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Appropriateness Criteria

Variant 1: High index of suspicion of renovascular hypertension. Normal renal function.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US duplex Doppler kidneys retroperitoneal Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
9 (10742425) 3
13 (17384038) 4
15 (24172238) 4
16 (16301720) 2
17 (17192278) 4
18 (19233590) 3
14 (12515376) 4
19 (24155154) 3
3 (20864945) 4
MRA abdomen without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
33 (21542417) 2
34 (21833688) 4
36 (25204811) 4
38 (11956117) 2
39 (12773688) 2
37 (12704782) 2
35 (23917027) 4
32 (12096862) M
CTA abdomen with IV contrast Usually appropriate Strong ☢☢☢ 1-10 mSv 8 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
40 (12601190) 1
41 (8686635) 2
42 (8662167) 2
43 (9676442) 2
44 (11849401) 3
46 (12490511) 2
47 (12148095) 3
48 (19561264) 2
MRA abdomen without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 5 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
33 (21542417) 2
34 (21833688) 4
36 (25204811) 4
38 (11956117) 2
39 (12773688) 2
37 (12704782) 2
35 (23917027) 4
29 (18270376) 1
32 (12096862) M
30 (17499952) 1
31 (18372471) 1
ACE-inhibitor renography May be appropriate Strong ☢☢☢ 1-10 mSv 5 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
25 (1831342) 3
21 (11560453) M
20 (10992024) 4
24 (12230421) 2
22 (1837991) 4
23 (15728620) 3
26 (14500224) 3
27 (10816399) 2
28 (12411867) 4
Arteriography kidney Usually not appropriate Strong ☢☢☢ 1-10 mSv 3 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
25 (1831342) 3
21 (11560453) M
20 (10992024) 4
24 (12230421) 2
23 (15728620) 3
26 (14500224) 3
27 (10816399) 2
28 (12411867) 4
Venography with renal vein sampling Usually not appropriate Limited Varies Varies 3 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
25 (1831342) 3
57 (3160766) 4
58 (2944011) 3
59 (1994424) 3
Variant 2: High index of suspicion of renovascular hypertension. Decreased renal function, eGFR <30 mL/min/1.73 m2.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US duplex Doppler kidneys retroperitoneal Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
9 (10742425) 3
10 (10957652) 3
11 (22595689) 2
12 (17764871) 4
13 (17384038) 4
15 (24172238) 4
16 (16301720) 2
17 (17192278) 4
18 (19233590) 3
14 (12515376) 4
19 (24155154) 3
3 (20864945) 4
MRA abdomen without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
66 (23096208) 3
65 (21098205) 2
64 (18728334) 3
CTA abdomen with IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv 5 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
7 (-3132600) 4
Arteriography kidney Usually not appropriate Limited ☢☢☢ 1-10 mSv 3 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
68 (10584800) 4
69 (10207465) 4
Venography with renal vein sampling Usually not appropriate Expert Consensus Varies Varies 3 n/a 0 0 0 0 0 0 0 0 0
MRA abdomen without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
66 (23096208) 3
65 (21098205) 2
64 (18728334) 3
ACE-inhibitor renography Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 3 n/a 0 0 0 0 0 0 0 0 0
Appendix Key

A more complete discussion of the items presented below can be found by accessing the supporting documents at the designated hyperlinks.

Appropriateness Category:The panel’s recommendation for a procedure based on the assessment of the risks and benefits of performing the procedure for the specified clinical scenario.

SOE: Strength of Evidence. The assessment of the amount and quality of evidence found in the peer reviewed medical literature for an appropriateness recommendation.

  • References: The citation number and PMID for the reference(s) associated with the recommendation.
  • Study Quality: The assessment of the quality of an individual reference based on the number of study quality elements described in the reference.

RRL: Relative Radiation Level. A population based assessment of the amount of radiation a typical patient may be exposed to during the specified procedure.

Rating: The final rating (1-9 scale) for the procedure as determined by the panel during rating rounds.

Median: The median rating (1-9 scale) for the procedure as determined by the panel during rating rounds.

Final tabulations: A histogram showing the number of panel members who rated the procedure as noted in the column heading (ie, 1, 2, 3, etc.).

Additional supporting documents about the AC methodology and processes can be found at www.acr.org/ac.