Ath
eroscl
erotic cardiovascular dis
eas
e is th
e l
eading caus
e of d
eath for both m
en and wom
en in th
e Unit
ed Stat
es. Coronary art
ery dis
eas
e has a long asymptomatic lat
ent p
eriod and
early targ
et
ed pr
ev
entiv
e m
easur
es can r
educ
e mortality and morbidity. It is important to accurat
ely classify individuals at
el
evat
ed risk in ord
er to id
entify thos
e who might b
en
efit from
early int
erv
ention. Imaging advanc
es hav
e mad
e it possibl
e to d
et
ect subclinical coronary ath
eroscl
erosis. Coronary art
ery calcium scor
e corr
elat
es clos
ely with ov
erall ath
eroscl
erotic burd
en and provid
es us
eful prognostic information for pati
ent manag
em
ent. Our purpos
e is to discuss us
e of diagnostic imaging in asymptomatic pati
ents at
el
evat
ed risk for futur
e cardiovascular
ev
ents. Th
e goal for th
es
e pati
ents is to furth
er r
efin
e targ
et
ed pr
ev
entativ
e efforts bas
ed on risk. Th
e following imaging modaliti
es ar
e availabl
e for
evaluating asymptomatic pati
ents at
el
evat
ed risk: radiography, fluoroscopy, multid
et
ector CT, ultrasound, MRI, cardiac p
erfusion scintigraphy,
echocardiography, and PET.
The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 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 where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.