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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Steege JJ, Siedhoff MM. Chronic pelvic pain. Obstet Gynecol 124:616-629, .
2. Bishop LA. Management of Chronic Pelvic Pain. Clinical Obstetrics & Gynecology. 60(3):524-530, 2017 09.Clin Obstet Gynecol. 60(3):524-530, 2017 09.
3. Latthe P, Latthe M, Say L, Gulmezoglu M, Khan KS. WHO systematic review of prevalence of chronic pelvic pain: a neglected reproductive health morbidity. BMC Public Health. 2006;6:177. Review/Other-Dx 148 articles To systematically review worldwide literature on the prevalence of different types of chronic pelvic pain (CPP) to assess the geographical distribution of data, and to explore sources of variation in its estimates. There were 178 studies (459975 participants) in 148 articles. Of these, 106 studies were (124259 participants) on dysmenorrhoea, 54 (35973 participants) on dyspareunia and 18 (301756 participants) on noncyclical pain. There were only 19/95 (20%) less developed and 1/45 (2.2%) least developed countries with relevant data in contrast to 22/43 (51.2%) developed countries. Meta-regression analysis showed that rates of pain varied according to study quality features. There were 40 (22.5%) high quality studies with representative samples. Amongst them, the rate of dysmenorrhoea was 16.8 to 81%, that of dyspareunia was 8 to 21.8%, and that for noncyclical pain was 2.1 to 24%. 4
4. Daniels JP, Khan KS. Chronic pelvic pain in women. BMJ. 341:c4834, 2010 Oct 05.BMJ. 341:c4834, 2010 Oct 05.
5. Ahangari A. Prevalence of chronic pelvic pain among women: an updated review. Pain Physician. 2014;17(2):E141-147. Review/Other-Dx 7 studies To update the review of the worldwide estimation of the chronic pelvic pain (CPP) prevalence considering the World Health Organization systematic review by Latthe et al in 2006 as point of departure. From 140 studies, only 7 studies were about CPP prevalence. Their study design consisted of 3 cross sectional studies, one population based mailing questionnaire study, one survey study (computer assisted telephone interview), one data analysis by questionnaire, and one prospective community based study. 4
6. Henrichsen TL, Maturen KE, Robbins JB, et al. ACR Appropriateness Criteria R Postmenopausal Acute Pelvic Pain. Journal of the American College of Radiology. 18(5S):S119-S125, 2021 May.J. Am. Coll. Radiol.. 18(5S):S119-S125, 2021 May. 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 postmenopausal acute pelvic pain. No results stated in abstract. 4
7. Maturen KE, Akin EA, Dassel M, et al. ACR Appropriateness Criteria R Postmenopausal Subacute or Chronic Pelvic Pain. Journal of the American College of Radiology. 15(11S):S365-S372, 2018 Nov.J. Am. Coll. Radiol.. 15(11S):S365-S372, 2018 Nov. 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 postmenopausal subacute or chronic pelvic pain. No results stated in abstract. 4
8. Somprasit C, Tanprasertkul C, Suwannarurk K, Pongrojpaw D, Chanthasenanont A, Bhamarapravatana K. Transvaginal color Doppler study of uterine artery: is there a role in chronic pelvic pain? J Obstet Gynaecol Res. 2010;36(6):1174-1178. Observational-Dx 25 patients To determine the value of transvaginal color Doppler study of uterine artery and investigate the differences in blood flow of uterine artery among women with chronic pelvic pain (CPP). The mean ages were 36.6 +/- 10.6 and 32.0 +/- 6.7 years in the study group and control group, respectively. The duration of pain ranges from 6-48 months (mean, 14.8). The mean PI and RI values of the uterine arteries in patients with CPP were significantly lower than in the control group; PI = 2.12 +/- 0.78, 2.76 +/- 0.84 and RI = 0.79 +/- 0.19, 0.89 +/- 0.05, respectively (P < 0.05). 3
9. Bookwalter CA, VanBuren WM, Neisen MJ, Bjarnason H. Imaging Appearance and Nonsurgical Management of Pelvic Venous Congestion Syndrome. [Review]. Radiographics. 39(2):596-608, 2019 Mar-Apr.Radiographics. 39(2):596-608, 2019 Mar-Apr. Review/Other-Dx N/A Pelvic venous congestion syndrome (PVCS) is a challenging and complex cause of chronic pelvic pain in female patients. No results stated in abstract. 4
10. Brahmbhatt A, Macher J, Shetty AN, Chughtai K, Baah NO, Dogra VS. Sonographic Evaluation of Pelvic Venous Disorders. [Review]. Ultrasound Quarterly. 37(3):219-228, 2021 Sep 01.ULTRASOUND Q.. 37(3):219-228, 2021 Sep 01. Review/Other-Dx N/A To review pelvic congestion syndrome, nutcracker syndrome, May-Thurner syndrome, and other venous disorders, with a specific focus on sonographic findings and considerations. No results stated in abstract. 4
11. 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
12. Patel MD, Young SW, Dahiya N. Ultrasound of Pelvic Pain in the Nonpregnant Woman. [Review]. Radiologic Clinics of North America. 57(3):601-616, 2019 May.Radiol Clin North Am. 57(3):601-616, 2019 May. Review/Other-Dx N/A To consider the sonographic observations and techniques useful in diagnosis of a variety of gynecologic causes of pelvic pain No results stated in abstract. 4
13. 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
14. Reinhold C, Khalili I. Postmenopausal bleeding: value of imaging. [Review] [132 refs]. Radiol Clin North Am. 40(3):527-62, 2002 May. Review/Other-Dx N/A Endovaginal sonography in combination with HSG is an effective screening tool in evaluating patients with postmenopausal bleeding. No results stated in abstract. 4
15. Thomassin-Naggara I, Darai E, Bazot M. Gynecological pelvic infection: what is the role of imaging?. [Review]. Diagn Interv Imaging. 93(6):491-9, 2012 Jun. Review/Other-Dx N/A To review the role of imaging in gynecological pelvic infection. No results stated in abstract. 4
16. Tabibian N, Swehli E, Boyd A, Umbreen A, Tabibian JH. Abdominal adhesions: A practical review of an often overlooked entity. Ann Med Surg (Lond). 2017;15:9-13. Review/Other-Dx N/A To provide a clinically practical synopsis of the etiopathogenesis, symptoms, differential diagnosis, evaluation, and treatment of abdominal adhesive disease. No results stated in abstract. 4
17. Spens K, Bird L, Bright P. Transabdominal ultrasound: Can it be used to detect and quantify adhesions/reported pain, following Caesarean section? J Bodywork Mov Ther. 22(3):733-740, 2018 Jul. Review/Other-Dx 22 patients To explore associations between these surgical adhesions, via transabdominal ultrasound findings, and perceived symptoms. Twenty-two subjects (mean-age 35) were recruited; twenty participants (91%) had undergone 1 Caesarean, one each of the remainder had undergone 2 and 3 Caesareans respectively. Increased Visceral slide (>1 cm) was seen as predictive of increased scar pain (R2 = 0.76 (95% CI 0.12-0.28), P < 0.001). 4
18. Bonney R, Revels JW, Wang SS, et al. A comprehensive radiologic review of abdominal and pelvic torsions. [Review]. Abdom Radiol. 46(6):2942-2960, 2021 06. Review/Other-Dx N/A The clinical manifestations of abdominal and pelvic organ torsion can often be non-specific and can affect a wide range of ages and demographic groups. No results stated in abstract. 4
19. Valentini AL, Gui B, Basilico R, Di Molfetta IV, Micco M, Bonomo L. Magnetic resonance imaging in women with pelvic pain from gynaecological causes: a pictorial review. [Review]. Radiol Med (Torino). 117(4):575-92, 2012 Jun. Review/Other-Dx N/A To illustrate the causes of pelvic pain in girls and women that may be inadequately diagnosed by ultrasound (US) and more adequately assessed by magnetic resonance imaging (MRI). No results stated in abstract. 4
20. Juhan V. Chronic pelvic pain: An imaging approach. Diagnostic and Interventional Imaging. 96(10):997-1007, 2015 Oct.Diagn Interv Imaging. 96(10):997-1007, 2015 Oct. Review/Other-Dx N/A To describe endometriosis, adenomyosis, chronic pelvic infections, adhesions, pelvic congestion syndrome, and pudendal neuralgia, which are the major causes of chronic pelvic pain (CPP) and to highlight the role of imaging in the diagnostic approach. No results stated in abstract. 4
21. American College of Radiology. Manual on Contrast Media. Available at: https://www.acr.org/Clinical-Resources/Contrast-Manual. Review/Other-Dx N/A To assist radiologists in recognizing and managing risks associated with the use of contrast media. No abstract available. 4
22. Kuligowska E, Deeds L, 3rd, Lu K, 3rd. Pelvic pain: overlooked and underdiagnosed gynecologic conditions. Radiographics. 2005;25(1):3-20. Review/Other-Dx N/A To describe the transvaginal ultrasonographic (US) and magnetic resonance (MR) imaging appearances of some gynecologic conditions that can cause chronic pelvic pain. No results stated in abstract. 4
23. Hwang JH, Oh MJ, Lee NW, Hur JY, Lee KW, Lee JK. Multiple vaginal mullerian cysts: a case report and review of literature. Arch Gynecol Obstet. 2009;280(1):137-139. Review/Other-Dx N/A To review the case of abnormal menstruation in malarial infection. No results stated in abstract. 4
24. Surabhi VR, Menias CO, George V, Siegel CL, Prasad SR. Magnetic resonance imaging of female urethral and periurethral disorders. [Review]. Radiol Clin North Am. 51(6):941-53, 2013 Nov. Review/Other-Dx N/A To review the normal anatomy of the female urethra, magnetic resonance (MR) imaging techniques, and the role of MR imaging in the evaluation of diverse urethral and periurethral diseases. No results stated in abstract. 4
25. Cope AG, Laughlin-Tommaso SK, Famuyide AO, Gebhart JB, Hopkins MR, Breitkopf DM. Clinical Manifestations and Outcomes in Surgically Managed Gartner Duct Cysts. J Minim Invasive Gynecol. 24(3):473-477, 2017 Mar - Apr. Review/Other-Dx 29 patients To determine the manifestations and outcomes of surgically managed patients with GDCs with important implications for surveillance, monitoring, and management. A total of 29 patients met the inclusion criteria for this study. The median age of the patients included in the analysis was 36 years old. Eleven patients were asymptomatic at the time of diagnosis (37.9%). The reason for surgical intervention was not available in 9 of these patients. Surgical intervention was performed in 2 of the 11 asymptomatic patients because of an increasing size of the lesion during observation. Presenting symptoms included dyspareunia or pain with tampon placement (37.9%), pelvic pain or pressure (24.1%), pelvic mass or bulge (17.2%), and urinary incontinence (6.9%). Preoperative imaging studies were obtained in 62% of patients; ultrasound was used in 44.4%, computed tomographic scanning in 22.2%, magnetic resonance imaging in 16.7%, and multiple modalities in 16.7%. Approximately 10% were found to have other genitourinary anomalies, including a bladder cyst, urethral diverticulum, and a solitary right kidney with uterine didelphis and septate vagina. The average cyst size was 3.5 cm (±1.8 cm). Surgical excision of GDCs was performed in all except for 3 cases of marsupialization. No intraoperative complications occurred. The median follow-up was 82 months (range, 0-246 months). One patient had possible recurrence with dyspareunia and protruding tissue diagnosed 14 months postoperatively. There were no other postoperative complications in the follow-up period. 4
26. Osman AM, Mordi A, Khattab R. Female pelvic congestion syndrome: how can CT and MRI help in the management decision?. British Journal of Radiology. 94(1118):20200881, 2021 Feb 01.Br J Radiol. 94(1118):20200881, 2021 Feb 01. Review/Other-Dx 50 patients To highlight the role of CT and MRI as non-invasive tools in the diagnosis and management of PCS. The mean age of the patients was 48 years ± 12 years SD. Vaginal discharge and pelvic heaviness were the commonest symptoms (46 and 42% respectively). The commonest risk factor was multiparity (56%) followed by the RVF uterus (26%). No significant difference was found between CT, MRI, and venography as regarding the diameter of the ovarian vein, diameter, and the number of the varicose veins. The sensitivity of CT and MRI was 94.8 and 96%. CT and MRI discovered five cases with local pelvic obstructing cause,14 cases with evidence of vascular compression syndrome, and the rest 31 cases diagnosed to have primary non-obstructing PCS which was effective in decision-making with the surgery indicated in the first group while stenting of the vascular obstruction followed by bilateral ovarian veins coiling was the better option for the second group and only bilateral coiling was needed for the last group. 4
27. Topper SR, Winokur RS. Imaging of Pelvic Venous Disorders (PeVD); Should Every Patient Get an MRI?. [Review]. Techniques in Vascular & Interventional Radiology. 24(1):100731, 2021 Mar.Tech Vasc Interv Radiol. 24(1):100731, 2021 Mar. Review/Other-Dx N/A to review imaging as a component of the outpatient workup of patients with chronic pelvic pain to guide appropriate understanding and use of imaging modalities to accurately identify patients suffering from pelvic venous disease. No results stated in abstract. 4
28. Shahat M, Abdelbaqy OMA, AbdelHakam AM, Ali SH, Attalla K. Can cross-sectional imaging replace diagnostic venography in pelvic venous disorder (PeVD)? J Vasc Surg Venous Lymphat Disord. 12(2):101724, 2024 Mar. Review/Other-Dx 120 patients Pelvic venous disorder is multifactorial and challengeable in vascular surgery as it mandates multidisciplinary team cooperation for its evaluation and management. The total number of patients was 120 with a mean age of 34.4 ± 7.1 years; 86.7% were multiparous. All patients presented chronic pelvic pain with vulvoperineal and/or atypical lower limb varicosities. Then patients were divided into two groups: those with CTV and those with MRV. Sensitivity, specificity, and diagnostic accuracy of CTV were 50%, 33%, and 47% for the detection of incompetent ovarian veins, 83%, 33%, and 53% for the detection of incompetent internal iliac veins, and 50%, 40%, and 47% for the detection of incompetent pelvic plexus veins, respectively, whereas time-resolved MRV achieved sensitivity, specificity, and diagnostic accuracy of 73%, 25%, and 60% for the detection of incompetent ovarian veins, 75%, 46%, and 53% for the detection of incompetent internal iliac veins, and 67%, 33% and 60% for detection of incompetent pelvic plexus veins, respectively. 4
29. Basile A, Failla G, Gozzo C. Pelvic Congestion Syndrome. Semin Ultrasound CT MR. 2021 Feb;42(1):S0887-2171(20)30082-2. Review/Other-Dx N/A Pelvic congestion syndrome (PCS) is often an underdiagnosed cause of chronic pelvic pain in female patients with radiology detection of gonadal vein dilatation and parauterine varices. No results stated in abstract. 4
30. Tirlapur SA, Daniels JP, Khan KS. Chronic pelvic pain: how does noninvasive imaging compare with diagnostic laparoscopy?. [Review]. Current Opinion in Obstetrics & Gynecology. 27(6):445-8, 2015 Dec.Curr Opin Obstet Gynecol. 27(6):445-8, 2015 Dec. Review/Other-Dx N/A To explore the value of noninvasive imaging, such as pelvic ultrasound and MRI in diagnosing coexisting pathologies with chronic pelvic pain (CPP). A literature review from inception until January 2015 of the following databases: PubMed, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica database, and System for Information on Grey Literature in Europe were performed to identify published studies assessing the usefulness of ultrasound, MRI, and laparoscopy in the diagnosis of CPP. Three studies (194 women) addressed their comparative performance in patients with endometriosis, showing the sensitivity of ultrasound ranged between 58 and 88.5%; MRI was 56–91.5% and in the one study using histology as its reference standard, the sensitivity of laparoscopy was 85.7%. Noninvasive imaging has the additional benefit of being well tolerated, safer, and cheaper than surgery. 4
31. Silva PD, Suarez SA. A Case of Disabling Urinary Frequency and Pelvic Pain Due to Postoperative Uterine Adhesions. WMJ. 115(1):43-5, 2016 Feb.WMJ. 115(1):43-5, 2016 Feb. Review/Other-Dx 1 case To confirm the possibility that clinically significant lower abdominal adhesions may be visualized by ultrasound, we report on a patient who had developed disabling urinary frequency and pelvic pain after a cesarean section. No results stated in abstract. 4
32. Szaflarski D, Sosner E, French TD, et al. Evaluating the frequency and severity of ovarian venous congestion on adult computed tomography. Abdom Radiol. 44(1):259-263, 2019 01. Review/Other-Dx 1,042 consecutive abdominal and pelvic CT scans To analyze a large number of consecutive abdominal and pelvic CT scans in adult women to determine OVD frequency and severity. 143 of the CT scans had OVD (13.7%). Of the positive scans, 96 were bilateral, 29 were left-side only, 18 were right-side only, and 18 had nutcracker-type compression of the left renal vein (14.4% of scans with left or bilateral OVD). In positive scans, the mean and median left OVD were 7.5 and 7 mm, respectively, and right-side were 7.2 and 7 mm, respectively. Based on quartile analysis, OVD grading was mild (< 6 mm), moderate (6-8 mm), or severe (> 8 mm), with moderate including the middle 50% of patients. 4
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