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.
Cardiac dysfunction
Vascular disease
Recent vascular surgery or intervention (including catheter arteriography)
Advanced age (>60)
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
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
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
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
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
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