ACR Appropriateness Criteria® Evaluation of Coronary Artery Anomalies

Congenital anomalies of the coronary arteries are often discovered incidentally yet in the context of acute cardiac symptoms. The management and decision-making pathway of anomalous coronary arteries relies heavily on imaging to determine the type of anomaly, its clinical significance, and ultimately to plan any surgical interventions. Imaging also provides guidance for patients if no further interventions are needed, and watchful management is the right choice. Imaging also allows to anticipate potential high-risk scenarios during surgery or intervention by determining patients with high-risk features that already cause ischemia during stress. In summary, cardiac imaging determines, guides, and reassures patients and physicians in the managements of congenital coronary anomalies.

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.