ACR Appropriateness Criteria® Acute Pelvic Pain in the Reproductive Age Group: 2023 Update

Olga R. Brook, Beth Israel Deaconess Medical Center, Boston, Massachusetts. Electronic address: obrook@bidmc.harvard.edu.
Joseph R. Dadour, Research Author, Centre Hospitalier de l'Université de Montréal, Montréal, Montreal, Quebec, Canada.
Jessica B. Robbins, Panel Chair, University of Wisconsin, Madison, Wisconsin.
Ashish P. Wasnik, Panel Vice Chair, University of Michigan, Ann Arbor, Michigan.
Esma A. Akin, The George Washington University Medical Center, Washington, District of Columbia; Commission on Nuclear Medicine and Molecular Imaging.
Matthew P. Borloz, Virginia Tech Carilion School of Medicine, Roanoke, Virginia; American College of Emergency Physicians.
Adrian A. Dawkins, University of Kentucky, Lexington, Kentucky.
Myra K. Feldman, Cleveland Clinic, Cleveland, Ohio.
Lisa P. Jones, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Lee A. Learman, Virginia Tech Carilion School of Medicine, Roanoke, Virginia; American College of Obstetricians and Gynecologists.
Kira Melamud, New York University Langone Health, New York, New York.
Krupa K. Patel-Lippmann, Vanderbilt University Medical Center, Nashville, Tennessee.
Carl J. Saphier, Women's Ultrasound, LLC, Englewood, New Jersey; American College of Obstetricians and Gynecologists.
Kimberly Shampain, University of Michigan, Ann Arbor, Michigan.
Jennifer W. Uyeda, Brigham & Women's Hospital, Boston, Massachusetts; Committee on Emergency Radiology-GSER.
Wendaline VanBuren, Mayo Clinic, Rochester, Minnesota.
Stella K. Kang, Specialty Chair, New York University Medical Center, New York, New York.

Document Type

Journal Article

Publication Date

6-1-2024

Journal

Journal of the American College of Radiology : JACR

Volume

21

Issue

6S

DOI

10.1016/j.jacr.2024.02.014

Keywords

AUC; Appropriateness Criteria; acute pelvic pain; appendicitis; appropriate use criteria; diverticulitis; imaging; pregnancy

Abstract

This review focuses on the initial imaging in the reproductive age adult population with acute pelvic pain, including patients with positive and negative beta-human chorionic gonadotropin (β-hCG) levels with suspected gynecological and nongynecological etiology. For all patients, a combination of transabdominal and transvaginal pelvic ultrasound with Doppler is usually appropriate as an initial imaging study. If nongynecological etiology in patients with negative β-hCG is suspected, then CT of the abdomen and pelvis with or without contrast is also usually appropriate. In patients with positive β-hCG and suspected nongynecological etiology, CT of the abdomen and pelvis with contrast and MRI of the abdomen and pelvis without contrast may be appropriate. In patients with negative β-hCG and suspected gynecological etiology, CT of the abdomen and pelvis with contrast, MRI of pelvis without contrast, or MRI of pelvis with and without contrast may 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 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.

Department

Radiology

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