American College of Radiology
ACR Appropriateness Criteria®

Radiologic Management of Uterine Leiomyomas

Variant 1: Middle-aged woman with multiple uterine fibroids resulting in a 20-week-sized uterus on physical examination and menorrhagia. Bulk symptoms of urinary frequency and bloating are present. The patient has a recent negative serum pregnancy test and has no desire for future fertility.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Medical management Usually not appropriate N/A N/A 3 n/a 0 0 0 0 0 0 0 0 0
MR-guided high-frequency focused ultrasound ablation Usually not appropriate N/A N/A 2 n/a 0 0 0 0 0 0 0 0 0
Endometrial ablation Usually not appropriate N/A N/A 2 n/a 0 0 0 0 0 0 0 0 0
Uterine artery embolization Usually appropriate N/A N/A 8 n/a 0 0 0 0 0 0 0 0 0
Laparoscopic uterine artery occlusion Usually not appropriate N/A N/A 1 n/a 0 0 0 0 0 0 0 0 0
Myomectomy Usually not appropriate N/A N/A 3 n/a 0 0 0 0 0 0 0 0 0
Hysterectomy Usually appropriate N/A N/A 8 n/a 0 0 0 0 0 0 0 0 0
Variant 2: Childbearing age woman with multiple submucosal and intramural fibroids presents with menorrhagia and pelvic pain. Most of the fibroids measure <4 cm, with two dominant fibroids measuring >6 cm. Uterus is 12 cm on MRI. The patient states that she does not desire future pregnancies and is concerned about the loss of femininity with hysterectomy.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Medical management Usually not appropriate N/A N/A 3 n/a 0 0 0 0 0 0 0 0 0
MR-guided high-frequency focused ultrasound ablation Usually not appropriate N/A N/A 3 n/a 0 0 0 0 0 0 0 0 0
Endometrial ablation Usually not appropriate N/A N/A 2 n/a 0 0 0 0 0 0 0 0 0
Uterine artery embolization Usually appropriate N/A N/A 8 n/a 0 0 0 0 0 0 0 0 0
Laparoscopic uterine artery occlusion Usually not appropriate N/A N/A 1 n/a 0 0 0 0 0 0 0 0 0
Myomectomy Usually not appropriate N/A N/A 3 n/a 0 0 0 0 0 0 0 0 0
Hysterectomy May be appropriate N/A N/A 4 n/a 0 0 0 0 0 0 0 0 0
Variant 3: Childbearing age woman with menometrorrhagia. On MRI, she has three dominant leiomyomas, ranging in size from 6 to 8 cm and intramural in location. She states that she does not have plans for future pregnancy but would like to have the option in the future.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Medical management Usually not appropriate N/A N/A 3 3 0 3 6 0 0 1 0 0 0
MR-guided high-frequency focused ultrasound ablation May be appropriate N/A N/A 4 n/a 0 0 0 0 0 0 0 0 0
Endometrial ablation Usually not appropriate N/A N/A 1 n/a 0 0 0 0 0 0 0 0 0
Uterine artery embolization Usually appropriate N/A N/A 7 n/a 0 0 0 0 0 0 0 0 0
Laparoscopic uterine artery occlusion Usually not appropriate N/A N/A 1 n/a 0 0 0 0 0 0 0 0 0
Myomectomy Usually appropriate N/A N/A 7 n/a 0 0 0 0 0 0 0 0 0
Hysterectomy Usually not appropriate N/A N/A 2 n/a 0 0 0 0 0 0 0 0 0
Variant 4: Middle-aged woman with menorrhagia. MRI reveals a single 3 cm intramural fibroid and diffuse adenomyosis.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Medical management Usually not appropriate N/A N/A 3 n/a 0 0 0 0 0 0 0 0 0
MR-guided high-frequency focused ultrasound ablation Usually not appropriate N/A N/A 3 n/a 0 0 0 0 0 0 0 0 0
Endometrial ablation May be appropriate N/A N/A 4 4 0 2 1 7 1 0 0 0 0
Uterine artery embolization Usually appropriate N/A N/A 7 n/a 0 0 0 0 0 0 0 0 0
Laparoscopic uterine artery occlusion Usually not appropriate N/A N/A 1 n/a 0 0 0 0 0 0 0 0 0
Myomectomy Usually not appropriate N/A N/A 3 n/a 0 0 0 0 0 0 0 0 0
Hysterectomy Usually appropriate N/A N/A 7 n/a 0 0 0 0 0 0 0 0 0
Variant 5: Middle-aged woman with pelvic discomfort and 8 cm pedunculated subserosal fibroid on MRI.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Medical management May be appropriate N/A N/A 4 n/a 0 0 0 0 0 0 0 0 0
MR-guided high-frequency focused ultrasound ablation Usually not appropriate N/A N/A 3 n/a 0 0 0 0 0 0 0 0 0
Endometrial ablation Usually not appropriate N/A N/A 1 n/a 0 0 0 0 0 0 0 0 0
Uterine artery embolization Usually appropriate N/A N/A 7 n/a 0 0 0 0 0 0 0 0 0
Laparoscopic uterine artery occlusion Usually not appropriate N/A N/A 2 n/a 0 0 0 0 0 0 0 0 0
Myomectomy Usually appropriate N/A N/A 8 n/a 0 0 0 0 0 0 0 0 0
Hysterectomy Usually appropriate N/A N/A 7 7 0 0 0 1 0 4 5 0 0
Variant 6: Middle-aged woman with constipation. MRI reveals a 12 cm subserosal leiomyoma compressing the rectum.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Medical management Usually not appropriate N/A N/A 3 n/a 0 0 0 0 0 0 0 0 0
MR-guided high-frequency focused ultrasound ablation Usually not appropriate N/A N/A 3 n/a 0 0 0 0 0 0 0 0 0
Endometrial ablation Usually not appropriate N/A N/A 1 n/a 0 0 0 0 0 0 0 0 0
Uterine artery embolization Usually appropriate N/A N/A 7 n/a 0 0 0 0 0 0 0 0 0
Laparoscopic uterine artery occlusion Usually not appropriate N/A N/A 1 n/a 0 0 0 0 0 0 0 0 0
Myomectomy Usually appropriate N/A N/A 8 n/a 0 0 0 0 0 0 0 0 0
Hysterectomy Usually appropriate N/A N/A 7 n/a 0 0 0 0 0 0 0 0 0
Please refer to the supporting documentation for a more complete discussion of the concepts and their definitions below.
Final Tabulations:
A histogram of the number of panel members who rated the recommendation as noted in the column heading (ie, 1, 2, 3, …etc.)
Disagree:
The variation of the individual ratings from the median rating indicates panel disagreement on the final recommendation.
References:
Lists the references associated with the recommendation
SQ:
Study Quality (1, 2, 3, 4, Good M or Inadequate M) of the references listed.
RRL:
Information on the Relative Radiation Level (RRL) designations can be found here.