hold.

MDCT necrosis quantification in the assessment of hepatocellular carcinoma response to yttrium 90 radioembolization therapy: comparison of two-dimensional and volumetric techniques.

Rationale And Objectives: The purpose of this study is to evaluate the reproducibility and agreement of tumor necrosis quantification performed by two-dimensional and volumetric methods in a cohort of patients with hepatocellular carcinoma (HCC) treated with yttrium-90 ((90)Y) radioembolization.

Materials And Methods: Twenty-nine consecutive patients (21 men, 8 women; mean age 66.6 years; age range, 44-90 years) with HCC treated with (90)Y radioembolization that underwent liver multidetector computed tomography (MDCT) were included.

Evaluation of hepatocellular carcinoma size using two-dimensional and volumetric analysis: effect on liver transplantation eligibility.

Rationale And Objectives: Milan criteria recommends selection of candidates with hepatocellular carcinoma (HCC) for liver transplantation based on strict tumor size thresholds. The purpose of this study is to compare the effect of two-dimensional and three-dimensional tumor measurements on the selection of candidates for liver transplantation using Milan criteria.

Materials And Methods: This retrospective Health Insurance Portability and Accountability Act-compliant study was approved by our institutional review board.

Change in the growth rate of localized pancreatic adenocarcinoma in response to gemcitabine, bevacizumab, and radiation therapy on MDCT.

Purpose: To depict treatment response to chemoradiotherapy by comparing tumor growth rate between treated and untreated patients and to compare depicted response with objective response according to the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 guideline.

Methods And Materials: This Health Insurance Portability and Accountability Act-compliant, retrospective study was approved by the institutional review board.