Leipsic Jonathon A, Blanke Philipp, Hanley Michael, Batlle Juan C, Bolen Michael A, Brown Richard K J, Desjardins Benoit, Eberhardt Robert T, Gornik Heather L, Hurwitz Lynne M, Maniar Hersh, Patel Himanshu J, Sheybani Elizabeth F, Steigner Michael L, Verma Nupur, Abbara Suhny, Rybicki Frank J, Kirsch Jacobo, Dill Karin E
Principal Author, St. Paul's Hospital, Vancouver, British Columbia, Canada.
Research Author, St. Paul's Hospital, Vancouver, British Columbia, Canada.
J Am Coll Radiol. 2017 Nov;14(11S):S449-S455. doi: 10.1016/j.jacr.2017.08.046.
Aortic stenosis is a common valvular condition with increasing prevalence in aging populations. When severe and symptomatic, the downstream prognosis is poor without surgical or transcatheter aortic valve replacement. Transcatheter aortic valve replacement is now considered a viable alternative to surgical aortic valve replacement in patients considered high and intermediate risk for surgery. Pre-intervention imaging with echocardiography and CT are essential for procedure planning and device selection to help optimize clinical outcomes with MR angiography playing largely a complementary role. Modern 3-D cross-sectional imaging has consistently shown to help reduce procedural complications from vascular access injury to paravalvular regurgitation and coronary obstruction. 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 include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
主动脉瓣狭窄是一种常见的瓣膜疾病，在老年人群中的患病率呈上升趋势。当病情严重且出现症状时，若不进行外科手术或经导管主动脉瓣置换术，其下游预后较差。对于被认为手术风险高和中等的患者，经导管主动脉瓣置换术现在被认为是外科主动脉瓣置换术的一种可行替代方案。术前使用超声心动图和CT进行成像对于手术规划和器械选择至关重要，有助于优化临床结果，而磁共振血管造影在很大程度上起辅助作用。现代三维横截面成像一直显示有助于减少从血管入路损伤到瓣周反流和冠状动脉阻塞等手术并发症。美国放射学会适宜性标准是针对特定临床情况的循证指南，每年由多学科专家小组进行审查。指南的制定和修订包括对同行评审期刊上的当前医学文献进行广泛分析，并应用成熟的方法（兰德/加州大学洛杉矶分校适宜性方法以及推荐分级评估、制定和评价或GRADE）来评估特定临床场景下成像和治疗程序的适宜性。在缺乏证据或证据不明确的情况下，专家意见可能会补充现有证据以推荐成像或治疗方法。
