ACR Appropriateness Criteria® Suspected Acute Aortic Syndrome

Area of Science:

• Cardiovascular Imaging
• Thoracic Radiology
• Aortic Diseases

Background:

• Acute Aortic Syndrome (AAS) encompasses acute aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcers.
• AAS often presents with severe chest or back pain and can lead to malperfusion syndrome.
• Rapid diagnosis is critical, as untreated ascending aortic dissection has a 1-2% hourly mortality rate.

Framework:

• The American College of Radiology Appropriateness Criteria guide imaging selection for AAS.
• Guidelines are evidence-based, reviewed annually by multidisciplinary experts, and use established methodologies like RAND/UCLA and GRADE.
• Expert opinion supplements evidence when data is lacking or equivocal.

Implementation:

• Imaging appropriateness is based on its ability to provide key information for surgical, endovascular, or medical therapy planning.
• Essential information includes AAS confirmation, classification, entry/reentry site characterization, false lumen patency, and branch vessel compromise.
• CT, CTA, and MRA with intravenous contrast are considered usually appropriate for initial AAS evaluation.
• Transesophageal ultrasound with contrast is also usually appropriate for initial AAS assessment.

Implications:

• Appropriate imaging facilitates timely and effective management of AAS.
• Accurate characterization of AAS pathology guides therapeutic decisions, potentially improving patient outcomes.
• Standardized guidelines ensure consistent and evidence-based evaluation of patients with suspected AAS.