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MRI with MRA in abdominal aortic aneurysm

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21. Nontraumatic Aortic Disease

using double-inversion recovery T1-weighted imaging and balanced steady-state free precession (bSSFP), allows for imaging of the aorta, especially when acquisition is ECG-gated [53]. The accuracy of bSSFP is close to 100% for detecting thoracic aortic aneurysm, dissection, intramural hematoma, and penetrating aortic ulcer when measured against the reference standard of magnetic resonance angiography (MRA) with contrast material [54,55]. MRI is superior to CT in differentiating an acute intramural (...) and endovascular therapies; however, CT/MRA superseded its use due to their noninvasiveness and higher sensitivity. Ultrasonography The role of US is limited to evaluating the abdominal aorta and its branches and extracranial cerebral vasculature. Its role in detecting an abdominal aortic aneurysm is well described in the ACR Appropriateness Criteria ® topic on “Pulsatile Abdominal Mass, Suspected Abdominal Aortic Aneurysm” [4]. US tends to underestimate the size of abdominal aortic aneurysm by 4 mm [4

2013 American College of Radiology

22. Brain and Abdominal Aneurysm Study

), computed tomographic angiography (CTA), or catheter-based cerebral angiography. Diagnosis of subarachnoid hemorrhage diagnosed by head CT, brain MRI or lumbar puncture. Provides written informed consent. No know diagnosis of aortic aneurysm No history of prior screening for aortic aneurysm No condition like recent abdominal surgical scar that would preclude abdominal ultrasonography No therapy like abdominal hypothermia pads that would preclude abdominal ultrasonography Contacts and Locations Go (...) intracranial aneurysms and aortic aneurysms. These GWAS data, along with linkage data for other susceptibility loci, indicate that individuals and families harboring one type of aneurysm may be at especially increased risk of the other. The rationale for this project is that opportunistic screening for abdominal aortic aneurysms (AAA) may be warranted in patients who present with aneurysmal subarachnoid hemorrhage. This study is meant to see if the yield of screening in this population is too low

2011 Clinical Trials

23. Aortic Dissection

deficits. Diagnosis Transesophageal echocardiography (TEE), CT angiography (CTA), or magnetic resonance angiography (MRA) Aortic dissection must be considered in any patient with chest pain, thoracic back pain, unexplained syncope, unexplained abdominal pain, stroke, or acute-onset heart failure, especially when pulses or blood pressures in the limbs are unequal. Such patients require a chest x-ray; in 60 to 90%, the mediastinal shadow is widened, usually with a localized bulge signifying the site (...) of Aneurysms SOCIAL MEDIA Add to Any Platform Loading , MD, FACS, University of North Carolina; Thaniyyah S. Ahmad , MD, MPH, University of North Carolina Click here for Patient Education NOTE: This is the Professional Version. CONSUMERS: Topic Resources Aortic dissection is the surging of blood through a tear in the aortic intima with separation of the intima and media and creation of a false lumen (channel). The intimal tear may be a primary event or secondary to hemorrhage within the media

2013 Merck Manual (19th Edition)

24. AIM Clinical Appropriateness Guidelines for Advanced Imaging of the Heart.

artery disease (MPI, stress echo, cardiac PET, coronary CTA or cardiac catheterization) within the preceding three (3) years; OR ? Patients with diseases/conditions with which coronary artery disease commonly coexist and who have not had evaluation of coronary artery disease (MPI, stress echo, cardiac PET, coronary CTA or cardiac catheterization) within the preceding three (3) years: ? Diabetes mellitus; OR ? Abdominal aortic aneurysm; OR ? Established and symptomatic peripheral vascular disease (...) (dyspnea), neck, jaw, arm, epigastric or back pain, sweating (diaphoresis), or exercise-induced syncope ? With moderate or high risk of CAD (SCORE) ? Other symptoms: palpitation, nausea, vomiting, anxiety, weakness, fatigue, or exercise-induced dizziness, lightheadedness, or near syncope, etc. ? With high risk of CAD (SCORE) ? Patients with any cardiac symptom who have diseases/conditions with which coronary artery disease commonly coexists such as: ? Diabetes mellitus; OR ? Abdominal aortic aneurysm

2019 AIM Specialty Health

25. Vascular imaging

. 10 Vasculitis Advanced imaging is considered medically necessary for diagnosis and management when the results of imaging will impact treatment decisions. IMAGING STUDY - CTA or MRA brain, neck, chest, abdomen and pelvis, or extremities (based on location) - MRI brain - CT chest Procedure-related Imaging Procedure-related Imaging For procedures related to aortic aneurysm or dissection, see Aneurysm and Dissection indications for the appropriate anatomic region. Advanced imaging is considered (...) of the aorta) Vascular Imaging Copyright © 2019. AIM Specialty Health. All Rights Reserved. 16 ? Evaluation when there is concern for complications (such as dissection) ? Further characterization of suspected aneurysm based on prior diagnostic or imaging study ? Patient with confirmed aortic dissection experiencing new or worsening symptoms ? Periodic surveillance in patients with known aneurysm ? Pre- and postoperative evaluation IMAGING STUDY - CT, CTA, MRI or MRA chest Note: Echocardiogram is generally

2019 AIM Specialty Health

26. ESC/ESH Management of Arterial Hypertension

Rosuvastatin LDH Lactate dehydrogenase LDL-C LDL cholesterol LEAD Lower extremity artery disease LIFE Losartan Intervention For Endpoint reduction in hypertension LV Left ventricular LVH Left ventricular hypertrophy MAP Mean arterial pressure MI Myocardial infarction MR Magnetic resonance MRA Mineralocorticoid receptor antagonist MRI Magnetic resonance imaging MUCH Masked uncontrolled hypertension NORDIL Nordic Diltiazem NS Non-significant NT-proBNP N-terminal pro-B natriuretic peptide o.d. Omni die (every (...) hypertension3037 4.7.1 White-coat hypertension3037 4.7.2 Masked hypertension3038 4.8 Screening for the detection of hypertension3038 4.9 Confirming the diagnosis of hypertension3038 4.10 Clinical indications for out-of-office blood pressure measurements3038 4.11 Blood pressure during exercise and at high altitude3040 4.12 Central aortic pressure3040 5 Clinical evaluation and assessment of hypertension-mediated organ damage in patients with hypertension3041 5.1 Clinical evaluation3041 5.2 Medical history3041

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2018 European Society of Cardiology

27. Management of Cardiovascular Diseases during Pregnancy

5-HT1A 5-hydroxytryptamine (serotonin) HTAD Heritable thoracic aortic disease ICD Implantable cardioverter-defibrillator ICU Intensive care unit IE Infective endocarditis INR International normalized ratio i.v. Intravenous KLH Keyhole limpet haemocyanin LMWH Low molecular weight heparin LQTS Long QT syndrome LV Left ventricular LVEF Left ventricular ejection fraction MCS Mechanical circulatory support mGy Milligray MI Myocardial infarction MR Mitral regurgitation MRA Mineralocorticoid receptor (...) ), echocardiography, and an exercise test should be performed. In case of aortic pathology, complete aortic imaging by computed tomography (CT) scanning or magnetic resonance imaging (MRI) is necessary for appropriate pre-conception counselling. Peak heart rate and peak oxygen uptake are both known to be predictive of maternal cardiac events in pregnancy. A pregnancy exercise capacity >80% is associated with a favourable pregnancy outcome. Several aspects must be discussed, including long-term prognosis

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2018 European Society of Cardiology

28. Nonatherosclerotic Peripheral Arterial Disease

gene that codes for fibrillin-1 and occurs in 1 in 20,000 individuals. The systems typically affected by MS are cardiovascular, ocular, and skeletal. MS is classically associated with aortic root aneurysms and dissection; however, the dissection flap may extend into the iliac arteries resulting in pain, pallor, paresthesias, and pulselessness [1,24]. LDS results from an AD heterozygous mutation in either of the genes that encode transforming growth factor beta. LDS has a much more aggressive (...) clinical course than MS, with a mean survival of 26 years. Like MS, LDS is associated with aortic root aneurysm and dissection [3]. Vascular EDS, formerly known as EDS type IV, is an AD disease caused by a heterozygous mutation in the COL3A1 gene that encodes type III collagen. Vascular EDS can affect any vessel and carries a poor prognosis that is due to risk of life-threatening arterial rupture [4]. FMD is a nonatherosclerotic, noninflammatory vascular disease that most commonly affects the renal

2019 American College of Radiology

29. Treatment of Diabetes in Older Adults

panel Nephropathy Cognition Bone mineral density Neuropathy Fall risk AAA ultrasound Medical nutrition therapy Weight (kg)/height (m) 2 = BMI Diabetes screening (for nondiabetic persons) Diabetes management Blood pressure Diabetes self-management training Tobacco use Alcohol use Medication review Cancer screening Hearing Comorbid conditions Visual acuity Frailty/physical performance Abbreviations: AAA, abdominal aortic aneurysm; ADL, activity of daily living; BMI, body mass index; IADL, instrumental (...) screening Hearing Comorbid conditions Visual acuity Frailty/physical performance Abbreviations: AAA, abdominal aortic aneurysm; ADL, activity of daily living; BMI, body mass index; IADL, instrumental activity of daily living. a All items are required services to qualify for Medicare coverage of annual wellness examinations for people in the United States >65 y of age, except for frailty/physical performance ( ). These are generally conducted by primary care providers. b All items are services covered

2019 The Endocrine Society

30. An Overview of Clinical Applications of 3-D Printing and Bioprinting

models have been developed for infrarenal and juxtarenal arteries, abdominal aortic aneurysm, and thoracic aorta pathology and 3-DP of vessel pathologies have been used to better understand anatomy and post-surgical complications. 78 Plastic and Reconstructive Surgery 3-DP is being studied and used in plastic and reconstructive surgery for procedural planning, the creation of surgical tools, and the customization of implants. 3-DP has been studied or used in maxillofacial surgery, dental implant (...) of the object being printed and the requirements of the printing process and equipment being used 26 design considerations beyond the object itself, such as the support structures and the thickness of layered materials. 26,33 Table 2: A General Approach to the Production of 3-D Printed Objects and Considerations for Bioprinting Production Step 3-D Printing Bioprinting Considerations Pre-processing Acquire images (e.g., from MRI or CT). 7,33 Convert images into files the printer can use (e.g., computer-aided

2019 CADTH - Issues in Emerging Health Technologies

31. Diagnosis and Treatment of Peripheral Arterial Diseases

arterial diseases and vascular access site for cardiac interventions 806 13. Gaps in evidence807 14. To do and not to do messages from the Guidelines 808 15. Web addenda and companion document 811 16. Appendix 811 17. References 811 Abbreviations and acronyms Abbreviations and acronyms Abbreviations and acronyms AAA Abdominal aorta aneurysm ABI Ankle-brachial index ACAS Asymptomatic Carotid Atherosclerosis Study ACEIs Angiotensin-converting enzyme inhibitors ACS Acute coronary syndrome ACSRS (...) extremity artery disease LV Left ventricular MACE Major adverse cardiovascular event MI Myocardial infarction MRA Magnetic resonance angiography MR CLEAN MultiCenter Randomized Clinical Trial of Ischemic Stroke in the Netherlands MRI Magnetic resonance imaging MSAD Multisite artery disease MWD Maximal walking distance NASCET North American Symptomatic Carotid Endarterectomy Trial NNH Number needed to harm NNT Number needed to treat NOAC Non-vitamin K oral anticoagulant OAC Oral anticoagulation ONTARGET

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2017 European Society of Cardiology

32. FDG-PET/CT(A) Imaging in Large Vessel Vasculitis and Polymyalgia Rheumatica: Joint Procedural Recommendation of the EANM, SNMMI, PET Interest Group, and endorsed by ASNC

: - Carotid arteries - Subclavia arteries - Axillary arteries - Vertebral arteries - Ascending aorta - Aortic arch - Pulmonary arteries - Descending aorta - Abdominal aorta Joints: scapulae and pelvic girdles, knees, cervical and lumbar interspinous bursae, trochantheric and ischiatic bursae. For clinical use Contrast-enhanced (PET/)CTA Regular Vascular wall thickness in mm Contrast enhancement Presence of stenosis / aneurysm Abbreviations: TBR = target to background ratio; SUV = standardized uptake value (...) % of patients with apparently isolated PMR show LVV on FDG-PET/CT [10], which percentage can even be higher, depending on the presence of LVV symptoms [11-13]. It is important to realize that a negative temporal artery biopsy, an ultrasonography without a halo sign, or a magnetic resonance imaging (MRI) without aortic wall thickening or edema does not definitively exclude the presence of LVV and should therefore not limit the use of FDG-PET/CT when LVV is clinically suspected [14,15]. Furthermore

2018 Society of Nuclear Medicine and Molecular Imaging

33. AIM Clinical Appropriateness Guidelines for Advanced Imaging of the Heart

; OR ? Abdominal aortic aneurysm; OR ? Established and symptomatic peripheral vascular disease; OR ? Prior history of cerebrovascular accident (CVA), transient ischemic attack (TIA) or carotid endarterectomy (CEA) or high grade carotid stenosis (>70%); OR ? Chronic renal insufficiency or renal failure; OR ? Patients who have undergone cardiac transplantation; OR ? Patients in whom a decision has been made to treat with Interleukin 2; OR ? Patients awaiting solid organ transplantation Established coronary (...) ; OR ? Abdominal aortic aneurysm; OR ? Established and symptomatic peripheral vascular disease; OR ? Prior history of cerebrovascular accident (CVA), transient ischemic attack (TIA) or carotid endarterectomy (CEA) or high grade carotid stenosis (>70%); OR ? Chronic renal insufficiency; OR ? Patients who have undergone cardiac transplantation and have had no evaluation for coronary artery disease within the preceding one (1) year; OR ? Patients in whom a decision has been made to treat with Interleukin 2

2018 AIM Specialty Health

34. Appropriate Use Criteria: Imaging of the Abdomen & Pelvis

. AIM Specialty Health. All Rights Reserved. 2 Table of Contents Description and Application of the Guidelines 3 Administrative Guidelines 4 Ordering of Multiple Studies 4 Pre-test Requirements 5 Abdominal & Pelvic Imaging 6 CT of the Abdomen 6 MRI of the Abdomen 15 MRCP of the Abdomen 20 CTA/MRA of the Abdomen 22 CTA Abdominal Aorta and Bilateral Illiofemoral Lower Extremity Run-off 26 CT of the Pelvis 28 MRI of the Pelvis 35 Fetal MRI 41 CTA/MRA of the Pelvis 43 CT of the Abdomen & Pelvis (...) from the diaphragmatic dome to the iliac crests Technology Considerations ? Abdominal MRI studies are usually targeted for further evaluation of indeterminate or questionable findings, identified on more standard imaging exams such as ultrasound and CT . ? For evaluation of vascular abnormalities such as renal artery stenosis and celiac/superior mesenteric artery stenosis (in chronic mesenteric ischemia), Doppler ultrasound, MRA or CTA should be considered as the preferred imaging modalities

2018 AIM Specialty Health

35. Imaging Guidelines

a primary adjunct to rapidly diagnose immediate life-threatening injuries. Computed tomography (CT) and magnetic resonance imaging (MRI) later became additional imaging modalities important for injury diagnosis and management. By the early 90s, bedside abdominal examination with Focused Assessment with Sonography in Trauma (FAST) largely replaced diagnostic peritoneal lavage as the primary imaging modality for rapid assessment of intra-abdominal hemorrhage in unstable trauma patients. This guideline (...) Imaging Guidelines ACS TQIP BEST PRACTICES GUIDELINES IN IMAGING ER AS 1988 THE AMERICAN SOCIETY OFTable of Contents Introduction 3 1. Overview 4 Part 1: General Issues 4 Part 2: Contrast Considerations 8 Part 3: Sedation 10 2. Brain Imaging 15 3. Cervical Spine Imaging 21 4. Imaging for Blunt Cerebrovascular Injury 32 5. Chest Imaging 36 6. Abdominal Imaging 40 7 . Genitourinary Imaging 45 8. Thoracic and Lumbar Spine Imaging 48 9. Whole-Body CT Imaging 51 10. Imaging in Orthopaedic Trauma 56

2018 American College of Surgeons

36. 2018 guidelines for the early management of patients with acute ischemic stroke

cerebral artery MI Myocardial infarction MRA Magnetic resonance angiography MRI Magnetic resonance imaging mRS Modified Rankin Scale mTICI Modified Thrombolysis in Cerebral Infarction NCCT Noncontrast computed tomography NIHSS National Institutes of Health Stroke Scale NINDS National Institute of Neurological Disorders and Stroke OR Odds ratio OSA Obstructive sleep apnea RCT Randomized clinical trial RR Relative risk rtPA recombinant tissue-type plasminogen activator sICH Symptomatic intracerebral (...) stroke ARD Absolute risk difference ASCVD Atherosclerotic cardiovascular disease ASPECTS Alberta Stroke Program Early Computed Tomography Score BP Blood pressure CEA Carotid endarterectomy CeAD Cervical artery dissection CI Confidence interval CMB Cerebral microbleed COR Class of recommendation CS Conscious sedation CT Computed tomography CTA Computed tomographic angiography CTP Computed tomographic perfusion DTN Door-to-needle DVT Deep vein thrombosis DW-MRI Diffusion-weighted magnetic resonance

2018 American Academy of Neurology

37. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

1 M2 Middle cerebral artery segment 2 M3 Middle cerebral artery segment 3 MCA Middle cerebral artery MI Myocardial infarction MRA Magnetic resonance angiography MRI Magnetic resonance imaging mRS Modified Rankin Scale mTICI Modified Thrombolysis in Cerebral Infarction NCCT Noncontrast computed tomography NIHSS National Institutes of Health Stroke Scale NINDS National Institute of Neurological Disorders and Stroke OR Odds ratio OSA Obstructive sleep apnea RCT Randomized clinical trial RR Relative (...) Door-to-needle DVT Deep vein thrombosis DW-MRI Diffusion-weighted magnetic resonance imaging ED Emergency department EMS Emergency medical services EVT Endovascular therapy GA General anesthesia GWTG Get With The Guidelines HBO Hyperbaric oxygen HR Hazard ratio ICH Intracerebral hemorrhage IPC Intermittent pneumatic compression IV Intravenous LDL-C Low-density lipoprotein cholesterol LMWH Low-molecular-weight heparin LOE Level of evidence LVO Large vessel occlusion M1 Middle cerebral artery segment

2018 American Heart Association

38. Thoracic Aorta Interventional Planning and Follow-up

, the thoracic aorta is generally considered aneurysmal at 4 cm. Up to one-third of thoracic aortic aneurysms extend into the abdominal aorta, increasing complexity of endovascular or surgical repair [10]. Intervention is indicated when aneurysm diameter exceeds 5.5 cm or demonstrates rapid growth [10]. More conservative thresholds are implemented in patients with underlying connective tissue disorders or a bicuspid aortic valve. Acute aortic syndromes, broadly defined as a disease spectrum encompassing PAU (...) ideally be 2 to 3 cm in length to ensure an adequate seal and decreased rates of endoleaks, aneurysmal degeneration, and device migration [27]. When the proximal landing zone approaches the aortic arch vessels, the possibility of the stent graft occluding a vessel ostium arises. In such cases, vascular bypass or a staged or hybrid approach may be necessary to ensure patency. If aortic pathology extends into the abdominal aorta, care must be taken to assess for possible stent coverage of major branch

2017 American College of Radiology

39. Imaging Program Guidelines: Pediatric Imaging

– Pediatrics 49 MRA of the Chest – Pediatrics 52 Abdominal & Pelvic Imaging 54 CT Abdomen – Pediatrics 54 MRI Abdomen – Pediatrics 65 MR Cholangiopancreatography (MRCP) Abdomen – Pediatrics 74 CTA and MRA of the Abdomen - Pediatrics 76 CT Pelvis – Pediatrics 79 MRI Pelvis – Pediatrics 85 CTA and MRA of the Pelvis – Pediatrics 91 CT of the Abdomen and Pelvis Combination – Pediatrics 93 CTA of the Abdomen and Pelvis Combination – Pediatrics 101Table of Contents – Pediatrics | Copyright © 2017. AIM Specialty (...) Bryn Mawr Avenue South Tower – Suite 800 Chicago, IL 60631 P . 773.864.4600 www.aimspecialtyhealth.comTable of Contents – Pediatrics | Copyright © 2017. AIM Specialty Health. All Rights Reserved. 2 Table of Contents Description and Application of the Guidelines 4 Administrative Guidelines 5 Ordering of Multiple Studies 5 Pre-test Requirements 6 Head & Neck Imaging 7 CT of the Head – Pediatrics 7 MRI of the Head/Brain – Pediatrics 14 CTA/MRA Head: Cerebrovascular – Pediatrics 21 Functional MRI (fMRI

2017 AIM Specialty Health

40. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults

associated with increased risk of CVD incidence and angina, myocardial infarction (MI), HF, stroke, peripheral artery disease (PAD), and abdominal aortic aneurysm, each evaluated separately. An increased risk of CVD associated with higher SBP and DBP has been reported across a broad age spectrum, from 30 years to >80 years of age. Although the relative risk of incident CVD associated with higher SBP and DBP is smaller at older ages, the corresponding high BP–related increase in absolute risk is larger (...) With Preserved Ejection Fraction e51 9.3. Chronic Kidney Disease e51 9.3.1. Hypertension After Renal Transplantation e53 9.4. Cerebrovascular Disease e53 9.4.1. Acute Intracerebral Hemorrhage e54 9.4.2. Acute Ischemic Stroke e54 9.4.3. Secondary Stroke Prevention e56 9.5. Peripheral Artery Disease e57 9.6. Diabetes Mellitus e58 9.7. Metabolic Syndrome e59 9.8. Atrial Fibrillation e59 9.9. Valvular Heart Disease e60 9.10. Aortic Disease e60 10. Special Patient Groups e60 10.1. Race and Ethnicity e60 10.1.1

2017 American Heart Association

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