ACR Appropriateness Criteria® Pelvic Floor Dysfunction in Females

Gaurav Khatri, Division Chief, Body MRI; Associate Division Chief, Abdominal Imaging, UT Southwestern Medical Center, Dallas, Texas; Program Director, Body MRI Fellowship. Electronic address: Gaurav.khatri@utsouthwestern.edu.
Priyadarshani R. Bhosale, Director of Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Jessica B. Robbins, Panel Vice-Chair, University of Wisconsin, Madison, Wisconsin.
Esma A. Akin, George Washington University Hospital, Washington, District of Columbia.
Susan M. Ascher, Georgetown University Hospital, Washington, District of Columbia.
Olga R. Brook, Section Chief of Abdominal Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Mark Dassel, Director Endometriosis and Chronic Pelvic Pain, Cleveland Clinic, Cleveland, Ohio; American College of Obstetricians and Gynecologists.
Phyllis Glanc, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Tara L. Henrichsen, Mayo Clinic, Rochester, Minnesota.
Lee A. Learman, Dean, Virginia Tech Carilion School of Medicine, Roanoke, Virginia; American College of Obstetricians and Gynecologists.
Elizabeth A. Sadowski, University of Wisconsin, Madison, Wisconsin; and ACR O-RADS MRI Education Subcommittee Chair.
Carl J. Saphier, Women's Ultrasound, LLC, Englewood, New Jersey; American College of Obstetricians and Gynecologists.
Ashish P. Wasnik, Division Chief, Abdominal Radiology, University of Michigan, Ann Arbor, Michigan.
Katherine E. Maturen, Associate Chair for Ambulatory Care and Specialty Chair, University of Michigan, Ann Arbor, Michigan.

Document Type

Journal Article

Publication Date

5-1-2022

Journal

Journal of the American College of Radiology : JACR

Volume

19

Issue

5S

DOI

10.1016/j.jacr.2022.02.016

Keywords

AUC; Appropriate Use Criteria; Appropriateness Criteria; Defecatory dysfunction; Pelvic floor disorder; Pelvic mesh; Pelvic organ prolapse; Urethral sling; Urinary incontinence; Vaginal bulge; Voiding dysfunction

Abstract

Pelvic floor disorders including pelvic organ prolapse (POP), urinary dysfunction, defecatory dysfunction, and complications after pelvic floor surgery are relatively common in the female population. Imaging tests are obtained when the initial clinical evaluation is thought to be incomplete or inconclusive or demonstrates findings that are discordant with patients' symptoms. An integrated imaging approach is optimal to evaluate the complex anatomy and dynamic functionality of the pelvic floor. Fluoroscopic cystocolpoproctography (CCP) and MR defecography are considered the initial imaging tests of choice for evaluation of POP. Fluoroscopic voiding cystourethrography is considered the initial imaging test for patients with urinary dysfunction. Fluoroscopic CCP and MR defecography are considered the initial imaging test for patients with defecatory dysfunction, whereas ultrasound pelvis transrectal is a complementary test in patients requiring evaluation for anal sphincter defects. MRI pelvis without and with intravenous contrast, MRI pelvis with dynamic maneuvers, and MR defecography are considered the initial imaging tests in patients with suspected complications of prior pelvic floor surgical repair. Transperineal ultrasound is emerging as an important imaging tool, in particular for screening of pelvic floor dysfunction and for evaluation of midurethral slings, vaginal mesh, and complications related to prior pelvic floor surgical repair. 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.

Department

Radiology

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