ACR Appropriateness Criteria® Abnormal Uterine Bleeding

Abstract

This publication summarizes the relevant literature for the imaging of patients with symptoms of abnormal uterine bleeding, including initial imaging, follow-up imaging when the original ultrasound is inconclusive, and follow-up imaging when surveillance is appropriate. For patients with abnormal uterine bleeding, combined transabdominal and transvaginal ultrasound of the pelvis with Doppler is the most appropriate initial imaging study. If the uterus is incompletely visualized with the initial ultrasou2nd, MRI of the pelvis without and with contrast is the next appropriate imaging study, unless a polyp is suspected on the original ultrasound, then sonohysterography can be performed. If the patient continues to experience abnormal uterine bleeding, assessment with ultrasound of the pelvis, sonohysterography, and MRI of the pelvis without and with contrast would be appropriate. 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 include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Canadian Association of Radiologists Obstetrics and Gynecology Diagnostic Imaging Referral Guideline

“…We reviewed relevant recommendations related to the 12 clinical/diagnostic scenarios previously published by radiology and specialty societies, including: the Canadian Association of Radiologists, 9 the American College of Obstetricians and Gynecologists, 10,11 the American College of Radiology, 12 -28 the American Society of Clinical Oncology, 29 the European Society of Urogenital Radiology Scrotal and Penile Imaging Working Group, 30,31 the European Society of Urogenital Radiology, 32 the French College of Gynecologists and Obstetricians, 33 the International Society of Ultrasound in Obstetrics and Gynecology, 34 the International guideline on polycystic ovarian syndrome, 35 -38 the National Institute for Health and Care Excellence, 39 -47 the Society for Maternal-Fetal Medicine, 48 the Society of Abdominal Radiology, 49 the Society of Obstetricians and Gynaecologists of Canada, 50 -57 the Royal College of Obstetricians and Gynaecologists, 58 -60 and the 2017 Royal College of Radiologists. 61…”