ACR Appropriateness Criteria® Suspected and Known Renal or Splanchnic Artery Aneurysm

Renal and splanchnic artery aneurysms are clinically significant vascular abnormalities with potential for life-threatening complications, including rupture. Accurate imaging is essential for initial detection, risk stratification, treatment planning purposes, and longitudinal surveillance. This document provides evidence-based recommendations for imaging evaluation of suspected and known renal and/or splanchnic artery aneurysms across four clinical scenarios: adults undergoing initial evaluation, adults under active surveillance, pregnant patients with suspected aneurysm, and pregnant patients undergoing surveillance. The roles of CTA, MRA, ultrasound (including duplex Doppler and contrast-enhanced techniques), and catheter angiography are reviewed with attention to diagnostic performance and safety considerations. CTA and MRA are generally preferred in nonpregnant adults, whereas ultrasound and noncontrast MRA are favored in pregnancy to minimize radiation and contrast exposure. These document aims to optimize imaging utilization, enhance diagnostic accuracy, and support safe, patient-centered management of renal and/or splanchnic artery aneurysms. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.