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ACR Appropriateness Criteria® Nonischemic Myocardial Disease With Clinical Manifestations (Ischemic Cardiomyopathy Already Excluded)

Mammen, Leena MD; Woodard, Pamela K. MD; Abbara, Suhny MD; Dorbala, Sharmila MD; Javidan-Nejad, Cylen MD; Julsrud, Paul R. MD; Kirsch, Jacobo MD; Kramer, Christopher M. MD; Krishnamurthy, Rajesh MD; Laroia, Archana T. MD; Shah, Amar B. MD; Vogel-Claussen, Jens MD; White, Richard D. MDExpert Panel on Cardiac Imaging

doi: 10.1097/RTI.0000000000000096
Web Exclusive Content—ACR Appropriateness Criteria® Review

Nonischemic myocardial disease or cardiomyopathy can present as arrhythmia, palpitations, heart failure, dyspnea, lower extremity edema, ascites, syncope, and/or chest discomfort and can be classified as either systolic, diastolic, or a combination of both. Echocardiography is the mainstay of evaluating left ventricular function. However, cardiac magnetic resonance imaging (MRI) is now considered the reference standard imaging technique to assess myocardial anatomy, function, and viability. Advanced MRI techniques with delayed myocardial enhancement, especially, can provide information beyond echocardiography for tissue characterization in CM and can assist in determining specific etiology or in narrowing the differential. Often imaging enhancement patterns, signal characteristics, and morphology on MRI can lead to specific diagnoses such as amyloidosis, hypertrophic CM, or iron deposition. Cardiac computed tomography is usually used in excluding coronary artery disease but can also be used in some patients unable to undergo cardiac MRI to assess arrhythmogenic right ventricular dysplasia. Both 18-F-fluoro-2-deoxyglucose positron emission tomography and delayed contrast-enhanced MRI can be used to assess for cardiac sarcoidosis. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

*Advanced Radiology Services, Grand Rapids, MI

Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO

Massachusetts General Hospital, Boston, MA

§Society of Nuclear Medicine, Brigham and Women’s Hospital, Boston, MA

Mayo Clinic, Rochester, MN

Cleveland Clinic, Weston, FL

#Department of Radiology, American College of Cardiology, University of Virginia Health System, Charlottesville, VA

**Texas Children’s Hospital, Houston, TX

††Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA

‡‡Westchester Medical Center, Valhalla, NY

§§Johns Hopkins Hospital, Baltimore, MD

∥∥Ohio State University Medical Center, Columbus, OH

This article is a summary of the complete version of this topic, which is available on the ACR website at Practitioners are encouraged to refer to the complete version.

Reprinted with permission of the American College of Radiology.

The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document.

Sharmila Dorbala is a recipient of research grant from Astells Pharma US (funded by the NIG, a K23 grant). The remaining authors declare no conflicts of interest.

Corresponding Author: Leena Mammen, MD, 1819 Argentina Dr SE Grand Rapids, MI 49506-6530 (e-mail: Reprints: (e-mail:

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