Although it is rated as a separate imaging procedure per ACR methodology, the expert panel considers Doppler imaging to be a standard component of pelvic sonography. Special considerations for women with chronic pelvic pain may include evaluation of uterine artery blood flow, with low-resistance waveforms having been described in women with chronic pelvic pain [12]. CT Abdomen and Pelvis To our knowledge, there is currently no evidence to support the use of CT for primary evaluation of postmenopausal subacute or chronic pelvic pain localized to the perineum, vulva, or vagina. CT Pelvis To our knowledge, there is currently no evidence to support the use of CT for primary evaluation of postmenopausal subacute or chronic pelvic pain localized to the perineum, vulva, or vagina. MRI Pelvis When MRI is clinically indicated, the use of a gadolinium-based IV contrast agent is preferred. Please see the ACR Manual on Contrast Media for additional information [25]. When a cyst or mass is identified by US in the perineum, vulva, or vagina, MRI provides additional anatomic detail and evaluation of any enhancing soft-tissue components that might favor infection or neoplasia [11,24,32,33]. MRI has an important role as a problem-solving examination for lesion characterization and surgical planning, but there is, to our knowledge, no direct evidence to support the use of MRI as the initial or primary imaging examination for evaluation of pelvic pain localized to the perineum, vulva, or vagina, particularly when the physical examination is normal. However, there is emerging evidence to support the first- line utility of MRI when endometriosis or fistulizing disease are suspected [34]; readers are again referred to specific ACR Appropriateness Criteria guidelines for these clinical scenarios (see Appendix 1). MRI also enables accurate depiction of pelvic floor muscular anatomy, integrity, and function [35,36].
Postmenopausal Subacute or Chronic Pelvic Pain. Although it is rated as a separate imaging procedure per ACR methodology, the expert panel considers Doppler imaging to be a standard component of pelvic sonography. Special considerations for women with chronic pelvic pain may include evaluation of uterine artery blood flow, with low-resistance waveforms having been described in women with chronic pelvic pain [12]. CT Abdomen and Pelvis To our knowledge, there is currently no evidence to support the use of CT for primary evaluation of postmenopausal subacute or chronic pelvic pain localized to the perineum, vulva, or vagina. CT Pelvis To our knowledge, there is currently no evidence to support the use of CT for primary evaluation of postmenopausal subacute or chronic pelvic pain localized to the perineum, vulva, or vagina. MRI Pelvis When MRI is clinically indicated, the use of a gadolinium-based IV contrast agent is preferred. Please see the ACR Manual on Contrast Media for additional information [25]. When a cyst or mass is identified by US in the perineum, vulva, or vagina, MRI provides additional anatomic detail and evaluation of any enhancing soft-tissue components that might favor infection or neoplasia [11,24,32,33]. MRI has an important role as a problem-solving examination for lesion characterization and surgical planning, but there is, to our knowledge, no direct evidence to support the use of MRI as the initial or primary imaging examination for evaluation of pelvic pain localized to the perineum, vulva, or vagina, particularly when the physical examination is normal. However, there is emerging evidence to support the first- line utility of MRI when endometriosis or fistulizing disease are suspected [34]; readers are again referred to specific ACR Appropriateness Criteria guidelines for these clinical scenarios (see Appendix 1). MRI also enables accurate depiction of pelvic floor muscular anatomy, integrity, and function [35,36].