Workup of Noncerebral Systemic Arterial Embolic Source

Variant: 1   Known upper extremity arterial occlusion. Suspected embolic etiology. Next imaging study to determine source.
Procedure Appropriateness Category
US echocardiography transesophageal Usually Appropriate
US echocardiography transthoracic resting Usually Appropriate
MRA chest without and with IV contrast Usually Appropriate
MRI heart function and morphology without and with IV contrast Usually Appropriate
MRI heart function and morphology without IV contrast Usually Appropriate
CTA chest with IV contrast Usually Appropriate
CT heart function and morphology with IV contrast Usually Appropriate
MRA chest without IV contrast May Be Appropriate
US duplex Doppler abdomen Usually Not Appropriate
Aortography chest Usually Not Appropriate
Variant: 2   Known arterial occlusion in the mesenteric or renal arterial system or renal infarcts. Suspected embolic etiology. Next imaging study to determine source.
Procedure Appropriateness Category
US echocardiography transesophageal Usually Appropriate
US echocardiography transthoracic resting Usually Appropriate
MRA chest and abdomen without and with IV contrast Usually Appropriate
MRI heart function and morphology without and with IV contrast Usually Appropriate
MRI heart function and morphology without IV contrast Usually Appropriate
CTA chest with IV contrast Usually Appropriate
CT heart function and morphology with IV contrast Usually Appropriate
CTA chest and abdomen with IV contrast Usually Appropriate
US duplex Doppler abdomen May Be Appropriate
MRA chest and abdomen without IV contrast May Be Appropriate
MRA chest without and with IV contrast May Be Appropriate
MRA chest without IV contrast May Be Appropriate
Aortography chest and abdomen Usually Not Appropriate
Variant: 3   Known lower extremity arterial occlusion. Suspected embolic etiology. Next imaging study to determine source.
Procedure Appropriateness Category
US echocardiography transesophageal Usually Appropriate
US echocardiography transthoracic resting Usually Appropriate
MRA chest abdomen pelvis without and with IV contrast Usually Appropriate
MRA chest without and with IV contrast Usually Appropriate
MRI heart function and morphology without and with IV contrast Usually Appropriate
MRI heart function and morphology without IV contrast Usually Appropriate
CTA chest with IV contrast Usually Appropriate
CT heart function and morphology with IV contrast Usually Appropriate
CTA chest abdomen pelvis with IV contrast Usually Appropriate
MRA chest abdomen pelvis without IV contrast May Be Appropriate
MRA chest without IV contrast May Be Appropriate
US duplex Doppler abdomen Usually Not Appropriate
Aortography chest abdomen pelvis Usually Not Appropriate
Variant: 4   Known multiorgan system arterial occlusions. Suspected embolic etiology. Next imaging study to determine source.
Procedure Appropriateness Category
US echocardiography transesophageal Usually Appropriate
US echocardiography transthoracic resting Usually Appropriate
MRA chest abdomen pelvis without and with IV contrast Usually Appropriate
MRA chest abdomen pelvis without IV contrast Usually Appropriate
MRA chest without and with IV contrast Usually Appropriate
MRI heart function and morphology without and with IV contrast Usually Appropriate
MRI heart function and morphology without IV contrast Usually Appropriate
CTA chest with IV contrast Usually Appropriate
CT heart function and morphology with IV contrast Usually Appropriate
CTA chest abdomen pelvis with IV contrast Usually Appropriate
US duplex Doppler abdomen May Be Appropriate
MRA chest without IV contrast May Be Appropriate

The evidence table, literature search, and appendix for this topic are available at https://acsearch.acr.org/list. The appendix includes the strength of evidence assessment and the final rating round tabulations for each recommendation.

For additional information on the Appropriateness Criteria methodology and other supporting documents, please go to the ACR website at https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Appropriateness-Criteria.

Appropriateness Category Name

Appropriateness Rating

Appropriateness Category Definition

Usually Appropriate

7, 8, or 9

The imaging procedure or treatment is indicated in the specified clinical scenarios at a favorable risk-benefit ratio for patients.

May Be Appropriate

4, 5, or 6

The imaging procedure or treatment may be indicated in the specified clinical scenarios as an alternative to imaging procedures or treatments with a more favorable risk-benefit ratio, or the risk-benefit ratio for patients is equivocal.

May Be Appropriate (Disagreement)

5

The individual ratings are too dispersed from the panel median. The different label provides transparency regarding the panel’s recommendation. “May be appropriate” is the rating category and a rating of 5 is assigned.

Usually Not Appropriate

1, 2, or 3

The imaging procedure or treatment is unlikely to be indicated in the specified clinical scenarios, or the risk-benefit ratio for patients is likely to be unfavorable.




























































The ACR Committee on Appropriateness Criteria and its expert panels have developed criteria for determining appropriate imaging examinations for diagnosis and treatment of specified medical condition(s). These criteria are intended to guide radiologists, radiation oncologists and referring physicians in making decisions regarding radiologic imaging and treatment. Generally, the complexity and severity of a patient’s clinical condition should dictate the selection of appropriate imaging procedures or treatments. Only those examinations generally used for evaluation of the patient’s condition are ranked.  Other imaging studies necessary to evaluate other co-existent diseases or other medical consequences of this condition are not considered in this document.  The availability of equipment or personnel may influence the selection of appropriate imaging procedures or treatments. Imaging techniques classified as investigational by the FDA have not been considered in developing these criteria; however, study of new equipment and applications should be encouraged.  The ultimate decision regarding the appropriateness of any specific radiologic examination or treatment must be made by the referring physician and radiologist in light of all the circumstances presented in an individual examination