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February 28, 2026Journal of the American College of Radiology0 citationsOpen Access

ACR Appropriateness Criteria® Evaluation of Cardiac Masses

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PRPrabhakar RajiahKHKate HannemanBABradley D. Allen

Key Result

Evidence-based guidelines recommend specific imaging modalities, including echocardiography, MRI, CT, and PET, for the initial evaluation, characterization, and follow-up of adult cardiac masses.

Key Points

  • This document aims to evaluate the appropriateness of various imaging modalities for the diagnosis and management of cardiac masses.
  • Assessment of imaging techniques for three clinical variants regarding cardiac masses.
  • Review of established guidelines from the American College of Radiology.
  • Utilization of methods such as GRADE and the RAND/UCLA Appropriateness Method.
  • For initial imaging of suspected cardiac masses, echocardiography, MRI, and CT are appropriate.
  • Next imaging for known cardiac masses includes various echocardiography techniques and advanced imaging modalities like FDG-PET.
  • Follow-up imaging similarly highlights the use of echocardiography, MRI, and CT for monitoring established conditions.

Structured PICO

What are the appropriate imaging modalities for the initial evaluation, characterization, and follow-up of cardiac masses in adults?

P
Population
Adults with suspected or known cardiac masses
I
Intervention
Imaging modalities including transthoracic and transesophageal echocardiography, cardiac MRI with and without contrast, cardiac CT with contrast, and FDG-PET/CT or FDG-PET/MRI
O
Outcome
Appropriateness of imaging modalities for specific clinical scenarios

This document provides evidence-based guidelines on the appropriate use of multimodality imaging for the initial evaluation, characterization, and follow-up of cardiac masses in adults.

Abstract

This document discusses the appropriateness of imaging modalities for cardiac masses under 3 variants: 1) adult with suspected cardiac mass, initial imaging; 2) adult with known cardiac mass in echocardiography of unknown etiology, next imaging; and 3) adult with known cardiac mass and established etiology, follow-up imaging. US echocardiography transthoracic resting, MRI heart function and morphology without and with contrast, and CT heart function and morphology with contrast are usually appropriate for Variant 1. US echocardiography transesophageal, US echocardiography transthoracic resting, MRI heart function and morphology without and with contrast, CT heart function and morphology with contrast, FDG-PET/CT heart, and FDG-PET/MRI heart are usually appropriate for Variant 2. US echocardiography transthoracic resting, MRI heart function and morphology without and with contrast, MRI heart function and morphology without contrast, CT heart function and morphology with contrast, and FDG-PET/MRI heart are usually appropriate for Variant 3. 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.

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Cite This Study

Rajiah et al. (2026) conducted a review in Cardiac masses. Imaging modalities (Echocardiography, MRI, CT, PET) was evaluated on Appropriateness of imaging modalities. Evidence-based guidelines recommend specific imaging modalities, including echocardiography, MRI, CT, and PET, for the initial evaluation, characterization, and follow-up of adult cardiac masses.

synapsesocial.com/papers/6a025a3d9cddff7633412a87https://doi.org/10.1016/j.jacr.2026.01.014
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