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Lee YJ, Aghayev A, Azene EM, Bhatti S, Ewell JC, Hedgire SS, Kendi AT, Kim ESH, Kirsch DS, Nagpal P, Pillai AK, Ripley B, Tannenbaum A, Thiessen MEW, Thomas R, Woolsey S, Steigner ML. ACR Appropriateness Criteria® Screening for Abdominal Aortic Aneurysm. J Am Coll Radiol 2024; 21:S286-S291. [PMID: 38823950 DOI: 10.1016/j.jacr.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 06/03/2024]
Abstract
Abdominal aortic aneurysm (AAA) is a significant vascular disease found in 4% to 8% of the screening population. If ruptured, its mortality rate is between 75% and 90%, and it accounts for up to 5% of sudden deaths in the United States. Therefore, screening of AAA while asymptomatic has been a crucial portion of preventive health care worldwide. Ultrasound of the abdominal aorta is the primary imaging modality for screening of AAA recommended for asymptomatic adults regardless of their family history or smoking history. Alternatively, duplex ultrasound and CT abdomen and pelvis without contrast may be appropriate for screening. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Yoo Jin Lee
- University of California, San Francisco, San Francisco, California.
| | - Ayaz Aghayev
- Panel Chair, Brigham & Women's Hospital, Boston, Massachusetts
| | | | - Salman Bhatti
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Society for Cardiovascular Magnetic Resonance
| | - Joshua C Ewell
- Rutgers, New Jersey Medical School, Newark, New Jersey; Committee on Emergency Radiology-GSER
| | - Sandeep S Hedgire
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - A Tuba Kendi
- Mayo Clinic, Rochester, Minnesota; Commission on Nuclear Medicine and Molecular Imaging
| | - Esther S H Kim
- Atrium Health, Sanger Heart and Vascular Institute, Charlotte, North Carolina; American Society of Echocardiography
| | | | - Prashant Nagpal
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Anil K Pillai
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Beth Ripley
- VA Puget Sound Health Care System and University of Washington, Seattle, Washington
| | | | - Molly E W Thiessen
- Denver Health Medical Center, Denver, Colorado and University of Colorado School of Medicine, Aurora, Colorado; American College of Emergency Physicians
| | - Richard Thomas
- Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Sarah Woolsey
- Association for Utah Community Health, Salt Lake City, Utah; American Academy of Family Physicians
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Wang DS, Shen J, Majdalany BS, Khaja MS, Bhatti S, Ferencik M, Ganguli S, Gunn AJ, Heitner JF, Johri AM, Obara P, Ohle R, Sadeghi MM, Schermerhorn M, Siracuse JJ, Steenburg SD, Sutphin PD, Vijay K, Waite K, Steigner ML. ACR Appropriateness Criteria® Pulsatile Abdominal Mass, Suspected Abdominal Aortic Aneurysm: 2023 Update. J Am Coll Radiol 2023; 20:S513-S520. [PMID: 38040468 DOI: 10.1016/j.jacr.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
Abdominal aortic aneurysm (AAA) is defined as abnormal dilation of the infrarenal abdominal aortic diameter to 3.0 cm or greater. The natural history of AAA consists of progressive expansion and potential rupture. Although most AAAs are clinically silent, a pulsatile abdominal mass identified on physical examination may indicate the presence of an AAA. When an AAA is suspected, an imaging study is essential to confirm the diagnosis. This document reviews the relative appropriateness of various imaging procedures for the initial evaluation of suspected AAA. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- David S Wang
- Stanford University Medical Center, Stanford, California.
| | - Jody Shen
- Research Author, Stanford University Medical Center, Stanford, California
| | - Bill S Majdalany
- Panel Chair, University of Vermont Medical Center, Burlington, Vermont
| | - Minhaj S Khaja
- Panel Vice-Chair, University of Michigan, Ann Arbor, Michigan
| | - Salman Bhatti
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Society for Cardiovascular Magnetic Resonance
| | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon; Society of Cardiovascular Computed Tomography
| | - Suvranu Ganguli
- Boston Medical Center/Boston University School of Medicine, Boston, Massachusetts
| | - Andrew J Gunn
- University of Alabama at Birmingham, Birmingham, Alabama
| | - John F Heitner
- New York University Langone Health, New York, New York; Society for Cardiovascular Magnetic Resonance
| | - Amer M Johri
- Queen's University, Kingston, Ontario, Canada; American Society of Echocardiography
| | - Piotr Obara
- NorthShore University HealthSystem, Evanston, Illinois
| | - Robert Ohle
- Northern Ontario School of Medicine, Sudbury, Ontario, Canada; American College of Emergency Physicians
| | - Mehran M Sadeghi
- Yale School of Medicine, New Haven, Connecticut; American Society of Nuclear Cardiology
| | - Marc Schermerhorn
- Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts; Society for Vascular Surgery
| | - Jeffrey J Siracuse
- Boston Medical Centers, Boston University, and Chobanian and Avedisian School of Medicine, Boston, Massachusetts; Society for Vascular Surgery
| | - Scott D Steenburg
- Indiana University School of Medicine and Indiana University Health, Indianapolis, Indiana; Committee on Emergency Radiology-GSER
| | | | - Kanupriya Vijay
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kathleen Waite
- Duke University Medical Center, Durham, North Carolina, Primary care physician
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Contrella BN, Khaja MS, Majdalany BS, Kim CY, Kalva SP, Beck AW, Browne WF, Clough RE, Ferencik M, Fleischman F, Gunn AJ, Hickey SM, Kandathil A, Kim KM, Monroe EJ, Ochoa Chaar CI, Scheidt MJ, Smolock AR, Steenburg SD, Waite K, Pinchot JW, Steigner ML. ACR Appropriateness Criteria® Thoracoabdominal Aortic Aneurysm or Dissection: Treatment Planning and Follow-Up. J Am Coll Radiol 2023; 20:S265-S284. [PMID: 37236748 DOI: 10.1016/j.jacr.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
As the incidence of thoracoabdominal aortic pathology (aneurysm and dissection) rises and the complexity of endovascular and surgical treatment options increases, imaging follow-up of patients remains crucial. Patients with thoracoabdominal aortic pathology without intervention should be monitored carefully for changes in aortic size or morphology that could portend rupture or other complication. Patients who are post endovascular or open surgical aortic repair should undergo follow-up imaging to evaluate for complications, endoleak, or recurrent pathology. Considering the quality of diagnostic data, CT angiography and MR angiography are the preferred imaging modalities for follow-up of thoracoabdominal aortic pathology for most patients. The extent of thoracoabdominal aortic pathology and its potential complications involve multiple regions of the body requiring imaging of the chest, abdomen, and pelvis in most patients. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | | | - Bill S Majdalany
- Panel Chair, University of Vermont Medical Center, Burlington, Vermont
| | - Charles Y Kim
- Panel Chair, Duke University Medical Center, Durham, North Carolina
| | - Sanjeeva P Kalva
- Panel Vice-Chair, Massachusetts General Hospital, Boston, Massachusetts
| | - Adam W Beck
- University of Alabama at Birmingham Medical Center, Birmingham, Alabama; Society for Vascular Surgery
| | | | - Rachel E Clough
- St Thomas' Hospital, King's College, School of Biomedical Engineering and Imaging Science, London, United Kingdom; Society for Cardiovascular Magnetic Resonance
| | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon; Society of Cardiovascular Computed Tomography
| | - Fernando Fleischman
- Keck School of Medicine of USC, Los Angeles, California; American Association for Thoracic Surgery
| | - Andrew J Gunn
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Sean M Hickey
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; American College of Emergency Physicians
| | - Asha Kandathil
- UT Southwestern Medical Center, Dallas, Texas; Commission on Nuclear Medicine and Molecular Imaging
| | - Karen M Kim
- University of Michigan, Ann Arbor, Michigan; The Society of Thoracic Surgeons
| | | | | | | | - Amanda R Smolock
- Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Scott D Steenburg
- Indiana University School of Medicine and Indiana University Health, Indianapolis, Indiana; Committee on Emergency Radiology-GSER
| | - Kathleen Waite
- Duke University Medical Center, Durham, North Carolina, Primary care physician
| | - Jason W Pinchot
- Specialty Chair, University of Wisconsin, Madison, Wisconsin
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Zhu C, Leach JR, Wang Y, Gasper W, Saloner D, Hope MD. Intraluminal Thrombus Predicts Rapid Growth of Abdominal Aortic Aneurysms. Radiology 2020; 294:707-713. [PMID: 31990263 DOI: 10.1148/radiol.2020191723] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Intraluminal thrombus (ILT) within abdominal aortic aneurysms (AAAs) may be a potential marker for subsequent aneurysm growth. Purpose To investigate the role of ILT in AAA progression as assessed with CT and MRI. Materials and Methods This was a retrospective study, with patient data included from January 2004 to December 2018 at a Veteran Affairs medical center. Male patients with AAA who underwent contrast material-enhanced CT at baseline and CT or black-blood MRI at follow-up (minimal follow-up duration of 6 months) were included. The maximal AAA diameter was measured with multiplanar reconstruction, and the annual growth rate of aneurysms was calculated. Uni- and multivariable linear regression analyses were used to determine the relationship between demographic and imaging factors and aneurysm growth. Results A total of 225 patients (mean age, 72 years ± 9 [standard deviation]) were followed for a mean of 3.3 years ± 2.5. A total of 207 patients were followed up with CT, and 18 were followed up with MRI. At baseline, the median size of the AAA was 3.8 cm (interquartile range [IQR], 3.3-4.3 cm); 127 of 225 patients (54.7%) had ILT. When compared with AAAs without ILT, AAAs with ILT had larger baseline diameters (median, 4.1 cm [IQR, 3.6-4.8 cm] vs 3.4 cm [IQR, 3.2-3.9 cm]; P < .001) and faster growth rates (median, 2.0 mm/y [IQR, 1.3-3.2 mm/y] vs 1.0 mm/y [IQR, 0.4-1.8 mm/y]; P < .001). Small AAAs (size range, 3-4 cm) with ILT grew 1.9-fold faster than did those without ILT (median, 1.5 mm/y [IQR, 0.9-2.7 mm/y] vs 0.8 mm/y [IQR, 0.3-1.5 mm/y]; P < .001). Medium AAAs (size range, 4-5 cm) with ILT had 1.2-fold faster growth than did those without ILT (median growth, 2.1 mm/y [IQR, 1.4, 3.7 mm/y] vs 1.8 mm/y [IQR, 0.9, 2.0 mm/y]; P = .06). In multivariable analysis, baseline diameter and ILT were independently positively related to aneurysm growth rate (standardized regression coefficient, 0.43 [P < .001] and 0.15 [P = .02], respectively). Conclusion Both maximal cross-sectional aneurysm diameter and the presence of intraluminal thrombus are independent predictors of abdominal aortic aneurysm growth. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- Chengcheng Zhu
- From the Departments of Radiology and Biomedical Imaging (C.Z., J.R.L., D.S., M.D.H.) and Surgery (W.G.), University of California, San Francisco, 4150 Clement St, San Francisco, CA 94121; and Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China (Y.W.)
| | - Joseph R Leach
- From the Departments of Radiology and Biomedical Imaging (C.Z., J.R.L., D.S., M.D.H.) and Surgery (W.G.), University of California, San Francisco, 4150 Clement St, San Francisco, CA 94121; and Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China (Y.W.)
| | - Yuting Wang
- From the Departments of Radiology and Biomedical Imaging (C.Z., J.R.L., D.S., M.D.H.) and Surgery (W.G.), University of California, San Francisco, 4150 Clement St, San Francisco, CA 94121; and Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China (Y.W.)
| | - Warren Gasper
- From the Departments of Radiology and Biomedical Imaging (C.Z., J.R.L., D.S., M.D.H.) and Surgery (W.G.), University of California, San Francisco, 4150 Clement St, San Francisco, CA 94121; and Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China (Y.W.)
| | - David Saloner
- From the Departments of Radiology and Biomedical Imaging (C.Z., J.R.L., D.S., M.D.H.) and Surgery (W.G.), University of California, San Francisco, 4150 Clement St, San Francisco, CA 94121; and Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China (Y.W.)
| | - Michael D Hope
- From the Departments of Radiology and Biomedical Imaging (C.Z., J.R.L., D.S., M.D.H.) and Surgery (W.G.), University of California, San Francisco, 4150 Clement St, San Francisco, CA 94121; and Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China (Y.W.)
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