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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Allison SO, Lev-Toaff AS. Acute pelvic pain: what we have learned from the ER. ULTRASOUND Q.. 26(4):211-8, 2010 Dec. Review/Other-Dx N/A To review the etiology of acute pelvic pain. No abstract available. 4
2. Bhosale PR, Javitt MC, Atri M, et al. ACR Appropriateness Criteria R Acute Pelvic Pain in the Reproductive Age Group. Ultrasound Quarterly. 32(2):108-15, 2016 Jun.ULTRASOUND Q.. 32(2):108-15, 2016 Jun. Review/Other-Dx N/A To provide evidence-based guidelines to assist referring physicians and other providers to make the most appropriate imaging and treatment decision in acute pelvic pain in the reproductive age group. No results stated in abstract. 4
3. Kurt S, Uyar I, Demirtas O, Celikel E, Beyan E, Tasyurt A. Acute pelvic pain: evaluation of 503 cases. Arch Iran Med. 16(7):397-400, 2013 Jul. Review/Other-Dx 503 patients To investigate the etiology according to the age groups (adolescent, reproductive, and perimenopausal / menopausal periods) of women who were admitted with complaints of acute pelvic pain (APP). The mean age was 29.9 ± 6.01 years. Gynecologic factors were present in 469 cases, APP was nongynecologic in nature in 24 cases, while the cause was unknown in 10 cases. The patients were evaluated in terms of APP duration, accompanying symptoms, and pain localization. There were 36 cases in the adolescent group, 361 cases in the reproductive age group, and 72 cases in the perimenopausal / menopausal group. Adnexal pathologies were the most commonly observed APP factor in all three groups. 4
4. Amirbekian S, Hooley RJ. Ultrasound evaluation of pelvic pain. [Review]. Radiol Clin North Am. 52(6):1215-35, 2014 Nov. Review/Other-Dx N/A To review the ultrasound imaging technique and provide a thorough differential of gynecologic and nongynecologic causes of both acute and chronic pelvic pain. No results stated in abstract. 4
5. Lameris W, van Randen A, van Es HW, et al. Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: diagnostic accuracy study. BMJ. 2009;338:b2431. Observational-Dx 1,021 patients Multicentre diagnostic accuracy study with prospective data collection to identify an optimal imaging strategy for the accurate detection of urgent conditions in patients with acute abdominal pain. 661 (65%) patients had a final diagnosis classified as urgent. The initial clinical diagnosis resulted in many false positive urgent diagnoses, which were significantly reduced after US or CT. CT detected more urgent diagnoses than did US: sensitivity was 89% (95% CI, 87% to 92%) for CT and 70% (67% to 74%) for US (P<0.001). A conditional strategy with CT only after negative or inconclusive US yielded the highest sensitivity, missing only 6% of urgent cases. With this strategy, only 49% (46% to 52%) of patients would have CT. Alternative strategies guided by body mass index, age, or location of the pain would all result in a loss of sensitivity. Although CT is the most sensitive imaging investigation for detecting urgent conditions in patients with abdominal pain, using US first and CT only in those with negative or inconclusive US results in the best sensitivity and lowers exposure to radiation. 3
6. Perry H, Foley KG, Witherspoon J, et al. Relative accuracy of emergency CT in adults with non-traumatic abdominal pain. British Journal of Radiology. 89(1059):20150416, 2016. Observational-Dx 361 patients To determine the accuracy and strength of agreement between the pre-operative CT and emergency laparotomy findings in adult patients with non-traumatic abdominal pain. 361 patients [median age 67 years (18–98 years); 180 males] underwent CT prior to emergency laparotomy. CT reports were deemed accurate in 318 (88.1%) cases and inaccurate in 43 (11.9%) cases, which resulted in 5 negative laparotomies in this latter cohort (11.6%, x2 37.50, df 1; p , 0.0001). Accuracy and strength of agreement varied with anatomical location of the pathology; upper gastrointestinal (UGI) 75.5%, Kw 0.673 (0.531–0.815; p , 0.001); small bowel 89.9%, Kw 0.781 (0.687–0.875, p , 0.001); lower gastrointestinal (LGI) 90.4%, Kw 0.821 (0.749–0.893; p , 0.001). CT examinations reported within normal working hours had higher strength of agreement [Kw 0.832 (0.768–0.896), p , 0.001] than CTs reported out of hours [Kw 0.789 (0.721–0.857), p , 0.001], but there was no significant difference in overall accuracy (89.9 vs 86.0%; x2 1.306, df 1, p 5 0.253). Reporter seniority was not associated with improved diagnostic accuracy (x2 1.825, df 1; p 5 0.177). 3
7. Martin JF, Mathison DJ, Mullan PC, Otero HJ. Secondary imaging for suspected appendicitis after equivocal ultrasound: time to disposition of MRI compared to CT. EMERG. RADIOL.. 25(2):161-168, 2018 Apr. Observational-Dx 55 children To compare MRI to CT as a secondary imaging modality for children age 5 years and older with suspected appendicitis after an equivocal abdominal ultrasound in terms of (1) the time to ED disposition decision, (2) surgery consultation rate, and (3) imaging test accuracy. Twenty-five patients underwent CT and 30 underwent MRI, with no significant difference in the median time from ultrasound to disposition between the CT (5.9 h, IQR 4.5, 8.4) and the MRI (5.9 h, IQR 4.6, 6.9) groups (p?= 0.65). Fifteen patients had appendicitis. Of the 40 negative or equivocal studies, surgery was consulted for 79% in the CT and 48% in the MRI group (odds ratio 4.12, 95% CI 1.02–16.67). Diagnostic accuracy was as follows: MRI: sensitivity of 90%, specificity of 97.1%, positive predictive value of 90%, and negative predictive value of 97.1%. Abdominal CT: sensitivity of 88%, specificity of 98.6%, positive predictive value of 95.7%, and negative predictive value of 95.8%. 3
8. Asch E, Shah S, Kang T, Levine D. Use of pelvic computed tomography and sonography in women of reproductive age in the emergency department. Journal of Ultrasound in Medicine. 32(7):1181-7, 2013 Jul. Review/Other-Dx 509 women To review use of pelvic computed tomography (CT) and sonography in the emergency department for women of reproductive age and to identify cases in which sonography might have been adequate. Of 509 women who underwent CT, 407 (80%) underwent CT only; 54 (11%) underwent CT first; and 48 (9%) underwent pelvic sonography first. The percentages with negative CT findings were 42%,17%, and 50%, respectively. Overall, 63 (CT only), 38 (CT first), and 12 (sonography first) patients had CT diagnoses of pelvic conditions only (113 of 509 women [22%]). Of the patients with CT and discharge diagnoses of pelvic conditions, 36 of 44 (82%) had CT only or CT first; 58 of 110 (53%) of cases with sonography only showed acute pelvic conditions. 4
9. Patel MD, Ascher SM, Paspulati RM, et al. Managing incidental findings on abdominal and pelvic CT and MRI, part 1: white paper of the ACR Incidental Findings Committee II on adnexal findings. J. Am. Coll. Radiol.. 10(9):675-81, 2013 Sep. Review/Other-Dx N/A To describe adnexal (ovarian and paraovarian) incidental findings found on CT and MRI in nonpregnant postmenarchal patients in whom no adnexal disorder is clinically known or suspected. No results stated in abstract. 4
10. Boos J, Brook OR, Fang J, Brook A, Levine D. Ovarian Cancer: Prevalence in Incidental Simple Adnexal Cysts Initially Identified in CT Examinations of the Abdomen and Pelvis. Radiology. 286(1):196-204, 2018 01. Review/Other-Dx 2763 women To evaluate the rate of malignancy in incidentally detected simple adnexal cysts at computed tomography (CT) to determine if simple-appearing cysts require follow-up. Among 42,111 women who underwent abdominal and pelvic CT examinations in the study period, 2763 (6.6%; 95% CI: 6.3%, 6.8%) (mean age, 48.1 years ± 18.1; range, 15-102 years) had a newly detected finding of ovarian cyst described in the body or impression section of the report. Median cyst size was 3.1 cm (range, 0.8-20.0 cm). Eighteen (0.7%; 95% CI: 0.4%, 1.0%) of 2763 patients were found to have ovarian cancer after an average follow-up of 5.1 years ± 3.8 (range, 0-12.8 years). None (95% CI: 0%, 0.4%) of 1031 women with simple-appearing cysts were given a diagnosis of ovarian cancer. This included none (95% CI: 0%, 0.4%) of 904 women with simple-appearing cysts with an adequate reference standard for benign outcome. 4
11. Pickhardt PJ, Hanson ME. Incidental adnexal masses detected at low-dose unenhanced CT in asymptomatic women age 50 and older: implications for clinical management and ovarian cancer screening. Radiology 2010;257:144-50. Review/Other-Dx 2869 women To determine the prevalence, work-up, and outcomes of indeterminate adnexal masses identified at low-dose unenhanced computed tomography (CT) in asymptomatic women age 50 and older undergoing colonography screening. One hundred eighteen women (mean age, 56.2 years), representing 4.1% of the screening cohort, had an indeterminate adnexal mass (108 unilateral, 10 bilateral; mean size, 4.1 cm) at prospective CT interpretation. A total of 80 women underwent some combination of further imaging evaluation (n = 76) (transvaginal ultrasonography [n = 71], pelvic magnetic resonance imaging [n = 7], contrast material-enhanced CT [n = 7]) and/or surgery (n = 26). Mean serum CA-125 level in 33 women was 12.8 U/mL; levels were normal (<35 U/mL) in 32 (97%) cases (range, 3-26 U/mL) and mildly elevated (41 U/mL) in one case. Final pathologic findings of surgically excised lesions were cystadenoma or cystadenofibroma (n = 14; 11 serous, three mucinous); nonneoplastic cysts (n = 5; two endometriomas); mature teratoma (n = 3); hydrosalpinx (n = 2); fibroma (n = 1); and benign Brenner tumor (n = 1). Three additional teratomas were diagnosed at index CT only. No ovarian cancers were prospectively identified, although four cases of ovarian cancer developed subsequent to a negative adnexal finding at CT examination during a 15-44-month interval among the remaining 2751 women. 4
12. Iraha Y, Okada M, Iraha R, et al. CT and MR Imaging of Gynecologic Emergencies. [Review]. Radiographics. 37(5):1569-1586, 2017 Sep-Oct. Review/Other-Dx N/A To review CT and MR imaging for gynecologic emergencies. No results stated in abstract. 4
13. Ssi-Yan-Kai G, Rivain AL, Trichot C, et al. What every radiologist should know about adnexal torsion. [Review]. EMERG. RADIOL.. 25(1):51-59, 2018 Feb. Review/Other-Dx N/A To review the adnexal anatomy, to familiarize radiologists with the main imaging features, and to discuss the main mimickers and the most common pitfalls of adnexal torsion. No results stated in abstract. 4
14. Rha SE, Byun JY, Jung SE, et al. CT and MR imaging features of adnexal torsion. Radiographics. 2002;22(2):283-294. Review/Other-Dx N/A Retrospective studies on diagnosis of adnexal torsion with CT and MRI. CT and MRI are useful imaging tools. 4
15. Dhanda S, Quek ST, Ting MY, et al. CT features in surgically proven cases of ovarian torsion-a pictorial review. British Journal of Radiology. 90(1078):20170052, 2017 Oct.Br J Radiol. 90(1078):20170052, 2017 Oct. Review/Other-Dx N/A To illustrate CT findings with histological correlation of surgically proven ovarian torsion with a pictorial essay. No results stated in abstract. 4
16. Duigenan S, Oliva E, Lee SI. Ovarian torsion: diagnostic features on CT and MRI with pathologic correlation. AJR Am J Roentgenol. 2012;198(2):W122-131. Review/Other-Dx N/A CT and MRI features of ovarian torsion are illustrated with gross pathologic correlation. Ovarian enlargement with or without an underlying mass is the finding most frequently associated with torsion, but it is nonspecific. A twisted pedicle, although not often detected on imaging, is pathognomonic when seen. Subacute ovarian hemorrhage and abnormal enhancement is usually seen, and both features show characteristic patterns on CT and MRI. Ipsilateral uterine deviation can also be seen. 4
17. Roy C, Bierry G, El Ghali S, Buy X, Rossini A. Acute torsion of uterine leiomyoma: CT features. Abdom Imaging. 30(1):120-3, 2005 Jan-Feb. Review/Other-Dx 1 patient To report a case in which the diagnosis of acute torsion of a subserosal leiomyoma could have been suspected by its computed tomographic (CT) features. No results stated in abstract. 4
18. Ohgiya Y, Seino N, Miyamoto S, et al. CT features for diagnosing acute torsion of uterine subserosal leiomyoma. Jpn J Radiol. 36(3):209-214, 2018 Mar. Observational-Dx 51 Patients To evaluate the usefulness of computed tomographic (CT) features for identifying acute torsion of uterine subserosal leiomyoma (USL). The respective frequencies of CT features in USLs with and without torsion were as follows: poor contrast enhancement, 86 and 5% (P = 0.001); thin rim enhancement, 71 and 9% (P = 0.001); calcification, 29 and 18% (P = 0.61); beak sign, 57 and 86% (P = 0.10); dark fan sign, 57 and 0% (P = 0.001); and ascites, 100 and 20% (P = 0.01). 3
19. Murase E, Siegelman ES, Outwater EK, Perez-Jaffe LA, Tureck RW. Uterine leiomyomas: histopathologic features, MR imaging findings, differential diagnosis, and treatment. Radiographics. 19(5):1179-97, 1999 Sep-Oct. Review/Other-Dx N/A To review histopathologic features, MR imaging findings, differential diagnosis, and treatment of uterine leiomyomas. No results stated in abstract. 4
20. Revzin MV, Mathur M, Dave HB, Macer ML, Spektor M. Pelvic Inflammatory Disease: Multimodality Imaging Approach with Clinical-Pathologic Correlation. [Review]. Radiographics. 36(5):1579-96, 2016 Sep-Oct. Review/Other-Dx N/A To discuss a multimodality imaging approach with clinical-pathologic correlation for pelvic inflammatory disease. No results stated in abstract. 4
21. Siddall KA, Rubens DJ. Multidetector CT of the female pelvis. [Review] [65 refs]. Radiol Clin North Am. 43(6):1097-118, ix, 2005 Nov. Review/Other-Dx N/A To review the role of multidetector CT in evaluation of the female pelvis. No results stated in abstract. 4
22. Kalish GM, Patel MD, Gunn ML, Dubinsky TJ. Computed tomographic and magnetic resonance features of gynecologic abnormalities in women presenting with acute or chronic abdominal pain. [Review] [52 refs]. ULTRASOUND Q.. 23(3):167-75, 2007 Sep. Review/Other-Dx N/A To review the use of CT and MRI in diagnosing causes of pelvic pain in women. No results stated in abstract. 4
23. Wilbur AC, Aizenstein RI, Napp TE. CT findings in tuboovarian abscess. AJR Am J Roentgenol. 158(3):575-9, 1992 Mar. Review/Other-Dx N/A To illustrate the CT findings in tuboovarian abscess. No results stated in abstract. 4
24. Kassam Z, Petkovska I, Wang CL, Trinh AM, Kamaya A. Benign Gynecologic Conditions of the Uterus. [Review]. Magn Reson Imaging Clin N Am. 25(3):577-600, 2017 Aug. Review/Other-Dx N/A To review the anatomy, pathophysiology, MR imaging features, and diagnostic criteria for benign uterine conditions, including adenomyosis, uterine leiomyomas, retained products of conception, and uterine arteriovenous malformations. No results stated in abstract. 4
25. Forstner R, Thomassin-Naggara I, Cunha TM, et al. ESUR recommendations for MR imaging of the sonographically indeterminate adnexal mass: an update. Eur Radiol. 27(6):2248-2257, 2017 Jun. Review/Other-Dx N/A To provide an update of the 2010 published ESUR recommendations of MRI of the sonographically indeterminate adnexal mass integrating functional techniques. No results stated in abstract. 4
26. Atri M, Alabousi A, Reinhold C, et al. ACR Appropriateness Criteria® Clinically Suspected Adnexal Mass, No Acute Symptoms. J Am Coll Radiol 2019;16:S77-S93. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for clinically suspected adnexal mass, no acute symptoms. No results stated in abstract. 4
27. Beranger-Gibert S, Lagadec M, Boulay-Coletta I, et al. Hepatic and perihepatic involvement of female genital diseases and pregnancy: a review. [Review]. Abdom Imaging. 40(5):1331-49, 2015 Jun. Review/Other-Dx N/A To describe the imaging characteristics of different aspects of hepatic and perihepatic involvement in various female genital tract diseases, and during pregnancy, and to help the radiologist identify these lesions. No results stated in abstract. 4
28. Beranger-Gibert S, Sakly H, Ballester M, et al. Diagnostic Value of MR Imaging in the Diagnosis of Adnexal Torsion. Radiology. 279(2):461-70, 2016 May. Observational-Dx 58 patients To retrospectively evaluate the diagnostic performance of magnetic resonance (MR) imaging for the diagnosis of adnexal torsion in a series of patients with an equivocal adnexal mass at ultrasonography (US) in the context of acute or subacute pelvic pain. Twenty-two patients (38%) had a diagnosis of adnexal torsion. The accuracy of MR imaging at the time of prospective interpretation was 80.6% (25 of 31 patients) and 85.1% (23 of 27 patients) in acute and subacute torsion, respectively. The accuracy of image interpretation by each retrospective reader was 83.9% (26 of 31 patients), 90.3% (28 of 31 patients), and 83.9% (26 of 31 patients) in the context of acute pelvic pain and 92.6% (25 of 27 patients), 88.9% (24 of 27 patients), and 81.5% (22 of 27 patients) in the context of subacute pelvic pain for readers 1, 2, and 3, respectively. At multivariate analysis, the whirlpool sign (odds ratio = 6.5 [95% confidence interval: 1.36, 31.0], P = .01) and a thickened tube (>10 mm) (odds ratio = 8.2 [95% confidence interval: 1.2, 56.8], P = .03) were associated with adnexal torsion, with substantial interreader agreement (? = 0.71-0.84 and 0.82-0.86, respectively). The presence of adnexal hemorrhagic content was associated with nonviable ovaries in seven of 10 patients (70%) and with viable ovaries in 12 of 45 patients (27%) (P = .009). 3
29. Singh AK, Desai H, Novelline RA. Emergency MRI of acute pelvic pain: MR protocol with no oral contrast. EMERG. RADIOL.. 16(2):133-41, 2009 Mar. Observational-Dx 67 patients To evaluate the efficacy of magnetic resonance (MR) without oral contrast in the assessment of suspected acute pathologies of the pelvis in pregnant and non-pregnant patients. Positive pelvic MR findings were seen in 73% (49/67). Final diagnoses were acute appendicitis (n = 12), ovarian torsion (n = 6), abscess (n = 3), tubo-ovarian abscess (n = 2), ovarian tumor (n = 2), degenerating fibroid (n = 3), and perianal fistula (n = 2). For acute appendicitis, sensitivity was 100% (12/12), and positive predictive value was 92% (12/13). Post-gadolinium T1-weighted sequences and T2 SS-FSE with FS were the sequences, which were most likely to best demonstrate the acute appendicitis. For ovarian torsion, the sensitivity was 86% (6/7), and positive predictive value was 100% (6/6). 4
30. Lourenco AP, Swenson D, Tubbs RJ, Lazarus E. Ovarian and tubal torsion: imaging findings on US, CT, and MRI. [Review]. EMERG. RADIOL.. 21(2):179-87, 2014 Apr. Review/Other-Dx N/A To illustrate the findings of surgically confirmed ovarian and fallopian tube torsion on US, CT, and MRI, including those in the pregnant patient. No results stated in abstract. 4
31. Verma SK, Bergin D, Gonsalves CF, Mitchell DG, Lev-Toaff AS, Parker L. Submucosal fibroids becoming endocavitary following uterine artery embolization: risk assessment by MRI. AJR Am J Roentgenol. 190(5):1220-6, 2008 May. Observational-Dx 49 women To assess the relationship between the endometrium and submucosal fibroids before and after uterine artery embolization (UAE). One hundred forty dominant fibroids were identified on baseline MRI. Forty-nine (35%) were intramural, 39 (28%) were submucosal, 34 (24%) were subserosal, eight (6%) were pedunculated subserosal, and 10 (6%) were endocavitary in location on preembolization MRI. After UAE, of 39 dominant submucosal fibroids, 13 (33%) became endocavitary: complete (n = 4), partial (n = 9) on the basis of European Society of Gynaecological Endoscopy (ESGE) classification. The preembolization mean interface-dimension ratio and mean diameters for dominant fibroids that became endocavitary were significantly greater than for those that did not become endocavitary after embolization (0.65 vs 0.32, p < 0.005; 8 vs 5.4 cm, p < 0.05, respectively). All dominant submucosal fibroids showed 100% infarction after UAE. 4
32. Deshmukh SP, Gonsalves CF, Guglielmo FF, Mitchell DG. Role of MR imaging of uterine leiomyomas before and after embolization. [Review]. Radiographics. 32(6):E251-81, 2012 Oct. Review/Other-Dx N/A To review the role of MRI for the detection and evaluation of leiomyomas. MRI is the most accurate imaging technique for detection and evaluation of leiomyomas and therefore has become the imaging modality of choice before and after uterine fibroid embolization. As leiomyomas enlarge, they may outgrow their blood supply, resulting in various forms of degeneration that change their appearance. Leiomyomas are classified as submucosal, intramural, or subserosal. Submucosal and subserosal leiomyomas may be pedunculated, thus simulating other conditions. Understanding the MRI appearance of leiomyomas allows differentiation from other entities. The superior tissue contrast of MRI allows diagnosis of leiomyomas with a high level of confidence, ultimately leading to a decrease in the number of surgeries performed and thus reducing healthcare expenditures. MRI findings that influence the planning of uterine fibroid embolization include the location, size, number, and vascular supply of leiomyomas. In addition, MRI can be used to assess the success of uterine fibroid embolization and evaluate for potential complications. 4
33. Kubik-Huch RA, Weston M, Nougaret S, et al. European Society of Urogenital Radiology (ESUR) Guidelines: MR Imaging of Leiomyomas. Eur Radiol. 28(8):3125-3137, 2018 Aug. Review/Other-Dx 25 questionnaires To develop imaging guidelines for MR work-up in patients with known or suspected uterine leiomyomas. The 25 returned questionnaires as well as the expert consensus meeting have shown reasonable homogeneity of practice among institutions. Expert consensus and literature review lead to an optimized MRI protocol to image uterine leiomyomas. Recommendations include indications for imaging, patient preparation, MR protocols and reporting criteria. The incremental value of functional imaging (DWI, DCE) is highlighted and the role of MR angiography discussed. 4
34. Czeyda-Pommersheim F, Kalb B, Costello J, et al. MRI in pelvic inflammatory disease: a pictorial review. [Review]. Abdom Radiol. 42(3):935-950, 2017 03. Review/Other-Dx N/A To provide a pictorial review of MRI in pelvic inflammatory disease. No results stated in abstract. 4
35. Knoepp US, Mazza MB, Chong ST, Wasnik AP. MR Imaging of Pelvic Emergencies in Women. [Review]. Magn Reson Imaging Clin N Am. 25(3):503-519, 2017 Aug. Review/Other-Dx N/A To review imaging of pelvic emergencies in women. No results stated in abstract. 4
36. Valentini AL, Speca S, Gui B, Soglia G, Micco M, Bonomo L. Adenomyosis: from the sign to the diagnosis. Imaging, diagnostic pitfalls and differential diagnosis: a pictorial review. [Review][Erratum appears in Radiol Med. 2011 Dec;116(8):1314 Note: Soglia, B G [corrected to Soglia, G]]. Radiol Med (Torino). 116(8):1267-87, 2011 Dec. Review/Other-Dx N/A To analyze the features of adenomyosis by illustrating the most usual and typical imaging patterns, along with the unusual appearances, seen in a vast array of gynaecological imaging modalities. No results stated in abstract. 4
37. American College of Radiology. ACR-ACOG-AIUM-SRU Practice Parameter for the Performance of Ultrasound of the Female Pelvis. Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/US-Pelvis.pdf?la=en. April 2, 2019 Review/Other-Tx NA Guidance document to promote the safe and effective use of diagnostic and therapeutic radiology by describing specific training, skills and techniques. NA 4
38. Vandermeer FQ, Wong-You-Cheong JJ. Imaging of acute pelvic pain. [Review] [30 refs][Reprint in Top Magn Reson Imaging. 2010 Jul;21(4):201-11; PMID: 22082769]. Clin Obstet Gynecol. 52(1):2-20, 2009 Mar. Review/Other-Dx N/A To review diagnostic imaging of acute pelvic pain. No results stated in abstract. 4
39. Cicchiello LA, Hamper UM, Scoutt LM. Ultrasound evaluation of gynecologic causes of pelvic pain. Obstet Gynecol Clin North Am. 2011;38(1):85-114, viii. Review/Other-Dx N/A To review the role of ultrasound (US) in the evaluation of gynecologic causes of acute and chronic pelvic pain. No results stated in abstract. 4
40. Gentry-Maharaj A, Sharma A, Burnell M, et al. Acceptance of transvaginal sonography by postmenopausal women participating in the United Kingdom Collaborative Trial of Ovarian Cancer Screening. Ultrasound Obstet Gynecol. 41(1):73-9, 2013 Jan. Review/Other-Dx 202,638 women To assess pain and overall experience of transvaginal sonography (TVS) in asymptomatic postmenopausal women. Between 7 July and 9 September 2009, 1950 randomly chosen women (150 per regional center) were sent the questionnaire. Of the 800 (41.0%) who returned the questionnaire, 651 could be linked to their TVS appointment. One-hundred and fifty-two (23.3%) women reported pain/discomfort (score 3-5) during TVS and 473 (72.7%) reported no discomfort (score 0-2). Only 23 (3.5%) women reported experiencing moderate/severe pain. Increasing discomfort/pain was independently associated with a history of hysterectomy and participant's reporting of prolonged scan time. Women who experienced pain on TVS were less compliant (odds ratio?=?0.87) with the following year's scan compared with those who did not experience pain. 4
41. Valentin L, Ameye L, Franchi D, et al. Risk of malignancy in unilocular cysts: a study of 1148 adnexal masses classified as unilocular cysts at transvaginal ultrasound and review of the literature. [Review]. Ultrasound Obstet Gynecol. 41(1):80-9, 2013 Jan. Observational-Dx 3511 patients To estimate the rate of malignancy in adnexal lesions described as unilocular cysts at transvaginal ultrasound examination and to investigate if there are differences in clinical and ultrasound characteristics between benign and malignant unilocular cysts. Of the 3511 masses, 1148 (33%) were classified as unilocular cysts on ultrasound. Of these, 11 (0.96% (95% CI, 0.48-1.71)) were malignant. The malignancy rate was lower in premenopausal than in postmenopausal women: 0.54% (5/931; 95% CI, 0.17-1.25) vs. 2.76% (6/217; 95% CI, 1.02-5.92); P?=?0.009. More patients with malignant unilocular cysts had a personal history of breast cancer (18% vs. 2%; P?=?0.02) or ovarian cancer (18% vs 0.6%; P?=?0.003). Hemorrhagic cyst contents on ultrasound were more common in malignant than in benign unilocular cysts (18% vs. 2%; P?=?0.03). In seven of the 11 malignancies judged to be unilocular cysts at scan, papillary projections or other solid components were seen at macroscopic inspection of the surgical specimen. 3
42. Baheti AD, Lewis CE, Hippe DS, O'Malley RB, Wang CL. Adnexal lesions detected on CT in postmenopausal females with non-ovarian malignancy: do simple cysts need follow-up?. Abdom Radiol. 44(2):661-668, 2019 02. Review/Other-Dx CTs of 199 women To assess whether CT morphology of adnexal lesions in postmenopausal women with history of non-ovarian cancer could be used to discriminate benign and malignant lesions, particularly focusing on applicability of the ACR criteria. There were 223 adnexal lesions, including 123 (55%) simple cystic, 48 (22%) complex cystic, 40 (18%) solid-cystic, and 12 (5%) solid lesions. 186/223 (83%) lesions were benign, and 37/223 (17%) were malignant. Primary colorectal cancer was significantly associated with an increased likelihood of malignant adnexal lesions (OR 10.2, p??3 cm) were found to be malignant (malignancy rate: 0.0%, 95% CI 0.0–3.0%). Complex cysts were more likely to be malignant than simple cysts (p?=?0.002) and solid-cystic lesions were more likely to be malignant than complex cysts (p? 4
43. Nohuz E, De Simone L, Chene G. Reliability of IOTA score and ADNEX model in the screening of ovarian malignancy in postmenopausal women. Journal of Gynecology Obstetrics and Human Reproduction. 48(2):103-107, 2019 Feb. Review/Other-Dx 93 patients To test reliability of  IOTA ((International Ovarian Tumor Analysis) rules and ADNEX (Assessment of Different NEoplasias in the adneXa) model as prediction models used to discriminate between benign and malignant cysts in a postmenopausal population. The overall prevalence of malignancy was 4.3%. Every benign ovarian cyst was classified as probably benign by IOTA score which showed also a high specificity with the totality of probably malignant lesion proved malignant by histological exam. The limit of this score was the important rate of not classified or undetermined cysts. However, the malignancy risks calculated by ADNEX model allowed identifying the totality of malignancy. Thus, the combination of the two methods of analysis showed a sensitivity and specificity rates of respectively 100% and 98%. Evaluation of malignancy risks by these 2 tests highlighted a negative predictive value of 100% (there was no case of false negative) and a positive predictive value of 80%. 4
44. Van Calster B, Van Hoorde K, Valentin L, et al. Evaluating the risk of ovarian cancer before surgery using the ADNEX model to differentiate between benign, borderline, early and advanced stage invasive, and secondary metastatic tumours: prospective multicentre diagnostic study. BMJ. 349:g5920, 2014 Oct 15. Observational-Dx 5909 women To develop a risk prediction model to preoperatively discriminate between benign, borderline, stage I invasive. The Assessment of Different NEoplasias in the adneXa (ADNEX) model contains three clinical and six ultrasound predictors: age, serum CA-125 level, type of centre (oncology centres v other hospitals), maximum diameter of lesion, proportion of solid tissue, more than 10 cyst locules, number of papillary projections, acoustic shadows, and ascites. The area under the receiver operating characteristic curve (AUC) for the classic discrimination between benign and malignant tumours was 0.94 (0.93 to 0.95) on temporal validation. The AUC was 0.85 for benign versus borderline, 0.92 for benign versus stage I cancer, 0.99 for benign versus stage II-IV cancer, and 0.95 for benign versus secondary metastatic. AUCs between malignant subtypes varied between 0.71 and 0.95, with an AUC of 0.75 for borderline versus stage I cancer and 0.82 for stage II-IV versus secondary metastatic. Calibration curves showed that the estimated risks were accurate. 3
45. Kamaya A, Shin L, Chen B, Desser TS. Emergency gynecologic imaging. [Review] [68 refs][Erratum appears in Semin Ultrasound CT MR. 2008 Dec;29(6):491]. Semin Ultrasound CT MR. 29(5):353-68, 2008 Oct. Review/Other-Dx N/A To present the imaging features of important clinical entities in the female pelvis. No results stated in abstract. 4
46. Eitan R, Galoyan N, Zuckerman B, Shaya M, Shen O, Beller U. The risk of malignancy in post-menopausal women presenting with adnexal torsion. Gynecol Oncol. 106(1):211-4, 2007 Jul. Observational-Dx 58 patients To describe our experience with adnexal torsion in post-menopausal women and to discuss issues related to management in this situation. Twenty-seven patients were found to be menopausal at the time of diagnosis of adnexal torsion. Median age at presentation was 63 years (range 43-93). A median delay of 40 h was found between the time of hospital admittance to surgery for post-menopausal patients in comparison to the pre-menopausal ones. The cause of torsion was benign in pre-menopausal patients whereas 22% of post-menopausal patients were diagnosed with malignant disease. More adnexas were found to be necrotic in menopausal patients and this resulted in under-diagnosis of malignancy on frozen section analysis. 4
47. Lee EJ, Kwon HC, Joo HJ, Suh JH, Fleischer AC. Diagnosis of ovarian torsion with color Doppler sonography: depiction of twisted vascular pedicle. J Ultrasound Med. 17(2):83-9, 1998 Feb. Observational-Dx 32 Patients To assess the diagnostic value of ultrasonography for the detection of twisted vascular pedicle in ovarian torsion and to verify whether the blood flow alterations in the twisted vascular pedicle on color Doppler sonography can predict the viability of adnexal structures. In 28 of 32 patients with surgically proved torsion, the twisted vascular pedicle was detected preoperatively by ultrasonography, which shows a diagnostic accuracy of 87%. Arterial and venous flows were present in the twisted vessels on color Doppler sonography in 16 of 28 patients with a visible twisted vascular pedicle. In 11 patients who underwent adnexectomy, the pathologic findings revealed nonnecrotic ovaries in 10 patients. Untwisting of the twisted vascular pedicle was performed in five patients, and follow-up ultrasonography showed normal follicular development and ovulation. All 12 patients who showed no blood flow within the twisted vascular pedicle had necrotic ovaries. 4
48. Nizar K, Deutsch M, Filmer S, Weizman B, Beloosesky R, Weiner Z. Doppler studies of the ovarian venous blood flow in the diagnosis of adnexal torsion. J Clin Ultrasound. 37(8):436-9, 2009 Oct. Observational-Dx 199 patients To evaluate the role of ovarian Doppler studies in diagnosing adnexal torsion. Sensitivity and specificity of tissue edema, absence of intra-ovarian vascularity, absence of arterial flow, and absence or abnormal venous flow in the diagnosis of adnexal torsion were: 21% and 100%, 52% and 91%, 76% and 99%, and 100% and 97%, respectively. Abnormal ovarian venous flow may be the only abnormal US sign observed during the early stage of adnexal torsion. 3
49. Chiou SY, Lev-Toaff AS, Masuda E, Feld RI, Bergin D. Adnexal torsion: new clinical and imaging observations by sonography, computed tomography, and magnetic resonance imaging. J Ultrasound Med. 2007;26(10):1289-1301. Observational-Dx 58 patients To review the clinical, imaging, and pathologic findings associated with adnexal torsion. Imaging reports were assessed to determine whether a correct preoperative diagnosis was made. Common imaging findings were adnexal mass (65% on US, 87% on CT, and 75% on MRI), a displaced adnexal mass/enlarged ovary (53% on US, 87% on CT, and 75% on MRI), and ascites (53% on US, 73% on CT, and 50% on MRI). A correct preoperative diagnosis was made by initial US in 15 (71%) of 21 cases vs initial CT in 5 (38%) of 13. A correct imaging diagnosis was made more frequently in premenopausal than in menopausal patients (P=.02) and in patients without an underlying adnexal mass compared with those with a mass (P=.05). Although CT shows features suggestive of torsion, the diagnostic value of initial CT was less than that of initial US in this study. 3
50. Donnez J, Dolmans MM. Uterine fibroid management: from the present to the future. [Review]. Human Reproduction Update. 22(6):665-686, 2016 11.Hum Reprod Update. 22(6):665-686, 2016 11. Review/Other-Dx N/A To review current strategies for uterine fibroid management. No results stated in abstract. 4
51. De La Cruz MS, Buchanan EM. Uterine Fibroids: Diagnosis and Treatment. [Review]. Am Fam Physician. 95(2):100-107, 2017 Jan 15. Review/Other-Dx N/A To review diagnosis and treatment of uterine fibroids. No results stated in abstract. 4
52. Ghai S, Rajan DK, Benjamin MS, Asch MR, Ghai S, Uterine artery embolization for leiomyomas: pre- and postprocedural evaluation with US. [Review] [60 refs]. Radiographics. 25(5):1159-72; discussion 1173-6, 2005 Sep-Oct. Review/Other-Dx N/A To evaluate the role of ultrasound for uterine artery embolization of leiomyomas. No results stated in abstract. 4
53. Patten RM, Vincent LM, Wolner-Hanssen P, Thorpe E Jr. Pelvic inflammatory disease. Endovaginal sonography with laparoscopic correlation. J Ultrasound Med. 9(12):681-9, 1990 Dec. Observational-Dx 18 patients To evaluate the accuracy and sensitivity of endovaginal ultrasound (EVUS) in a group of patients with clinically suspected pelvic inflammatory disease (PID), confirmed by diagnostic laparoscopy and endometrial biopsy. Laparoscopy confirmed prospective sonographic abnormalities in 25 of 27 inflamed fallopian tubes (sensitivity, 93%) and in 19 of 21 ovaries with peri-ovarian inflammation (sensitivity, 90%). Overall accuracy for EVUS prediction of peri-ovarian or tubal disease was 91% and 93%, respectively. However, EVUS was less sensitive to uterine abnormalities and detected inflammatory changes in only three of 12 confirmed cases (25%). EVUS also failed to demonstrate small quantities of purulent fluid (less than 20 cc) in the pelvic cul-de-sac in six of nine cases. 4
54. Patel MD, Dubinsky TJ. Reimaging the female pelvis with ultrasound after CT: general principles. Ultrasound Q. 2007;23(3):177-187. Review/Other-Dx N/A To discuss the general principles that clarify when ultrasound is and is not helpful in reimaging the female pelvis after computed tomographic (CT). No results stated in abstract. 4
55. Yitta S, Mausner EV, Kim A, et al. Pelvic ultrasound immediately following MDCT in female patients with abdominal/pelvic pain: is it always necessary? Emerg Radiol. 2011;18(5):371-380. Observational-Dx 70 patients To determine the added value of reimaging the female pelvis with ultrasound (US) immediately following multidetector computed tomography (MDCT) in the emergent setting. Ultrasound changed the diagnosis for the ovaries/adnexa 8.1% of the time (three reader average); the majority being cases of a suspected CT abnormality found to be normal on US. Ultrasound changed the diagnosis for the uterus 11.9% of the time (three reader average); the majority related to the endometrial canal. The 95% confidence intervals for the ovaries/adnexa and uterus were 5-12.5% and 8-17%, respectively. Ten cases of a normal CT were followed by a normal US with 100% agreement across all three readers. Experienced readers correctly diagnosed ruptured ovarian cysts and tubo-ovarian abscesses (TOA) based on CT alone with 100% agreement. 2
56. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
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