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Thoracoabdominal Aortic Aneurysm or Dissection: Treatment Planning and Follow-Up
Variant: 1
Follow-up of known thoracoabdominal aortic aneurysm or dissection without repair. Without or with new symptoms.
| Procedure | Appropriateness Category | Relative Radiation Level |
| CTA chest abdomen pelvis with IV contrast | Usually Appropriate | ☢☢☢☢☢ |
| MRA chest abdomen pelvis without and with IV contrast | Usually Appropriate | O |
| MRA chest abdomen pelvis without IV contrast | Usually Appropriate | O |
| CTA chest and abdomen with IV contrast | May Be Appropriate | ☢☢☢☢ |
| MRA chest and abdomen without and with IV contrast | May Be Appropriate | O |
| MRA chest and abdomen without IV contrast | May Be Appropriate | O |
| CT chest abdomen pelvis with IV contrast | May Be Appropriate | ☢☢☢☢ |
| CT chest abdomen pelvis without and with IV contrast | May Be Appropriate | ☢☢☢☢ |
| CT chest abdomen pelvis without IV contrast | May Be Appropriate | ☢☢☢☢ |
| CT chest and abdomen with IV contrast | May Be Appropriate | ☢☢☢☢ |
| CT chest and abdomen without and with IV contrast | May Be Appropriate | ☢☢☢☢ |
| Aortography chest abdomen pelvis | Usually Not Appropriate | ☢☢☢☢ |
| CT chest and abdomen without IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| Radiography chest | Usually Not Appropriate | ☢ |
| US duplex Doppler aorta abdomen | Usually Not Appropriate | O |
| US echocardiography transthoracic resting | Usually Not Appropriate | O |
| Radiography chest abdomen pelvis | Usually Not Appropriate | ☢☢☢ |
Variant: 2
Planning for endovascular or open repair of thoracoabdominal aorta aneurysm or dissection.
| Procedure | Appropriateness Category | Relative Radiation Level |
| CTA chest abdomen pelvis with IV contrast | Usually Appropriate | ☢☢☢☢☢ |
| MRA chest abdomen pelvis without and with IV contrast | Usually Appropriate | O |
| MRA chest abdomen pelvis without IV contrast | Usually Appropriate | O |
| CT chest abdomen pelvis with IV contrast | May Be Appropriate (Disagreement) | ☢☢☢☢ |
| CT chest abdomen pelvis without and with IV contrast | May Be Appropriate (Disagreement) | ☢☢☢☢ |
| CTA chest and abdomen with IV contrast | May Be Appropriate (Disagreement) | ☢☢☢☢ |
| MRA chest and abdomen without and with IV contrast | May Be Appropriate (Disagreement) | O |
| Aortography chest abdomen pelvis | Usually Not Appropriate | ☢☢☢☢ |
| CT chest abdomen pelvis without IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT chest and abdomen with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT chest and abdomen without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT chest and abdomen without IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| MRA chest and abdomen without IV contrast | Usually Not Appropriate | O |
| Radiography chest | Usually Not Appropriate | ☢ |
| US duplex Doppler aorta abdomen | Usually Not Appropriate | O |
| US echocardiography transthoracic resting | Usually Not Appropriate | O |
| Radiography chest abdomen pelvis | Usually Not Appropriate | ☢☢☢ |
Variant: 3
Follow-up after endovascular repair of thoracoabdominal aortic aneurysm or dissection.
| Procedure | Appropriateness Category | Relative Radiation Level |
| CTA chest abdomen pelvis with IV contrast | Usually Appropriate | ☢☢☢☢☢ |
| MRA chest abdomen pelvis without and with IV contrast | Usually Appropriate | O |
| MRA chest abdomen pelvis without IV contrast | May Be Appropriate | O |
| Aortography chest abdomen pelvis | May Be Appropriate (Disagreement) | ☢☢☢☢ |
| CT chest abdomen pelvis with IV contrast | May Be Appropriate | ☢☢☢☢ |
| CT chest abdomen pelvis without and with IV contrast | May Be Appropriate | ☢☢☢☢ |
| CTA chest and abdomen with IV contrast | May Be Appropriate (Disagreement) | ☢☢☢☢ |
| MRA chest and abdomen without and with IV contrast | May Be Appropriate (Disagreement) | O |
| CT chest abdomen pelvis without IV contrast | May Be Appropriate | ☢☢☢☢ |
| MRA chest and abdomen without IV contrast | May Be Appropriate | O |
| CT chest and abdomen with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT chest and abdomen without and with IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| CT chest and abdomen without IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| Radiography chest | Usually Not Appropriate | ☢ |
| Radiography chest abdomen pelvis | Usually Not Appropriate | ☢☢☢ |
| US duplex Doppler aorta abdomen | Usually Not Appropriate | O |
| US echocardiography transthoracic resting | Usually Not Appropriate | O |
Variant: 4
Follow-up after open repair of thoracoabdominal aortic aneurysm or dissection.
| Procedure | Appropriateness Category | Relative Radiation Level |
| CTA chest abdomen pelvis with IV contrast | Usually Appropriate | ☢☢☢☢☢ |
| MRA chest abdomen pelvis without and with IV contrast | Usually Appropriate | O |
| CTA chest and abdomen with IV contrast | May Be Appropriate | ☢☢☢☢ |
| MRA chest abdomen pelvis without IV contrast | May Be Appropriate | O |
| MRA chest and abdomen without and with IV contrast | May Be Appropriate | O |
| CT chest abdomen pelvis with IV contrast | May Be Appropriate | ☢☢☢☢ |
| CT chest abdomen pelvis without and with IV contrast | May Be Appropriate | ☢☢☢☢ |
| CT chest abdomen pelvis without IV contrast | May Be Appropriate | ☢☢☢☢ |
| CT chest and abdomen with IV contrast | May Be Appropriate | ☢☢☢☢ |
| CT chest and abdomen without and with IV contrast | May Be Appropriate | ☢☢☢☢ |
| MRA chest and abdomen without IV contrast | May Be Appropriate | O |
| CT chest and abdomen without IV contrast | Usually Not Appropriate | ☢☢☢☢ |
| Aortography chest abdomen pelvis | Usually Not Appropriate | ☢☢☢☢ |
| US duplex Doppler aorta abdomen | Usually Not Appropriate | O |
| US echocardiography transthoracic resting | Usually Not Appropriate | O |
| Radiography chest | Usually Not Appropriate | ☢ |
| Radiography chest abdomen pelvis | Usually Not Appropriate | ☢☢☢ |
Panel Members
Summary of Literature Review
Introduction/Background
Special Imaging Considerations
Discussion of Procedures by Variant
Variant 1: Follow-up of known thoracoabdominal aortic aneurysm or dissection without repair. Without or with new symptoms.
Variant 1: Follow-up of known thoracoabdominal aortic aneurysm or dissection without repair. Without or with new symptoms.
A. Aortography Chest Abdomen Pelvis
A. Aortography Chest Abdomen Pelvis
Variant 1: Follow-up of known thoracoabdominal aortic aneurysm or dissection without repair. Without or with new symptoms.
B. CT Chest, Abdomen, and Pelvis With IV Contrast
B. CT Chest, Abdomen, and Pelvis With IV Contrast
Variant 1: Follow-up of known thoracoabdominal aortic aneurysm or dissection without repair. Without or with new symptoms.
C. CT Chest, Abdomen, and Pelvis Without and With IV Contrast
C. CT Chest, Abdomen, and Pelvis Without and With IV Contrast
Variant 1: Follow-up of known thoracoabdominal aortic aneurysm or dissection without repair. Without or with new symptoms.
D. CT Chest, Abdomen, and Pelvis Without IV Contrast
D. CT Chest, Abdomen, and Pelvis Without IV Contrast
Variant 1: Follow-up of known thoracoabdominal aortic aneurysm or dissection without repair. Without or with new symptoms.
E. CT Chest and Abdomen With IV Contrast
E. CT Chest and Abdomen With IV Contrast
Variant 1: Follow-up of known thoracoabdominal aortic aneurysm or dissection without repair. Without or with new symptoms.
F. CT Chest and Abdomen Without IV Contrast
F. CT Chest and Abdomen Without IV Contrast
Variant 1: Follow-up of known thoracoabdominal aortic aneurysm or dissection without repair. Without or with new symptoms.
G. CTA Chest, Abdomen, and Pelvis With IV Contrast
G. CTA Chest, Abdomen, and Pelvis With IV Contrast
Variant 1: Follow-up of known thoracoabdominal aortic aneurysm or dissection without repair. Without or with new symptoms.
H. CTA Chest and Abdomen With IV Contrast
H. CTA Chest and Abdomen With IV Contrast
Variant 1: Follow-up of known thoracoabdominal aortic aneurysm or dissection without repair. Without or with new symptoms.
I. MRA Chest, Abdomen, and Pelvis Without and With IV Contrast
I. MRA Chest, Abdomen, and Pelvis Without and With IV Contrast
Variant 1: Follow-up of known thoracoabdominal aortic aneurysm or dissection without repair. Without or with new symptoms.
J. MRA Chest, Abdomen, and Pelvis Without IV Contrast
J. MRA Chest, Abdomen, and Pelvis Without IV Contrast
Variant 1: Follow-up of known thoracoabdominal aortic aneurysm or dissection without repair. Without or with new symptoms.
K. MRA Chest and Abdomen Without and With IV Contrast
K. MRA Chest and Abdomen Without and With IV Contrast
Variant 1: Follow-up of known thoracoabdominal aortic aneurysm or dissection without repair. Without or with new symptoms.
L. MRA Chest and Abdomen Without IV Contrast
L. MRA Chest and Abdomen Without IV Contrast
Variant 1: Follow-up of known thoracoabdominal aortic aneurysm or dissection without repair. Without or with new symptoms.
M. Radiography Chest
M. Radiography Chest
Variant 1: Follow-up of known thoracoabdominal aortic aneurysm or dissection without repair. Without or with new symptoms.
N. Radiography Chest, Abdomen, and Pelvis
N. Radiography Chest, Abdomen, and Pelvis
Variant 1: Follow-up of known thoracoabdominal aortic aneurysm or dissection without repair. Without or with new symptoms.
O. US Duplex Doppler Aorta Abdomen
O. US Duplex Doppler Aorta Abdomen
Variant 1: Follow-up of known thoracoabdominal aortic aneurysm or dissection without repair. Without or with new symptoms.
P. US Echocardiography Transthoracic Resting
P. US Echocardiography Transthoracic Resting
Variant 2: Planning for endovascular or open repair of thoracoabdominal aorta aneurysm or dissection.
Variant 2: Planning for endovascular or open repair of thoracoabdominal aorta aneurysm or dissection.
A. Aortography Chest Abdomen Pelvis
A. Aortography Chest Abdomen Pelvis
Variant 2: Planning for endovascular or open repair of thoracoabdominal aorta aneurysm or dissection.
B. CT Chest, Abdomen, and Pelvis With IV Contrast
B. CT Chest, Abdomen, and Pelvis With IV Contrast
Variant 2: Planning for endovascular or open repair of thoracoabdominal aorta aneurysm or dissection.
C. CT Chest, Abdomen, and Pelvis Without and With IV Contrast
C. CT Chest, Abdomen, and Pelvis Without and With IV Contrast
Variant 2: Planning for endovascular or open repair of thoracoabdominal aorta aneurysm or dissection.
D. CT Chest, Abdomen, and Pelvis Without IV Contrast
D. CT Chest, Abdomen, and Pelvis Without IV Contrast
Variant 2: Planning for endovascular or open repair of thoracoabdominal aorta aneurysm or dissection.
E. CT Chest and Abdomen With IV Contrast
E. CT Chest and Abdomen With IV Contrast
Variant 2: Planning for endovascular or open repair of thoracoabdominal aorta aneurysm or dissection.
F. CT Chest and Abdomen Without and With IV Contrast
F. CT Chest and Abdomen Without and With IV Contrast
Variant 2: Planning for endovascular or open repair of thoracoabdominal aorta aneurysm or dissection.
G. CT Chest and Abdomen Without IV Contrast
G. CT Chest and Abdomen Without IV Contrast
Variant 2: Planning for endovascular or open repair of thoracoabdominal aorta aneurysm or dissection.
H. CTA Chest, Abdomen, and Pelvis With IV Contrast
H. CTA Chest, Abdomen, and Pelvis With IV Contrast
Variant 2: Planning for endovascular or open repair of thoracoabdominal aorta aneurysm or dissection.
I. CTA Chest and Abdomen With IV Contrast
I. CTA Chest and Abdomen With IV Contrast
Variant 2: Planning for endovascular or open repair of thoracoabdominal aorta aneurysm or dissection.
J. MRA Chest, Abdomen, and Pelvis Without and With IV Contrast
J. MRA Chest, Abdomen, and Pelvis Without and With IV Contrast
Variant 2: Planning for endovascular or open repair of thoracoabdominal aorta aneurysm or dissection.
K. MRA Chest, Abdomen, and Pelvis Without IV Contrast
K. MRA Chest, Abdomen, and Pelvis Without IV Contrast
Variant 2: Planning for endovascular or open repair of thoracoabdominal aorta aneurysm or dissection.
L. MRA Chest and Abdomen Without and With IV Contrast
L. MRA Chest and Abdomen Without and With IV Contrast
Variant 2: Planning for endovascular or open repair of thoracoabdominal aorta aneurysm or dissection.
M. MRA Chest and Abdomen Without IV Contrast
M. MRA Chest and Abdomen Without IV Contrast
Variant 2: Planning for endovascular or open repair of thoracoabdominal aorta aneurysm or dissection.
N. Radiography Chest
N. Radiography Chest
Variant 2: Planning for endovascular or open repair of thoracoabdominal aorta aneurysm or dissection.
O. Radiography Chest Abdomen Pelvis
O. Radiography Chest Abdomen Pelvis
Variant 2: Planning for endovascular or open repair of thoracoabdominal aorta aneurysm or dissection.
P. US Duplex Doppler Aorta Abdomen
P. US Duplex Doppler Aorta Abdomen
Variant 2: Planning for endovascular or open repair of thoracoabdominal aorta aneurysm or dissection.
Q. US Echocardiography Transthoracic Resting
Q. US Echocardiography Transthoracic Resting
Variant 3: Follow-up after endovascular repair of thoracoabdominal aortic aneurysm or dissection.
Variant 3: Follow-up after endovascular repair of thoracoabdominal aortic aneurysm or dissection.
A. Aortography Chest Abdomen Pelvis
A. Aortography Chest Abdomen Pelvis
Variant 3: Follow-up after endovascular repair of thoracoabdominal aortic aneurysm or dissection.
B. CT Chest, Abdomen, and Pelvis With IV Contrast
B. CT Chest, Abdomen, and Pelvis With IV Contrast
Variant 3: Follow-up after endovascular repair of thoracoabdominal aortic aneurysm or dissection.
C. CT Chest, Abdomen, and Pelvis Without and With IV Contrast
C. CT Chest, Abdomen, and Pelvis Without and With IV Contrast
Variant 3: Follow-up after endovascular repair of thoracoabdominal aortic aneurysm or dissection.
D. CT Chest, Abdomen, and Pelvis Without IV Contrast
D. CT Chest, Abdomen, and Pelvis Without IV Contrast
Variant 3: Follow-up after endovascular repair of thoracoabdominal aortic aneurysm or dissection.
E. CT Chest and Abdomen With IV Contrast
E. CT Chest and Abdomen With IV Contrast
Variant 3: Follow-up after endovascular repair of thoracoabdominal aortic aneurysm or dissection.
F. CT Chest and Abdomen Without and With IV Contrast
F. CT Chest and Abdomen Without and With IV Contrast
Variant 3: Follow-up after endovascular repair of thoracoabdominal aortic aneurysm or dissection.
G. CT Chest and Abdomen Without IV Contrast
G. CT Chest and Abdomen Without IV Contrast
Variant 3: Follow-up after endovascular repair of thoracoabdominal aortic aneurysm or dissection.
H. CTA Chest, Abdomen, and Pelvis With IV Contrast
H. CTA Chest, Abdomen, and Pelvis With IV Contrast
Variant 3: Follow-up after endovascular repair of thoracoabdominal aortic aneurysm or dissection.
I. CTA Chest and Abdomen With IV Contrast
I. CTA Chest and Abdomen With IV Contrast
Variant 3: Follow-up after endovascular repair of thoracoabdominal aortic aneurysm or dissection.
J. MRA Chest, Abdomen, and Pelvis Without and With IV Contrast
J. MRA Chest, Abdomen, and Pelvis Without and With IV Contrast
Variant 3: Follow-up after endovascular repair of thoracoabdominal aortic aneurysm or dissection.
K. MRA Chest, Abdomen, and Pelvis Without IV Contrast
K. MRA Chest, Abdomen, and Pelvis Without IV Contrast
Variant 3: Follow-up after endovascular repair of thoracoabdominal aortic aneurysm or dissection.
L. MRA Chest and Abdomen Without and With IV Contrast
L. MRA Chest and Abdomen Without and With IV Contrast
Variant 3: Follow-up after endovascular repair of thoracoabdominal aortic aneurysm or dissection.
M. MRA Chest and Abdomen Without IV Contrast
M. MRA Chest and Abdomen Without IV Contrast
Variant 3: Follow-up after endovascular repair of thoracoabdominal aortic aneurysm or dissection.
N. Radiography Chest
N. Radiography Chest
Variant 3: Follow-up after endovascular repair of thoracoabdominal aortic aneurysm or dissection.
O. Radiography Chest Abdomen Pelvis
O. Radiography Chest Abdomen Pelvis
Variant 3: Follow-up after endovascular repair of thoracoabdominal aortic aneurysm or dissection.
P. US Duplex Doppler Aorta Abdomen
P. US Duplex Doppler Aorta Abdomen
Variant 3: Follow-up after endovascular repair of thoracoabdominal aortic aneurysm or dissection.
Q. US Echocardiography Transthoracic Resting
Q. US Echocardiography Transthoracic Resting
Variant 4: Follow-up after open repair of thoracoabdominal aortic aneurysm or dissection.
Variant 4: Follow-up after open repair of thoracoabdominal aortic aneurysm or dissection.
A. Aortography Chest Abdomen Pelvis
A. Aortography Chest Abdomen Pelvis
Variant 4: Follow-up after open repair of thoracoabdominal aortic aneurysm or dissection.
B. CT Chest, Abdomen, and Pelvis With IV Contrast
B. CT Chest, Abdomen, and Pelvis With IV Contrast
Variant 4: Follow-up after open repair of thoracoabdominal aortic aneurysm or dissection.
C. CT Chest, Abdomen, and Pelvis Without and With IV Contrast
C. CT Chest, Abdomen, and Pelvis Without and With IV Contrast
Variant 4: Follow-up after open repair of thoracoabdominal aortic aneurysm or dissection.
D. CT Chest, Abdomen, and Pelvis Without IV Contrast
D. CT Chest, Abdomen, and Pelvis Without IV Contrast
Variant 4: Follow-up after open repair of thoracoabdominal aortic aneurysm or dissection.
E. CT Chest and Abdomen With IV Contrast
E. CT Chest and Abdomen With IV Contrast
Variant 4: Follow-up after open repair of thoracoabdominal aortic aneurysm or dissection.
F. CT Chest and Abdomen Without and With IV Contrast
F. CT Chest and Abdomen Without and With IV Contrast
Variant 4: Follow-up after open repair of thoracoabdominal aortic aneurysm or dissection.
G. CT Chest and Abdomen Without IV Contrast
G. CT Chest and Abdomen Without IV Contrast
Variant 4: Follow-up after open repair of thoracoabdominal aortic aneurysm or dissection.
H. CTA Chest, Abdomen, and Pelvis With IV Contrast
H. CTA Chest, Abdomen, and Pelvis With IV Contrast
Variant 4: Follow-up after open repair of thoracoabdominal aortic aneurysm or dissection.
I. CTA Chest and Abdomen With IV Contrast
I. CTA Chest and Abdomen With IV Contrast
Variant 4: Follow-up after open repair of thoracoabdominal aortic aneurysm or dissection.
J. MRA Chest, Abdomen, and Pelvis Without and With IV Contrast
J. MRA Chest, Abdomen, and Pelvis Without and With IV Contrast
Variant 4: Follow-up after open repair of thoracoabdominal aortic aneurysm or dissection.
K. MRA Chest, Abdomen, and Pelvis Without IV Contrast
K. MRA Chest, Abdomen, and Pelvis Without IV Contrast
Variant 4: Follow-up after open repair of thoracoabdominal aortic aneurysm or dissection.
L. MRA Chest and Abdomen Without and With IV Contrast
L. MRA Chest and Abdomen Without and With IV Contrast
Variant 4: Follow-up after open repair of thoracoabdominal aortic aneurysm or dissection.
M. MRA Chest and Abdomen Without IV Contrast
M. MRA Chest and Abdomen Without IV Contrast
Variant 4: Follow-up after open repair of thoracoabdominal aortic aneurysm or dissection.
N. Radiography Chest
N. Radiography Chest
Variant 4: Follow-up after open repair of thoracoabdominal aortic aneurysm or dissection.
O. Radiography Chest Abdomen Pelvis
O. Radiography Chest Abdomen Pelvis
Variant 4: Follow-up after open repair of thoracoabdominal aortic aneurysm or dissection.
P. US Duplex Doppler Aorta Abdomen
P. US Duplex Doppler Aorta Abdomen
Variant 4: Follow-up after open repair of thoracoabdominal aortic aneurysm or dissection.
Q. US Echocardiography Transthoracic Resting
Q. US Echocardiography Transthoracic Resting
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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Disclaimer
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