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2013 Updates

A new format is introduced to track changes. Changes will be grouped by examination, with each changes dated rather than by month the change was made. Additions to the indications will be indicated as such, changes in language will be italicized and deletions will be included as boldfaced.

Acute Mesenteric Ischemia suspected, History of:

Cardiac dysfunction

Vascular disease

Recent vascular surgery or intervention (including catheter arteriography)

Advanced age (>60)

Abdomnal angina suspected

Pain occurs 15 to 60 minutes after eating, lasting for several hours

May be associated with constipation, flatulence, diarrhea with or without some blood admixture, nausea and vomiting

Elliot K. Fishman; From the RSNA Refresher Courses: CT Angiography: Clinical Applications in the Abdomen; RadioGraphics 2001 21: 3S-16S.

Odenburg WA, Lau LL, Rodenberg TJ, Edmonds HJ, Burger CD. Acute mesenteric ischemia: a clinical review. Arch Intern Med 2004; 164:1054 -1062

Park WM, Gloviczki P, Cherry KJ, Hallett JW, Bower TC, Panneton JM, Schleck C, Ilstrup D, Harmsen WS, Noel AA (2002).Contemporary management of acute mesenteric ischemia: Factors associated with survival. J. Vasc. Surg. 35 (3): 445-52.

Harkin Denis W, Lindsay Thomas F, “Chapter 86. Mesenteric Ischemia” (Chapter). Hall JB, Schmidt GA, Wood LDH: Principles of Critical Care, 3e: http://www.accessmedicine.com/content.aspx?aID=2296692. accessed 10/20/10

Filippo Cademartiri, Rolf H. J. M. Raaijmakers, Jan W. Kuiper, Lukas C. van Dijk, Peter M. T. Pattynama, and Gabriel P. Krestin Multi–Detector Row CT Angiography in Patients with Abdominal Angina Radiographics July 2004 24:969-984; doi:10.1148/rg.244035166

Shih, Ming-Chen Paul, Hagspiel, Klaus D. CTA and MRA in Mesenteric Ischemia: Part 1, Role in Diagnosis and Differential Diagnosis Am. J. Roentgenol. 2007 188: 452-46

Shih, Ming-Chen Paul, Angle, John F., Leung, Daniel A., Cherry, Kenneth J., Harthun, Nancy L., Matsumoto, Alan H., Hagspiel, Klaus D. CTA and MRA in Mesenteric Ischemia: Part 2, Normal Findings and Complications After Surgical and Endovascular Treatment Am. J. Roentgenol. 2007 188: 462-471

Pain, crampy in nature during or after exercise, relieved by rest

Shih, Ming-Chen Paul, Hagspiel, Klaus D. CTA and MRA in Mesenteric Ischemia: Part 1, Role in Diagnosis and Differential Diagnosis Am. J. Roentgenol. 2007 188: 452-46

Shih, Ming-Chen Paul, Angle, John F., Leung, Daniel A., Cherry, Kenneth J., Harthun, Nancy L., Matsumoto, Alan H., Hagspiel, Klaus D. CTA and MRA in Mesenteric Ischemia: Part 2, Normal Findings and Complications After Surgical and Endovascular Treatment Am. J. Roentgenol. 2007 188: 462-471

Erectile dysfunction (Consider CTA of Abdomen And Pelvis CPT 74174)

Pain, crampy in nature during or after exercise, relieved by rest

May be associated with constipation, flatulence, diarrhea with or without some blood admixture, nausea and vomiting

Elliot K. Fishman; From the RSNA Refresher Courses: CT Angiography: Clinical Applications in the Abdomen; RadioGraphics 2001 21: 3S-16S.

Odenburg WA, Lau LL, Rodenberg TJ, Edmonds HJ, Burger CD. Acute mesenteric ischemia: a clinical review. Arch Intern Med 2004; 164:1054 -1062

Park WM, Gloviczki P, Cherry KJ, Hallett JW, Bower TC, Panneton JM, Schleck C, Ilstrup D, Harmsen WS, Noel AA (2002).Contemporary management of acute mesenteric ischemia: Factors associated with survival. J. Vasc. Surg. 35 (3): 445-52.

Harkin Denis W, Lindsay Thomas F, “Chapter 86. Mesenteric Ischemia” (Chapter). Hall JB, Schmidt GA, Wood LDH: Principles of Critical Care, 3e: http://www.accessmedicine.com/content.aspx?aID=2296692. accessed 10/20/10

Filippo Cademartiri, Rolf H. J. M. Raaijmakers, Jan W. Kuiper, Lukas C. van Dijk, Peter M. T. Pattynama, and Gabriel P. Krestin Multi–Detector Row CT Angiography in Patients with Abdominal Angina Radiographics July 2004 24:969-984; doi:10.1148/rg.244035166

Shih, Ming-Chen Paul, Hagspiel, Klaus D. CTA and MRA in Mesenteric Ischemia: Part 1, Role in Diagnosis and Differential Diagnosis Am. J. Roentgenol. 2007 188: 452-46

Shih, Ming-Chen Paul, Angle, John F., Leung, Daniel A., Cherry, Kenneth J., Harthun, Nancy L., Matsumoto, Alan H., Hagspiel, Klaus D. CTA and MRA in Mesenteric Ischemia: Part 2, Normal Findings and Complications After Surgical and Endovascular Treatment Am. J. Roentgenol. 2007 188: 462-471

Aortic Aneurysm Suspected (Consider CTA of Abdomen And Pelvis CPT 74174)

Dissection of the aorta, suspected (Consider CTA of Abdomen And Pelvis CPT 74174)

Ischemic bowel suspected (Consider CTA of Abdomen And Pelvis CPT 74174)

Thrombosis (clot) suspected in Vena Cava, or other abdominal veins 01/08/2013

Peripheral Vascular Disease (Consider CTA of Abdominal Aorta and Runoff CPT 75635)01/08/2013

Interval follow up at greater than 1 year

New or worsening symptoms 01/08/2013

Added clarification to four renal and hepatic transplant criteria:

Preoperative (For either donor or recipient) and interval follow up (of recipient.) 01/08/2013

Prior to surgical or other intervention

New or worsening symptoms 01/08/2013

Breast Reconstruction Planning (DIEP Flap) if Doppler US is inadequate 1/10/2013

Interval Follow up of surgical repair of vascular lesion(s) at 6-month intervals. 1/10/2013

Section 1: Major Symptom or Complaint Added language in italics to each subsection

Added Criteria for Intestinal Angina and Pain after Meals 1/10/2013

Added ((Consider CTA of Abdominal Aorta with Runoff 76135)) to criteria for peripheral Arterial Dis. 1/10/2013

Added Renovascular Hypertension (Consider CTA of Abdomen 74175) 1/10/2013

ABI 0.9 (Consider CTA of Abdominal Aorta with Runoff 76135)

Asymmetric Blood Pressure in Legs (Consider CTA of Abdominal Aorta with Runoff 76135)

Asymmetric Pulses in Legs (Consider CTA of Abdominal Aorta with Runoff 76135)

Bruit in Leg (Consider CTA of Abdominal Aorta with Runoff 76135)

Diminished femoral pulses (Consider CTA of Abdominal Aorta with Runoff 76135)

Palpable Arterial Thrill in Legs (Consider CTA of Abdominal Aorta with Runoff 76135)

Interval follow up at greater than 1 year

New or worsening symptoms 01/10/2013

Interval Follow up of surgical repair of vascular lesion(s) at 6-month intervals. 1/10/2013

Revised criteria for Suspected Peripheral Arterial Disease to be consistent throughout 1/18/2013

Removed criterion of “Peripheral Arterial Disease suspected” as it is not necessary 1/18/2013

Added criterion to Localized Skin Discoloration “Suspected AVM” 1/23/2013

Section 2: Working Diagnosis or Rule Out

Section 3: Abnormal Physical Exam Finding

Section 4: Abnormal Lab or Imaging

Section 5: Significant Prior Medical History

Cognitive Changes, Memory loss, and Mental Status Changes revised criteria and updated references 2/21/2013

Dizziness revised by adding: Prior MRI or CT nondiagnostic 2/19/2013

Changed Pattern: added for clarity: (Chronic headache with new features) 2/20//2013

Pregnancy, new onset during Added 2/20/2013

Vertigo revised by adding: Prior MRI or CT nondiagnostic 2/19/2013

Vertebrobasilar Insufficiency: updated references 2/20/2013

Added italicized words: Weakness involving structures on one or both sides of the body 2/20/2013

Changed indication for Sinusitis etc to Infections: Sinusitis, middle ear or systemic 2/21/2013

Added an indication for Weakness 2/21/2013

Added new risk factor: Pregancy MRA PREFERRED

Added a reference: (Stam) 2/21/2013

Section 3: Abnormal Physical Exam Finding

Added: Evidence of Carotid Stenosis on prior imaging 2/21/2013

Added: Stroke or Cerebral Infarction 2/21/2013

Section 5: Significant Prior Medical History

CT Chest 71250 Added criteria for low dose screening of smokers 10/28/2013

“Prior to Surgical Intervention, as a road map for the surgeon” 9/4/13

MRA (Magnetic Resonance Angiogram) Head 70544 70545 70546

Consolidated criteria to match CTA brain 2/21/2013

Dilated Biliary tree (bile ducts) on prior imaging (MRCP requested) 9/30/13

Updated Surveillance imaging to allow imaging at 6 month intervals for 2 years, and then annually. 1/29/2013

Oncology Guidelines: Prostate Cancer

Updated post therapy section to include recurrence after radiation therapy 5/7/2013

Added a criterion for Multiple Sclerisis (suspected) to Working Diagnosis section to allow for use to meet McDonald diagnostic criteria for Multiple Sclerosis 12/17/13

Added reference to Multiple Sclerosis in the Prior Medical History section 12/17/13

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