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Preprocedural Planning for Transcatheter Aortic Valve Replacement
Variant: 1
Preintervention planning for transcatheter aortic valve replacement: assessment of aortic root. Initial imaging.
| Procedure | Appropriateness Category | Relative Radiation Level |
| US echocardiography transesophageal | Usually Appropriate | O |
| MRI heart function and morphology without and with IV contrast | Usually Appropriate | O |
| MRI heart function and morphology without IV contrast | Usually Appropriate | O |
| CT heart function and morphology with IV contrast | Usually Appropriate | ☢☢☢☢ |
| MRA chest with IV contrast | May Be Appropriate | O |
| MRA chest without and with IV contrast | May Be Appropriate | O |
| CTA chest with IV contrast | May Be Appropriate | ☢☢☢ |
| CTA coronary arteries with IV contrast | May Be Appropriate | ☢☢☢ |
| US echocardiography transthoracic resting | Usually Not Appropriate | O |
| Aortography chest | Usually Not Appropriate | ☢☢☢ |
| MRA coronary arteries without and with IV contrast | Usually Not Appropriate | O |
| MRA coronary arteries without IV contrast | Usually Not Appropriate | O |
| CT chest with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT chest without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT chest without IV contrast | Usually Not Appropriate | ☢☢☢ |
Variant: 2
Preintervention planning for transcatheter aortic valve replacement: assessment of supravalvular aorta and vascular access. Initial imaging.
| Procedure | Appropriateness Category | Relative Radiation Level |
| CTA chest with IV contrast | Usually Appropriate | ☢☢☢ |
| CTA abdomen and pelvis with IV contrast | Usually Appropriate | ☢☢☢☢ |
| CTA chest abdomen pelvis with IV contrast | Usually Appropriate | ☢☢☢☢☢ |
| US intravascular aorta and iliofemoral system | May Be Appropriate (Disagreement) | O |
| MRA abdomen and pelvis without and with IV contrast | May Be Appropriate | O |
| MRA abdomen and pelvis without IV contrast | May Be Appropriate | O |
| MRA chest abdomen pelvis with IV contrast | May Be Appropriate | O |
| MRA chest without and with IV contrast | May Be Appropriate | O |
| US duplex Doppler chest abdomen pelvis | Usually Not Appropriate | O |
| US echocardiography transesophageal | Usually Not Appropriate | O |
| US echocardiography transthoracic resting | Usually Not Appropriate | O |
| Aortography chest abdomen pelvis | Usually Not Appropriate | ☢☢☢☢ |
| CT abdomen and pelvis with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT abdomen and pelvis without IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT chest with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT chest without and with IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT chest without IV contrast | Usually Not Appropriate | ☢☢☢ |
| CT abdomen and pelvis without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT chest abdomen pelvis with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT chest abdomen pelvis without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT chest abdomen pelvis without IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT heart function and morphology with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
Panel Members
Summary of Literature Review
Introduction/Background
Special Imaging Considerations
Initial Imaging Definition
Discussion of Procedures by Variant
Variant 1: Preintervention planning for transcatheter aortic valve replacement: assessment of aortic root. Initial imaging.
Variant 1: Preintervention planning for transcatheter aortic valve replacement: assessment of aortic root. Initial imaging.
A. Aortography Chest
A. Aortography Chest
Variant 1: Preintervention planning for transcatheter aortic valve replacement: assessment of aortic root. Initial imaging.
B. CT Chest With IV Contrast
B. CT Chest With IV Contrast
Variant 1: Preintervention planning for transcatheter aortic valve replacement: assessment of aortic root. Initial imaging.
C. CT Chest Without and With IV Contrast
C. CT Chest Without and With IV Contrast
Variant 1: Preintervention planning for transcatheter aortic valve replacement: assessment of aortic root. Initial imaging.
D. CT Chest Without IV Contrast
D. CT Chest Without IV Contrast
Variant 1: Preintervention planning for transcatheter aortic valve replacement: assessment of aortic root. Initial imaging.
E. CT Heart Function and Morphology With IV Contrast
E. CT Heart Function and Morphology With IV Contrast
Variant 1: Preintervention planning for transcatheter aortic valve replacement: assessment of aortic root. Initial imaging.
F. CTA Chest With IV Contrast
F. CTA Chest With IV Contrast
Variant 1: Preintervention planning for transcatheter aortic valve replacement: assessment of aortic root. Initial imaging.
G. CTA Coronary Arteries With IV Contrast
G. CTA Coronary Arteries With IV Contrast
Variant 1: Preintervention planning for transcatheter aortic valve replacement: assessment of aortic root. Initial imaging.
H. MRA Chest With IV Contrast
H. MRA Chest With IV Contrast
Variant 1: Preintervention planning for transcatheter aortic valve replacement: assessment of aortic root. Initial imaging.
I. MRA Chest Without and With IV Contrast
I. MRA Chest Without and With IV Contrast
Variant 1: Preintervention planning for transcatheter aortic valve replacement: assessment of aortic root. Initial imaging.
J. MRA Coronary Arteries Without and With IV Contrast
J. MRA Coronary Arteries Without and With IV Contrast
Variant 1: Preintervention planning for transcatheter aortic valve replacement: assessment of aortic root. Initial imaging.
K. MRA Coronary Arteries Without IV Contrast
K. MRA Coronary Arteries Without IV Contrast
Variant 1: Preintervention planning for transcatheter aortic valve replacement: assessment of aortic root. Initial imaging.
L. MRI Heart Function and Morphology Without and With IV Contrast
L. MRI Heart Function and Morphology Without and With IV Contrast
Variant 1: Preintervention planning for transcatheter aortic valve replacement: assessment of aortic root. Initial imaging.
M. MRI Heart Function and Morphology Without IV Contrast
M. MRI Heart Function and Morphology Without IV Contrast
Variant 1: Preintervention planning for transcatheter aortic valve replacement: assessment of aortic root. Initial imaging.
N. US Echocardiography Transesophageal
N. US Echocardiography Transesophageal
Variant 1: Preintervention planning for transcatheter aortic valve replacement: assessment of aortic root. Initial imaging.
O. US Echocardiography Transthoracic Resting
O. US Echocardiography Transthoracic Resting
Variant 2: Preintervention planning for transcatheter aortic valve replacement: assessment of supravalvular aorta and vascular access. Initial imaging.
Variant 2: Preintervention planning for transcatheter aortic valve replacement: assessment of supravalvular aorta and vascular access. Initial imaging.
A. Aortography Chest, Abdomen, and Pelvis
A. Aortography Chest, Abdomen, and Pelvis
Variant 2: Preintervention planning for transcatheter aortic valve replacement: assessment of supravalvular aorta and vascular access. Initial imaging.
B. CT Abdomen and Pelvis With IV Contrast
B. CT Abdomen and Pelvis With IV Contrast
Variant 2: Preintervention planning for transcatheter aortic valve replacement: assessment of supravalvular aorta and vascular access. Initial imaging.
C. CT Abdomen and Pelvis Without and With IV Contrast
C. CT Abdomen and Pelvis Without and With IV Contrast
Variant 2: Preintervention planning for transcatheter aortic valve replacement: assessment of supravalvular aorta and vascular access. Initial imaging.
D. CT Abdomen and Pelvis Without IV Contrast
D. CT Abdomen and Pelvis Without IV Contrast
Variant 2: Preintervention planning for transcatheter aortic valve replacement: assessment of supravalvular aorta and vascular access. Initial imaging.
E. CT Chest, Abdomen, and Pelvis With IV Contrast
E. CT Chest, Abdomen, and Pelvis With IV Contrast
Variant 2: Preintervention planning for transcatheter aortic valve replacement: assessment of supravalvular aorta and vascular access. Initial imaging.
F. CT Chest, Abdomen, and Pelvis Without and With IV Contrast
F. CT Chest, Abdomen, and Pelvis Without and With IV Contrast
Variant 2: Preintervention planning for transcatheter aortic valve replacement: assessment of supravalvular aorta and vascular access. Initial imaging.
G. CT Chest, Abdomen, and Pelvis Without IV Contrast
G. CT Chest, Abdomen, and Pelvis Without IV Contrast
Variant 2: Preintervention planning for transcatheter aortic valve replacement: assessment of supravalvular aorta and vascular access. Initial imaging.
H. CT Chest With IV Contrast
H. CT Chest With IV Contrast
Variant 2: Preintervention planning for transcatheter aortic valve replacement: assessment of supravalvular aorta and vascular access. Initial imaging.
I. CT Chest Without and With IV Contrast
I. CT Chest Without and With IV Contrast
Variant 2: Preintervention planning for transcatheter aortic valve replacement: assessment of supravalvular aorta and vascular access. Initial imaging.
J. CT Chest Without IV Contrast
J. CT Chest Without IV Contrast
Variant 2: Preintervention planning for transcatheter aortic valve replacement: assessment of supravalvular aorta and vascular access. Initial imaging.
K. CT Heart Function and Morphology With IV Contrast
K. CT Heart Function and Morphology With IV Contrast
Variant 2: Preintervention planning for transcatheter aortic valve replacement: assessment of supravalvular aorta and vascular access. Initial imaging.
L. CTA Abdomen and Pelvis With IV Contrast
L. CTA Abdomen and Pelvis With IV Contrast
Variant 2: Preintervention planning for transcatheter aortic valve replacement: assessment of supravalvular aorta and vascular access. Initial imaging.
M. CTA Chest, Abdomen, and Pelvis With IV Contrast
M. CTA Chest, Abdomen, and Pelvis With IV Contrast
Variant 2: Preintervention planning for transcatheter aortic valve replacement: assessment of supravalvular aorta and vascular access. Initial imaging.
N. CTA Chest With IV Contrast
N. CTA Chest With IV Contrast
Variant 2: Preintervention planning for transcatheter aortic valve replacement: assessment of supravalvular aorta and vascular access. Initial imaging.
O. MRA Abdomen and Pelvis Without and With IV Contrast
O. MRA Abdomen and Pelvis Without and With IV Contrast
Variant 2: Preintervention planning for transcatheter aortic valve replacement: assessment of supravalvular aorta and vascular access. Initial imaging.
P. MRA Abdomen and Pelvis Without IV Contrast
P. MRA Abdomen and Pelvis Without IV Contrast
Variant 2: Preintervention planning for transcatheter aortic valve replacement: assessment of supravalvular aorta and vascular access. Initial imaging.
Q. MRA Chest, Abdomen, and Pelvis With IV Contrast
Q. MRA Chest, Abdomen, and Pelvis With IV Contrast
Variant 2: Preintervention planning for transcatheter aortic valve replacement: assessment of supravalvular aorta and vascular access. Initial imaging.
R. MRA Chest With and Without IV Contrast
R. MRA Chest With and Without IV Contrast
Variant 2: Preintervention planning for transcatheter aortic valve replacement: assessment of supravalvular aorta and vascular access. Initial imaging.
S. US Duplex Doppler Chest, Abdomen, and Pelvis
S. US Duplex Doppler Chest, Abdomen, and Pelvis
Variant 2: Preintervention planning for transcatheter aortic valve replacement: assessment of supravalvular aorta and vascular access. Initial imaging.
T. US Echocardiography Transesophageal
T. US Echocardiography Transesophageal
Variant 2: Preintervention planning for transcatheter aortic valve replacement: assessment of supravalvular aorta and vascular access. Initial imaging.
U. US Echocardiography Transthoracic Resting
U. US Echocardiography Transthoracic Resting
Variant 2: Preintervention planning for transcatheter aortic valve replacement: assessment of supravalvular aorta and vascular access. Initial imaging.
V. US Intravascular Aorta and Iliofemoral System
V. US Intravascular Aorta and Iliofemoral System
Summary of Recommendations
Supporting Documents
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 Names and Definitions
|
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. |
Relative Radiation Level Information
References
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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